- Esther Casanueva, M.D.
Instituto Nacional de PerinatologÌa, Montes Urales No. 800,
Torre de Investigacion 1er. piso, Col. Lomas de Virreyes, MÈxico DF CP 11000

- RubÈn Lisker, M.D.
Instituto Nacional de NutriciÛn "Salvador Zubir·n"

\ Alessandra Carnevale, M.D.
Instituto Nacional de PediatrÌa

- Elisa Alonso, M.D.
Instituto Nacional de NeurologÌa y Neuropsiquiatria "Luis Velasco S_arez"

Eubios Journal of Asian and International Bioethics 8 (1998), 6-9.

The purpose of this paper is to explore and compare the opinion on matters related to genetic engineering among Mexican physicians with different specialties. Physicians from four of Mexico City's National Health Institutes (MNIH) were selected for the study. The following specialties were sampled: internists (n =56); pediatricians (n= 58); gynecologists and obstetricians (n = 50) and neurologists (n=27). The questionnaires designed by Macer were used. Even when 8 out of 10 physicians questioned responded they were interested or very interested in science, their knowledge on science and technology in general and on genetic engineering is poor. The survey results make it clear that there was consensus in that the intellectual property of ideas is acceptable, but not for the products of genetic engineering. Worth noting is the inverse relation between the acceptance of use of genetic engineering to modify physical, intellectual or ethical characteristics of individuals and the knowledge on the basis of genetic engineering.

Key words: ethics, -medical; genetic-engineering, human-rights, Mexico.

The purpose of the present paper is to explore and compare the opinion on matters related to genetic engineering among Mexican physicians with different specialties, using the instrument designed by Macer (4).

Material and Methods

The Questionnaire.

Two of us (RL and AC) modified part of the questionnaire used by Macer (4) and translated it into Spanish, to explore the perceived impact of science and technology in society. The questions identify the degree of agreement/disagreement in four different areas. The following aspects were included:

1. The genetic modification of entire live beings, parts of them or their products.

1. If any of the following were to be produced from genetically modified organisms, would you have any concerns about using them? (each item had 3 possible answers: no, few, some or a lot.): * dairy products, * vegetables or * meat.
2. Is gene therapy acceptable under any circumstance? The possible answers were: yes, no or I don't know.

2. To change the genetic structure of plants or animals, with genes of the same or other species. Assuming that genes from most organisms are interchangeable the questions were (the answer options were: acceptable, unacceptable, I don't know.) :

1. What do you think of improving potatoes with maize genes?
2. What do you think of improving potatoes with animal rather than plant genes?
3. What do you think of improving chicken meat with other animal genes?

What would you think if the animal gene came from a man or woman?

3. To change live organisms with different purposes (recreation, to obtain food, improve health). The questions were (the answer options were: I strongly approve, somewhat approve, somewhat disapprove, strongly disapprove or I don't know.):

1. If there was no direct risk to humans and only very remote risks to the environment, would you approve or disapprove of the environmental use of genetically engineered organisms designed to produce? * tomatoes with better taste, * healthier meat (e.g. less fat), *cows which produce more milk, or * larger sport fish

b) What do you feel about scientists changing the genetic makeup of human cells to: * Cure an usually fatal disease, such as cancer, * reduce the risk of developing a fatal disease later in life, * improve the physical characteristics that children would inherit, * Improve the intelligence level that children would inherit or * make people more ethical.

4. Patenting the products of genetic engineering. The question was (the response options were: approve, disapprove, don't know):

1. People who create something original can obtain financial reward for their efforts through patents and copyright. In your opinion, for which of the following should people be able to obtain patents and copyright ? * new plants, * new animal breeds, * new inventions, such as consumer products, * books and other information, * genetic material extracted from plants and animals or, * genetic material extracted from humans

The Sample

Physicians from four of Mexico City's National Health Institutes (MNIH) were selected for this study. The MNIH are government institutions providing tertiary medical care, and are strongly involved in teaching and research. The following specialties were sampled: a) internists - working at the Instituto Nacional de la NutriciÛn, where only adult patients are seen and there is little experience with genetic diseases- were invited to participate. Approximately one out of three specialists (59 physicians) were randomly selected, and 56 accepted; b) pediatricians, an identical random sample to the above was selected at the Instituto Nacional de PediatrÌa, where they frequently see patients with genetic diseases or congenital malformations and 58 out of 59 agreed to participate; c) all gynecologists and obstetricians (n= 50) working at the Instituto Nacional de PerinatologÌa agreed to participate in the survey, and d) 27 out of 30 neurologists working at the Instituto Nacional de NeurologÌa y NeurocirugÌa participated in the study, they all have experience with hereditary neurological conditions.

The differences in agreement or disagreement were compared. Whether or not, a difference of 5% or even 10% between two responses, may be statistically significant, it may still reflect different attitudes in opinions regarding ethical matters (5), and this study is not intended to be only quantitative but to seek trends for further examination (5).

Some parts of the survey had been applied to medical students by Macer et al in several countries, including Australia, Japan, Hong Kong, New Zealand and Philippines, and Japan (6) It is important to mention that we don't have information about the application of this survey to physicians, in any place of the world, though a survey is being conducted in Portugal (7). These are the best comparisons available to physicians. It is important to mention, that in general the students surveyed were approximately 20 years old, 60% were male, and approximately 70% cataloged themselves as religious, somewhat more in the Philippines.

Results

The survey was applied to 191 physicians, 79% of which were males, 36% were more than 35 years old, and 72% said they were religious, predominantly Catholic (Table 1). No differences between the four specialties were found, and the results are therefore presented together. In general they reported to be very interested in science, but only 35, 29 and 9% said they were able to explain the technology behind computers, biotechnology or pesticides respectively. 96% (185) answered that research in the area of genetic engineering is appropriate, although only 26% (50 individuals) said they had knowledge of the procedure.

Table 2: Approval To Modify Organisms With Genetic Engineering (%s, for N=191)

If any of the following we to be produced from genetically modified organism, would you have any concerns about using them? How much?

[No, Few, Some]

Vegetables 83 13 4

Dairy products 82 15 4

Meats 75 20 6

Humans* 26 17 57

* (mean of the answers of question 3b).

Table 3: Approval To Modify Products With Genetic Engineering (%s, for N=191)

Modified products

Acceptable Unacceptable Don't Know

potatoes with maize genes

83 5 12

chicken meat with animal genes

74 9 18

potatoes with animal genes

52 26 22

chicken meat with human genes

29 52 20

Regarding the justification to improve organisms, there was strong consensus for humanitarian goals, i.e. 97% would agree to improve plants in order to produce better food for man, while no consensus was reached in other circumstances, such as modifying fish for recreational purposes (Table 4). The same table shows the opinion on the modification of human genes, practically everyone agreed in the case of curative (99%) or preventive medicine (96%).

Between 30% and 38% would agree to genetic engineering to enhance physical or intellectual characteristics of children, and a similar proportion would use the procedure to make people more ethical. Table 5 shows that there was high agreement to the patenting of the products of intellectual activity in general, but not for biological material.

Table 5: Support For Patenting (%s, N=191)

Patenting Approve Disapprove Don't know

New inventions

87 8 4

Books and other information

83 15 3

New plant varieties

51 35 15

New animal breeds

41 39 20

Genetic material extracted from plants and animals

47 39 14

Genetic material extracted from humans

39 47 14

Table 6: Knowledge On Genetic Engineering and Approval of Human Gene Therapy In Seven Countries comparing to Macer (1994) (%s).

	New Zealand*	Japan*	Aus tralia*	Mexico	Philip- pines*	Hong Kong*
Can explain to friend	65	38	36	26	26	16
Objective of gene therapy

improve the intelligence level

10

10

14

38

41

36

Make people more ethical	14	8	16	38	58	71
Improve physical characteristics	13	11	16	30	43	37

It is difficult to know how representative of the Mexican medical profession the physicians sampled are, but it can be stated that their working in the MNIH, makes them opinion leaders and their knowledge of medicine should be at least average. It is important to note that the knowledge of this particular population on science and technology in general and on genetic engineering is poor, even when 8 out of 10 started they were interested or very interested in science. However, surprisingly 6 out of 10 physicians considered that one should not tamper with nature. These results show that it is important to increase the bioethical maturity of a society, and decrease its fears (8)

According to the results, there seems to be agreement with the utilization of genetic engineering to modify plants or animals, as long as no Kingdom barriers are crossed, which is the same fact encountered in the other countries of the International Bioethics Survey (4) and the United States (9). Regarding the use of gene therapy in humans, it is of interest that more people are in favor of both curing and preventing disease, although the latter is clearly more cost-effective.

The survey results make it clear that there was consensus in that the general idea intellectual property of ideas is acceptable, but not for products of genetic engineering. In fact, there is much International debate whether substances produced by life should be subject to patents. This norm should probably be revised because it has limited research by the pharmaceutical industry as some substances produced by humans which may have therapeutic uses, can not be patented and therefore can not produce revenue (10). It seems that patent issues are decided more on economical reasons than ethical ones.

It is interesting to note that probably only 26% of the interviewed specialists felt capable of explaining to a friend the basis of genetic engineering, and there was a marked resistance to accept the modification of chicken meat with human genes (only 28% agreed), while more than 80% agreed to improve potatoes with maize genes. This leads to the thought that the interviewed specialists ignore that genetic information is the same in the animal and vegetable reigns.

In the case of modifying human characteristics that can only be evaluated through value judgments, the different countries can be divided in three categories (Table 5) those such as New Zealand, Australia and Japan, in which the acceptance rate is low, intermediate values in Mexico and Philippines, and high rates in public samples as seen in Hong Kong (6). It is noteworthy to observe the inverse relation on the acceptance of genetic engineering to modify the physical, intellectual and ethical characteristics of the individuals and the knowledge on the basis of genetic engineering. Increasing claims about the relationship of genetics to ethically and politically significant traits and behaviors are challenging human self-understanding and the capacity of social institutions to respond adequately (11).

This may be related to the relative lack of information in the underdeveloped nations of human rights in general. This is important because the people interviewed were physicians or medical students, who should be at least familiar with the Universal Declaration of Human Rights, which states that the psychic, physical and moral integrity of every individual should be respected (12) Some may say that this type of enhancement is to improve individuals, which immediately raises the question as to which is the "ideal" and is reminiscent of the eugenic excesses that occurred earlier in this century.

References
1. Eisenberg R. Genes, Patents, and product development. Science 1992;257:903-7
2. Knoppers BM, Chadwick R. The human genome project: Under an international ethical microscope. Science 1994;265:2035-6.
3. Khan P Germany warily maps genome project. Science 1995;268:1556-7
4. Macer DRJ. Bioethics for the people by the people. New Zealand, Eubios Ethics Institute, 1994.
5. Leavitt F. Bioethics surveys and the quantification of ethics in Bioethics for the people by the people. DRJ Marcer ed. New Zealand, Eubios Ethics Institute 1994
6. Macer DRJ, et al. International perceptions and approval of gene therapy. Hum Gene Ther 1995;6:791-803.
7. Pinto MC, personal communication.
8. Macer DRJ. Perception of risk and benefits of in vitro fertilization, genetic engineering and biotechnology. Soc Sci Med 1994;38:23-33
9. Hoban TJ, Kendall PA. Consumer attitudes about the use of biotechnology in agriculture and food production. Raleigh NC North Carolina State University 1992.
10. Bilger B. Forever young. Can DHEA temper the ravages of time? some investigators can't afford to wait for the answer. Sciences 1995;35:26-32.
11. Murray TH, Livny E. The human genome project: ethical and social implications. Bull Med Libr Assoc. 1995;83:14-21.
12. Ledley FD. Distinguishing genetics and eugenics on the basis of fairness. J Med Ethics 1994;20:157-64.