The idea that heredity could be manipulated had a devastating consequence in the form of eugenics, but the actual manipulation of genes was yet a distant dream in the first half of the 20th century. The worst of eugenics was the manipulation of the phenotype, human beings. However, in Part 3, Mukherjee explores the world’s response to the knowledge that now tools were being developed to manipulate genes at the cellular level, possibly causing changes that can be heritable. Gene manipulation technologies opened up a whole new set of concerns, especially in the shadow of World War II, illustrating The Ethics of Eugenics and Gene Editing in Policy and Medicine. If eugenics planned to breed blonde hair and blue eyes through controlled marriages, gene editing may breed these traits by removing, say, the very gene for black hair itself.

The ethics of gene editing are particularly fraught because they pit scientific developments against caution. Mukherjee describes how one scientist at the second Asilomar conference reacted against the proposed moratorium, hissing, “You fucked the plasmid group” (230). Such scientists are quasi-Promethean figures in the book, signifying creativity and audacious thinking, while the more reserved characters are more wary of potential ethical misuse of scientific discoveries. The narrative does not take sides here, holding together two oppositional truths. It is true that the Asilomar conferences slowed down advances in gene editing that could have been useful, especially in medicine. It is also true that a measured approach is important, since “who could ensure that genetic technologies would not be schooled and perverted by powerful forces—as once before on that continent” (226). The “once before on that continent” is especially important here, since it reflects how the scepter of Nazism permanently changed the relationship between science and policy.

The ethics of using gene technology in medicine are particularly complex, as genetic therapies can also bring tremendous relief to patients. To illustrate this, Mukherjee shows that though insulin was a superhit drug for Genentech, the medicine which would bring gene-cloning technology to the forefront was a different one: Factor VIII, the crucial protein missing in hemophiliacs. The treatment of hemophilia requires regular injections of the concentrated factor. As the AIDS epidemic emerged in the US in the early 1980s, it was first assumed to affect only gay men, leading the disease to be briefly termed gay-related immune deficiency or GRID. However, the large number of hemophiliacs affected by the disease quickly dissolved that notion, making it clear it was spread through blood-products as well. To avoid hemophiliacs contracting such infections, Genentech used recombinant technology to synthesize factor VIII. Though recombinant factor VIII could not save the lives of most hemophiliacs affected by AIDS, factor VIII injections are now the staple of hemophilia treatment.

The text contains several allusions to literature and culture to amplify its subtext and meaning. For instance, Mukherjee refers to insulin as “the Garbo of hormones” (239), the mystique attached to the actor a metaphor for the hormone’s inscrutability. He prefaces the text of Chapter 20 with a quote by the science fiction writer Arthur C. Clarke, stating that advanced technology and magic are indistinguishable. The allusions link the world of hard science to the continuum of society and culture. 

In another example of the human anecdotes that are meant to make the text accessible for a general audience, Mukherjee recounts a conversation with Marianne Dieckmann, one of Berg’s associates. On the beach close to Dieckmann’s lab, Mukherjee asks her if the disagreements at Asilomar were worth anything. Dieckmann illustrates her point by drawing a line in the sand with a toe. Asilomar, she tells Mukherjee, signified that the line between theory and application in genetics had been breached. Now that science could enact genetics, the need for vigilance was all the more important. Asilomar’s quarrels were not fruitless; they showed that scientists were aware of their tremendous responsibility.