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Ringel, Steven P. MD

Section Editor(s): Cook, Robin

Book Review: Infobytes

384 Pages, Putnam, 2003

Dr. Ringel, Associate Editor-in-Chief of Neurology Today, is Professor and Director of the Neuromuscular Division of the University of Colorado Health Sciences Center in Denver.

Advances in bioscience have not come without controversy. For instance, a neurosurgical procedure for gene therapy in a 55-year-old man with Parkinson disease made front-page news in the the New York Times, eliciting instant criticism from several leading neurologists.

On any given day, one is likely to read either favorable or negative comments about stem cell research. At least two presidential candidates have promised, if elected, to rescind President Bush's stem cell research policy limiting federal funds to cell lines created before August 9, 2001.

While some oppose the expansion of research into an area that people find morally objectionable, others, including the AAN and the American Medical Association, say that cloning to create stem cells is both consistent with medical ethics and human research. While the debate will continue, Robin Cook has turned the controversy into a quick-read novel.

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Ever mindful of the nefarious potential of misdirected medical priorities, Robin Cook, MD, the author of a host of best-selling medical thrillers, has created a plot in Seizure that plays into people's fears of a Dr. Frankenstein performing unbridled stem cell research. Many of Cook's characters, infatuated with power and personal gain, are reminiscent of stereotypes in TV series and in the cinema.

Senator Ashley Butler, an old-fashioned Southern demagogue who espouses “traditional American values” and opposes most biotechnologies, has rapidly progressive Parkinson disease. He arranges for unapproved insertion of genetically altered stem cells into his basal ganglia. To do so, he secretly recruits Daniel Lowell, MD, a former Harvard researcher whose start-up stem cell biotech company is running out of money because his stockholders fear that Butler will spearhead unfavorable legislation.

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Somewhat predictably, these two highly successful but tragically flawed titans strike a Faustian bargain: favorable legislation for unethical treatment. As Butler puts it: “I want to barter your powers as a physician with my powers as a politician.”

Convinced of the potential of his research and blind to his own ambition, Lowell rationalizes the ethical concerns ultimately raised by Stephanie Castigliano, his young research collaborator and lover: “It seems to me a minor compromise in ethics is a small up-front price to pay for an enormous back-end payoff.”

Cook includes several subplots involving characters equally consumed by personal agendas. Butler wants his transplanted stem cells to contain Christ's DNA extracted from blood from the Shroud of Turin. To obtain a fragment from the shroud, he promises Cardinal O'Rourke, a man equally adept at trading favors, that he will introduce legislation to limit tort liability for recognized charities. The surgery is to take place in the Bahamas, where a businessman and discredited obstetrician perform in vitro fertilization using oogonia cultures created from young Bahamian pregnant women who are paid to abort.



Although these megalomaniacs have no experience with brain transplantation, and their operating room is inadequately equipped, they convince a neurosurgeon “looking for work” to perform the procedure.

While all of this is taking place, gangsters are lurking. Somewhat comically, Stephanie's brother Tony and two Italian gangsters, Sal and Louie, send their “muscle,” Gaetano Baresse, to the Bahamas to rough up Lowell. Why? They are tired of waiting for financial return on the money Stephanie encouraged Tony to invest in the start-up company. As the time for the surgery approaches and critical decisions have to be made, Gaetano's stalking and Stephanie's growing concerns heighten the suspense.

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Given Cook's medical background and interest in research discoveries, readers are also provided a window into the potential of gene transfer therapy. Stephanie adeptly removes nuclei cultured from Butler's fibroblasts and replaces the abnormal DNA causing Parkinson disease with disease free fragments of DNA retrieved from blood from the Shroud of Turin. To do so, she amplifies the fragments using PCR techniques and patches them into Butler's remaining nuclear DNA using enzymes.

Lowell's unique discovery is the ability to perform this transgenic segmental recombination step. Stephanie then transfers Butler's altered fibroblast nuclei into embryonic egg cells provided by her Bahamian co-conspirators. The stem cell lines she grows are directly injected into Butler's brain. Since most of the DNA is unchanged, there is little chance of rejection. Additionally, Stephanie inserts a tracer gene so that she can track cell localization and growth using imaging techniques. Cook has done his homework well, as much of this technology is possible today.

How the scheme falls apart in a disastrous fiasco is the climax of the book, one that should not appear in a review, lest readers will turn away. The title of the book gives only a partial clue.

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Uncharacteristic of novelists, Cook adds an author's note following the story explaining why he chose to write about “the collision of politics and rapidly advancing bioscience.” He advocates for a nonpartisan commission to make recommendations to Congress and emphasizes the distinction between reproductive (cloning people) and therapeutic cloning. The note comes across somewhat defensively.

The novelist needs to make his points within the story and should save his commentary for his promotional tour. In spite of this distraction, Seizure is an enjoyable book that underscores the fascinating potential of today's biomedical advances as well as the consequences of unchecked ambition and ethics gone awry.

©2003 American Academy of Neurology