Success at What Cost? A Case Study

By: Dr. Debbie Cherney, Cornell University; Dr. Cathy Ernst, Michigan State University; Dr. Lee Velicer, Michigan State University; Dr. Cheryl Wachenheim, Illinois State University

The numbers describing breast cancer incidence are frightening. The National Cancer Institute (NCI) estimates a woman's lifetime risk for developing the disease is one in eight. Every three minutes, a woman is diagnosed with breast cancer and every twelve minutes, an American woman dies from breast cancer.

Recently, scientists have begun to isolate genes responsible for hereditary breast cancer. In 1994 the gene, Breast Cancer 1 (BRCA-1), was isolated on Chromosome #17, one of the 23 pairs of chromosomes found in most human cells. A mutated form of BRCA-1 has been linked to the development of breast and ovarian cancer.

In 1995, scientists developed methods for detecting several recently discovered cancer genes, including BRCA-1. However preliminary studies have shown that testing positive for the mutated BRCA-1 gene does not mean a woman will develop breast cancer. At least 15% of the women who carry the mutated gene will never develop the disease. Scientists have no way of knowing yet which women fall into that category. In addition, because BRCA-1 alterations occur in many different places scattered throughout the gene, developing an accurate test will be very difficult.

The altered BRCA-1 gene appears in only 5% of the 182,000 breast cancer cases that develop annually. If a woman tests negative (that is, she does not have the altered gene), this does not necessarily mean she will be free of breast cancer during her lifetime.

The information above is factual. The case which follows is fictional.

Cheryl Wachenheim, a molecular geneticist, discovers a gene. When altered by a specific mutation, the gene produces a compound with cancer tumor suppression activity. Dr. Wachenheim has been unable to isolate the specific protein or set of proteins responsible for this action, but she knows that the compound is in the non-fat portion of the cow¼s milk in which the compound is produced. Mice with the mutated BRCA-1 gene that consumed this altered milk do not get mammary cancer. On the other hand, 55% to 85% of a group of control mice develop mammory tumors after consuming unaltered milk. The milk with the mutated gene in it, apparently, prevents mice from getting cancer.

These results are so exciting that the Food and Drug Administration allows clinical trials on humans. Two years later, the FDA knows of no adverse effects on human health based on clinical trials with 20,000 women, aged 50 and over. In addition, the incidence of breast-cancer in women consuming 16 ounces per day of the altered cow's milk is significantly lower than in a control group consuming unaltered milk. Based on this information, the FDA is prepared to give full approval for the marketing of the altered milk.

Unfortunately, the cows producing the altered milk are adversely affected. Approximately 60% of them develop severe arthritis, a painful and debilitating disease, by their second lactation. The condition primarily affects the joints in the hock and hip. The pain associated with arthritis is such that cows have problems lying down, and they eat less as a result. Because of regulations regarding drug residues in milk, treatment options to relieve their pain are limited.

In addition, the cost of producing altered milk is likely to be three times higher for the farmer than the cost of producing unaltered milk. Because of additional marketing costs associated with labeling and handling altered milk, an even higher cost increase to the consumer is expected; specifically, one gallon of altered milk at the retail store is expected to cost approximately $7.50 versus $2.25 for unaltered milk.

Discussion Questions

1. What moral issues are involved? Should society approve this biotechnological application? Why or why not?

2. How do we put a value on non-human animal suffering in relation to the benefits gained by humans? Would we be willing to ignore the animal's suffering if the animal in question were a mouse instead of a cow?

3. Assuming that the technology is adopted, who should pay for it? (consumers, government, health insurers, others?)

4. Market analysis indicates that it will likely take 10 years to meet consumer demand. How should the milk be rationed to consumers? (market forces, according to risk, lottery, others?)

Updated: July 23, 1998

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