The splendor and the nitty-gritty of genes
Two new books aim to unlock power, mystery of genetics
T WINS born minutes apart may be eerily similar or just as eerily different. Even if they are not identical, they share yards of genetic material, and yet one turns out large and one small, one strong and one weak, one a poet and the other a mumbler.
We see these disparities in people all the time. And now we see them in a pair of books on the gene, published on the same day. Sharing yards of genetic material, both works aim to explain the power and mystery of the human genome, yet could not be more different.
One is destined to soar into the firmament of the year’s must reads, to win accolades and welldeserved prizes, and to set a new standard for lyrical science writing.
The other, smaller and considerably less articulate, is likely to achieve none of these honors. Still, the little book manages to deliver some vitally important messages about the interactions between the average human and the average genome that the first book soars just a little too high to provide.
A cancer physician at Columbia University, Dr. Siddhartha Mukherjee dazzled readers with his Pulitzerwinning “The Emperor of All Maladies” in 2010. That achievement was evidently just a warm-up for his virtuoso performance in “The Gene: An Intimate History,” in which he braids science, history and memoir into an epic with all the range and biblical thunder of “Paradise Lost.”
Like all natural storytellers, Mukherjee knows to begin at the beginning. To explain the gene, he heads back to the ancient Greeks who first struggled to explain how fathers and sons could be so similar and yet so different. To explain his own family, he must revisit partition-era India, where two of his father’s brothers succumbed to serious mental illness, a scourge that claimed one of his first cousins as well.
Those are some bad genes: They dog Mukherjee’s heels as he writes, but like so many inheritances, they are complicated and disguised, muffled yet threatening.
Slowly his story weaves past the usual landmarks: Mendel’s peas, Darwin’s finches, Watson and Crick’s rough cardboard models of component nucleosides. The alphabet of the gene creates the words and sentences of the genome. The eugenicists who glom on to fledgling science to purify the race contribute their own vicious story line, stretching from Oliver Wendell Holmes Jr. to Adolf Hitler and beyond. “Of all the sciences, biology is the most lawless,” Mukherjee writes. Now we have become fluent enough in its language not only to understand what laws there are, but also to draft new ones.
It is a familiar narrative with a big difference: Thanks to Mukherjee’s remarkably clear and compelling prose, the reader has a fighting chance of arriving at the story of today’s genetic manipulations with an actual understanding of both the immensely complicated science and the even more complicated moral questions.
Looking to the future, Mukherjee worries that “illness might progressively vanish but so might identity. Grief might be diminished but so might tenderness. Traumas might be erased but so might history.” All who contemplate such a world should understand its origins, and Mukherjee’s readers will get it from the ground up.
Dr. Steven Lipkin lacks Mukherjee’s skills; even with a coauthor, he struggles mightily in “The Age of Genomes: Tales From the Front Lines of Genetic Medicine” to explain the scientific concepts underlying his work. What Lipkin does have are patients.
A clinical geneticist in New York City, he is among those charged with translating complicated principles into viable medical practice. In his work, Lipkin meets patients like “Lydia,” who worries that because she looks like her mother she is fated to die young of the same ovarian cancer.
There is “Samantha,” who suffers from a dire genetic syndrome that precludes safe pregnancy. There is “Sean,” a surfer dude with a relatively mild genetic condition that is ruining his sex life.
As in the rest of clinical medicine, though, nothing is entirely predictable for these patients. Lydia is relieved to hear she has little chance of developing her mother’s cancer, but expresses exactly zero interest in knowing more about her father’s early Alzheimer’s disease, a far more heritable condition.
Samantha would routinely be advised to avoid pregnancy at all costs, save for one small detail: She shows up for her first appointment with a healthy baby boy on one knee. Her one uneventful pregnancy complicates decision making about subsequent ones.
As for Sean, a honed state-of-the-art treatment to prop up his mutant genes is available. Unfortunately, it is very expensive, and he is uninsured.
Insurance is a scientific concept that Mukherjee does not include in his glorious tour of human genetics, but it governs the work of clinicians who must plead, bargain and appeal for indicated tests and treatments to be approved. The society that rewrites the genetic code, as Lipkin points out, is likely to become one in which the very expensive tools of genetic medicine forge yet one more barrier between rich and poor.
When Lipkin sequences his own genome, he runs into another feature of the landscape Mukherjee overlooks: the proliferation of cut-rate, poorly standardized services out there. Lipkin first springs for a cheap genotype and gets what he pays for in the form of a syndrome he knows perfectly well he doesn’t have. A better test corrects the error.
These stories from the trenches make it clear that the clinical genetics will not be spared the misery-inducing features of the rest of medicine, in which the reigning slogan is “caveat emptor.”
Let the poet sing his long, lovely epic; it is still the harried, inarticulate, much beleaguered guy in the white coat who will be cementing the transactions.