To the Editor:—
Dr. Bernards’ conclusion that gene therapy may be in our future, albeit in a very limited way, may be based on too limited a view of what clinical anesthesiology could become. 1For example, several laboratories in departments of anesthesiology are looking for new classes of biopharmaceuticals that target gene expression, not to mention viral vectors and other means of inserting novel genes, for the purpose of preconditioning vital organs that are likely to be jeopardized during pending surgery. How many of us could have foreseen the confluence of gene therapy and cerebral preconditioning 10 yr ago? And how many unforeseen applications of gene therapy in anesthesiology will be under investigation in 2011?
Regarding Dr. Bernards’ argument that the economics of anesthetic drugs is such that drug companies will not be rushing to market with novel gene therapies for our use because the world-wide value of all anesthetic drugs is less than the value of the United States’ salsa market—if the application of gene therapy in anesthesiology were one-tenth the value of the United States’ salsa market we would have more salesmen in our offices than we have patients in our operating rooms. Besides, since when is anesthesiology a passive vessel whose progress depends on what drug companies market for our use? Clinicians and researchers in anesthesiology delineate new problems, which define new needs, which generate new markets for new solutions. Pharmaceutical companies need our problems as much as we need their solutions. The relationship is synergistic, but it starts with us.
A “why bother?” attitude toward gene therapy and the view that it may not offer clinical anesthesiology as much as it offers other medical disciplines could become a self-fulfilling prophecy. Anesthesiology would do better to view itself and gene therapy as endeavors whose combined and separate future application is unlimited.