NEXT   by Michael Crichton, MD, Harper, New York, 10022, © 2006, by Michael Crichton,  ISBN: 978-0-06-087316-5, 547, pp, $9.95; Five Compact Discs, six hours, performed by Erik Singer, Harper Audio, $14.95.

Review by Del Meyer, MD

This novel is fiction, except for the parts that aren’t.
BioGen Research Inc, a company featured in this novel, is a product of the author’s imagination and should not be understood to refer to any actual company.

The more the universe seems comprehensible, the more it also seems pointless.–Steven Weinberg

Dr. Crichton welcomes us to our genetic world, which is fast, furious, and out of control. He warns us he’s not writing of the world in the future, but the world as he sees it right now. This is one of Dr. Crichton’s final novels, but may well be his most important. He is the author of Jurassic Park and State of Fear; and he is also the creator of the television series ER.

Crichton informs us there are only four hundred genes that are different in humans compared to the chimpanzee. Transgenic creatures (animals with injected human genes) are a possible occurrence in our time. What these creatures can do is obviously a figment of Crichton’s imagination, but he makes it very realistic and believable.

We are introduced to BioGen Research Inc, which is housed in a titanium-skinned cube in an industrial park outside Westview Village in Southern California. Majestically situated above the traffic on the 101 freeway, the cube had been the idea of BioGen’s president, Rick Diehl, who insisted on calling it a hexahedron. The cube looked impressive and high-tech while revealing absolutely nothing about what went on inside—which is exactly how Diehl wanted it.

In addition, BioGen maintained forty thousand square feet of nondescript shed space in an industrial park two miles away. It was there that the animal storage facilities were located, along with the more dangerous labs. Josh Winkler, an up-and-coming young researcher, preparing to enter the quarters, noticed that his assistant, Tom Weller, was reading a newspaper clipping from the Wall Street Journal taped to the wall saying, “Diehl must be crapping in his pants.” We learn the reason as he reads. . .

Toulouse, France—a team of French biologists isolated the gene that drives certain people to attempt to control others. Geneticists at the Biochemical Institute of Toulouse University headed by Dr. Michel Narcejac-Boileau, announce the “discovery of the ‘Master’ gene which is associated with social dominance and strong control over other people. We have isolated it in sports leaders, CEOs, and heads of state. We believe the gene is found in all dictators throughout history.”

Dr. Narcejac-Boileau explained that while the strong form of the gene produced dictators, the milder heterozygous form produced a “moderate, quasi-totalitarian urge” to tell other people how to run their lives, generally for their own good or for their own safety.

“Significantly, on psychological testing, individuals with the mild form will express the view that other people need their insights, and are unable to manage their own lives without their guidance. This form of the gene exists among politicians, policy advocates, religious fundamentalists, and celebrities. The belief complex is manifested by a strong feeling of certainty, coupled with a powerful sense of entitlement—and a carefully nurtured sense of resentment toward those who don’t listen to them.”

At the same time, he urged caution in interpreting the results. “Many people who are driven to control others merely want everybody to be the same as they are. They can’t tolerate difference.”

This explained the team’s paradoxical finding that individuals with the mild form of the gene were also the most tolerant of authoritarian environments with strict and invasive social rules. “Our study shows that the gene not only produces a bossy person, but also a person willing to be bossed. They have a distinct attraction to totalitarian states.” He noted that these people are especially responsive to fashions of all kinds, and suppress opinions and preferences not shared by their group.

“Unbelievable,” Josh said. “These guys in Toulouse hold a press conference and the whole world runs their story about the ‘master gene’? Have they published in a journal anywhere?”

“Nope, they just held a press conference. No publication and no mention of publication.” “What’s next, the slave gene? Looks like crap to me,” Josh replied. “You mean, we hope it’s crap,” as Josh and Tom begin their routine of taking the compressed-air cylinder, attaching a vial of retrovirus and having the preselected set of six rats do a 10-second inhalation of the retrovirus.

The retrovirus had been bioengineered to carry a gene in the family of genes controlling aminocarboxymuconate paraldehyde decarboxylase. Within BioGen they called it the maturity gene. When activated, it seemed to modify responses of the amygdala and cingulate gyrus in the brain. The result was an acceleration of maturational behavior—at least in rats. Infant female rats, for example, would show precursors of maternal behavior, such as rolling feces in their cages, far earlier than usual. And BioGen had preliminary evidence for the maturational gene action in rhesus monkeys, as well. 

Interest in the gene centered on a potential link to neurodegenerative disease. One school of thought argued that neurodegenerative illnesses were a result of disruptions of maturational pathways in the brain.

If that were true in Alzheimer’s disease or another form of senility—then the commercial value of the gene would be enormous.

As the story line progresses, Josh has to pick up his druggie brother at the courthouse to bring him home after their attorney sprung him from jail. When he arrives at home, he notices the cylinder in his back seat is empty. He looks at his brother he had brought home and asks him what he did. “I just thought I’d get a whiff of what I presume was nitrous oxide. Did I do something wrong?” “You just inhaled virus for a rat.”

In another plot, the cell line that BioGen used was obtained by UCLA from Frank Barnett. As the cell line ages, it is replenished and thus Mr Barnett comes face to face with the law. BioGen owns the cell line and they can replenish it any time they need to. Mr. Barnett has no rights to stop them from taking punch biopsies from six of his organ systems. Barnett becomes a fugitive. He doesn’t want to give UCLA and BioGen samples. He doesn’t realize their worth—three billion dollars. He hides from the BioGen bounty hunters. In court, the hunters are named “Professional fugitive recovery agents” with the purpose of obtaining cells from Mr. Barnett. When it is difficult to make a citizen’s arrest on Barnett, an ambulance, with a man in a white coat operating out of a small room in the back, go after his daughter, Tracy. When she manages to escape, they pursue her son, Jamie. They pick up a boy who says his name is Jamie, but just before the punch biopsy, they discover they have taken the wrong “Jamie.” The “fugitive recovery” has just become a kidnapping. The boy has to be reunited with his mother before it’s too late.

Meanwhile in France, a parrot that has been given some human genes begins to speak with an extraordinary vocabulary. “Gerard” is able to originate a sentence, rather than just repeat it, and learns math, enabling him to help his new owner’s son do well in school.

Back in America, a chimpanzee named “Dave,” who a researcher injected with some of his own genes, begins to talk. He doesn’t look entirely like other chimpanzees and the scientist takes him home to his family as his “son.” When he enrolls him in school, it causes a stir until the father convinces authorities that he has a rare genetic disorder. The chimp-son is allowed to remain in class.

Crichton skillfully weaves several ethical stories into very complicated, sometimes hilarious, plots with a surprise ending with far-reaching implications and human complications.

Crichton gives us a generous bibliography on Genetics, Human Tissue in the Biotechnology Age, New World Reproductive Technology and the Biotech Revolution, all resources for the information in this book.

At the end of his research for the book, Crichton arrived at the following conclusions, which he exemplifies in NEXT:

1. STOP PATENTING GENES

Gene patents might have looked reasonable twenty years ago, but the field has changed in ways nobody could have predicted. Today we have plenty of evidence that gene patents are unnecessary, unwise, and harmful. . .

First, genes are facts of nature. Like gravity, sunlight, and leaves on trees, genes exist in the natural world. Facts of nature can’t be owned. You can own a test for a gene, or a drug that affects a gene, but not the gene itself. You can own a treatment for a disease, but not the disease itself. . .  To argue that a gene is in any way a human invention is absurd. To grant a gene patent is like granting a patent on iron or carbon. . . Or to patent noses. . . [Can you imagine] chefs [being] sued for making fragrant dishes unless they paid the nose royalty?  . . .

Gene patents are bad public policy. We have ample evidence that they hurt patient care and suppress research. When Myriad patented two breast cancer genes, they charged nearly three thousand dollars for the test, even though the cost of creating gene tests is nothing like the cost to develop a drug. Some years ago, the owner of the gene for Canavan disease refused to make the test widely available, even though families who had suffered with the disease had contributed time, money, and tissues to get the gene identified. Now those same families could not afford the test.

That is an outrage, but it is far from the most dangerous consequence of gene patents. In its heyday, research on SARS (Severe Acute Respiratory Syndrome) was inhibited because scientists were unsure who owned the genome—three simultaneous patent claims had been filed. As a result, research on SARS wasn’t as vigorous as it might have been. That should scare every sensible person. Here was a contagious disease with a 10 percent death rate that had spread to two dozen countries around the World. Yet scientific research to combat the disease was inhibited—because of patent fears.

At the moment, hepatitis C, HIV, hemophilus influenza, and various diabetes genes are all owned by some entity. They shouldn’t be. Nobody should own a disease. . .

2. ESTABLISH CLEAR GUIDELINES FOR THE USE OF HUMAN TISSUES

Human tissue collections are increasingly important to medical research, and increasingly valuable. Appropriate federal regulations to manage tissue banks already exist, but courts have ignored federal rules. Historically, the courts have decided questions about human tissues based on existing property law. In general, they have ruled that once your tissue leaves your body, you no longer maintain any rights to it. They analogize tissues to, say, the donation of a book to a library. But people have a strong feeling of ownership about their bodies, and that feeling will never be abrogated by a mere legal technicality. Therefore we need new, clear, emphatic legislation. . .

The notion that once you part with your tissue you no longer have any rights is absurd. Consider this: Under present law, if somebody takes my picture, I have rights forever in the use of that photo. Twenty years later, if somebody publishes it or puts it in an advertisement, I still have rights. But if somebody takes my tissue-part of my physical body—I have no rights. This means I have more rights over my image than I have over the actual tissues of my body.

The required legislation should ensure that patients have control over their tissues. I donate my tissues for a purpose. And that purpose only. If later, someone wants to use them for another purpose, they need my permission again. If they can’t get permission, they can’t use my tissues. . .

We should not fear that such regulations will inhibit research. After all, the National Institute of Health seems to be able to conduct research while following these guidelines. Nor should we accept the argument that these rules impose an onerous burden. If a magazine can notify you that your subscription has run out, a university can notify you if they want to use your tissues for a new purpose.

3.  PASS LAWS TO ENSURE THAT DATA ABOUT GENE TESTING IS MADE PUBLIC

New legislation is needed if the FDA is to publish adverse results from gene therapy trial. At the moment, it cannot do so. In the past some researchers have tried to prevent the reporting of patient deaths, claiming that such deaths were a trade secret. 

. . .  Bias in published studies has become a bad joke. Psychiatrist John Davis looked at the trials funded by pharmaceutical companies in competition for the most effective of five different antipsychotic drugs. He found that 90 percent of the time, the drug manufactured by the company sponsoring (paying for) the study was judged superior to the others. Whoever paid for the study had the best drug. . .

4. AVOID BANS ON RESEARCH

Various groups of different political persuasions want to ban some aspect of genetic research. I agree that certain research ought not to be pursued, at least not now. But as a practical matter, I oppose bans on research and technology.

Bans can’t be enforced. I don’t know why we have not learned this lesson. From Prohibition to the war on drugs, we repeatedly indulge the fantasy that behavior can be banned. Invariably we fail. And in a global economy, bans take on other meanings: even if you stop research in one country, it still goes on in Shanghai. So what have you accomplished?

Of course, hope springs eternal. And fantasies never die: various groups imagine they can negotiate a global ban on certain research. But to the best of my knowledge, there has never been a successful global ban on anything. Genetic research is unlikely to be the first.

5. RESCIND THE BAYH-DOLE ACT

In 1980, Congress decided that the discoveries made within universities were not being made widely available, to benefit the public. To move things along, it passed a law permitting university researchers to sell their discoveries for their own profit, even when that research had been funded by taxpayer money.

As a result of this legislation, most science professors now have corporate ties—either to companies they have started or to other biotech companies. Thirty years ago, there was a distinct difference in approach between university research and that of private industry. Today the distinction is blurred, or absent. Thirty years ago, disinterested scientists were available to discuss any subject affecting the public. Now, scientists have personal interests that influence their judgment.

Academic institutions have changed in unexpected ways: The original Bayh-Dole legislation recognized that universities were not commercial entities, and encouraged them to make their research available to organizations that were. But today, universities attempt to maximize profits by conducting more and more commercial work themselves, thus making their products more valuable to them when they are finally licensed. For example, if universities think they have a new drug, they will do the FDA testing themselves, and so on. Thus Bayh-Dole has paradoxically, increased the commercial focus of the university. Many observers judge the effect of this legislation to be corrupting and destructive to universities as institutions of learning.

Bayh-Dole was always of uncertain benefit to the American taxpayers, who became, through their government, uniquely generous investors. Taxpayers finance research, but when it bears fruit, the researchers sell it for their own institutional and personal gain, after which the drug is sold back to the taxpayers. Consumers thus pay top dollar for a drug they helped finance. . .

All these trends were perfectly clear to observers years ago; no one paid much attention back then. Now the problems are becoming clear to everyone. A good first step toward restoring the balance between academia and corporations will be to repeal Bayh-Dole legislation.