Multifaceted diseases

One of the major consequences of widespread belief in biological determinism is the underlying assumption that if a trait or condition is genetic, it cannot be changed. However, the relationship between genotype (the actual genes an individual inherits) and phenotype (what traits are observable) is complex. For example, cystic fibrosis (CF) is a multifaceted disease that is present in about 1 in every 2,000 live births of individuals of European ancestry. The disease is recessive, meaning that in order for it to show up phenotypically, the individual must inherit the defective gene, known as CFTR, from both parents. More than 1,000 mutation sites have been identified in CFTR, and most have been related to different manifestations of the disease. However, individuals with the same genotype can show remarkably different phenotypes. Some will show early onset, others later onset; in some the kidney is most afflicted, whereas in others it is the lungs. In some individuals with the most common mutation the effects are severe, whereas in others they are mild to nonexistent. Although the reasons for those differences are not understood, their existence suggests that both genetic background and environmental factors (such as diet) play important roles. In other words, genes are not destiny, particularly when the genetic basis of a condition is unclear or circumstantial but also even in cases where the genetic basis of a disability can be well understood, such as in cystic fibrosis.

With modern genomics (the science of understanding complex genetic interactions at the molecular and biochemical levels), unique opportunities have emerged concerning the treatment of genetically based disabilities, such as type I diabetes mellitus, cystic fibrosis, and sickle-cell anemia. Those opportunities have centred primarily on gene therapy, in which a functional gene is introduced into the genome to repair the defect, and pharmacological intervention, involving drugs that can carry out the normal biochemical function of the defective gene.

Influence on disability

Social attitudes about what constitutes a disability, and how economic and social resources are to be allocated to deal with disabilities, change over time. In hard economic times the disabled are often written off as “too expensive,” a trend often justified on the basis of genetic determinism (whether scientifically valid or not). Arguments for biological determinism have long been employed more to restrict than to expand human potential.