Birth Defects: From Here to Eternity

BIRTH DEFECTS: FROM HERE TO ETERNITY* SAMUELJ. AJL-t andJOSEPH MORIt Introduction: The Long March When in 1958 the National Foundation for Infantile Paralysis (now known as March of Dimes Birth Defects Foundation) preempted for its future activity a field it chose to call birth defects, it was a violent wrench in its history. What a difference from polio! There the goal was clear, attainable, attained—in 20 years. Birth defects were then still considered a neglected area of medicine. But the transition came at a time of rising interest and expanding knowledge in human genetics and teratology. It was soon evident that birth defects covered a vast, complex, amorphous territory, seemingly spread over the whole world of biomedicine. One could not be sure where birth defects ended and other things began. The frontier of birth defects is still clouded in the murky interiors of multifactorial diseases and will likely remain so for a long time. We are faced with the fact that causes of birth defects are omnipresent in the environment and imprinted in our genes. Many birth defects arise from the interplay between a particular environment with a particular genotype. The challenge of birth defects will probably increasingly occupy the minds of the government, scientists, and the public in general. Pretty soon we may even find the phrase "birth defects" in our dictionaries , and it will be interesting to see what definition the lexicographers will come up with. We cannot say we hope to conquer birth defects in your lifetime. We cannot offer the possibility of a universal panacea. Prevention of some birth defects is already possible, and many others will join this list, but for all genetic diseases, and for some others as well, prevention will involve one or other ways of reproductive control by individuals or families involved, a practice requiring emotion-laden decisions which on ?Lecture delivered by S. J. Ajl at the Second Triennial Basil O'Connor Starter Research Colloquium, Key Biscayne, Florida, November 15, 1979. tVice-president for research, March of Dimes Birth Defects Foundation, 1275 Mamaroneck Avenue, White Plains, New York 106Ó5. ^Medical editor, March of Dimes Birth Defects Foundation, 1275 Mamaroneck Avenue, White Plains, New York 10605.© 1981 by The University of Chicago. 0031-5982/81/2402-0220$01.00 302 I SamuelJ. Ajl andJoseph Mori ¦ Birth Defects the public scale may be subjected to cross fire by contending groups with differing ethical outlooks. Prevention in the areas of our interest is unlikely to become public health measures with legal sanction—such as mandatory vaccination. Gone is the age of innocence when the scientific community and health agencies like the National Foundation for Infantile Paralysis operated in a kind of privileged sanctuary set aside by the society for "good causes." We will be competing for support from a public made up of small and large interest groups, often at war with each other, and must tread cautiously over the shifting sands of American pluralism. Basic research is where everything starts. When asked what good is basic research, Grant Liddle answered, what good is the baby [I]? It embodies all the potentials of the future. And basic research is also where everything comes back. The conceptual, technical, and applied developments it gives rise to lead to another series of problems to be faced by the younger investigators, just as the next generation's babies face a different world shaped by the earlier ones. The money we put into research is the fuel by which we hope to accelerate or at least maintain this helical trajectory of science. One of the unsung virtues of a good investigator is to sense quickly and exploit vigorously other men's discoveries, including the competitors '. Similarly, one of the attributes of a vice-president for research should be to know which way the fish are running this season, or better still, to sense which way the fish may be going next season. To cultivate this power of divination we sometimes indulge in ad hoc surveys of what is going on in various areas of research germane to our programs. You will be relieved to learn that this is not going to be a systematic review of...