Perfecting the craft

Abstract

Overlooking the Hudson River in far upper west Manhattan is a unique museum called The Cloisters. Composed of walls, columns, and courtyards reassembled from several old monasteries and convents from Europe, this imposing edifice contains the Unicorn Tapestries, arguably the finest extant specimens of Western civilization's weaving arts. Each tapestry tells a chapter of the story of the capture of the unicorn, speaking not in sound but in vision. Yet the true glory of these works lies not in the story told, nor even in the symbolism evoked, but in the intricate work that rendered countless different colored threads into such achingly beautiful cloth. Close examination of even the smallest part of one tapestry demonstrates how impossible the whole piece would be without the contribution of each thread, each knot. The Unicorn Tapestries are the ultimate triumph of the weaver's art, requiring not only the expertise of the tapestries’ immediate artisans, but also generations of contributions to perfection of the craft. Although most people who view the tapestries see only the final story, the discerning viewer sees the sweat and skill of the weavers. Although some may find it a bit of a stretch, I was reminded of the Unicorn Tapestries during last month's ASGT meeting. Medicine is truly more of an art than a science, and gene therapy researchers and practitioners are still at the stage of busily gathering up threads, selecting some and rejecting others. It stuck me that each presentation made was, in truth, a contribution to the eventual success of gene therapy. Every individual attending had a sense of what the final picture should be, and everyone also had at least one “thread” or one new “knot” which he or she believed would contribute to its completion. However, not every piece will fit, nor will each accepted piece contribute equally to the eventual success of gene therapy. Whether rejected or accepted, each does play a role in advancing the field. Despite gene therapy's early days, we can point to whole tapestries that are emerging, such as the work of Alain Fischer and his co-workers in treating SCID infants or the collaborative venture of Kathy High and Mark Kay and their co-workers in treating hemophilia. However, these stories can only be considered the success of “gene therapy” on one level. It is clear that ASGT is held together less by the notion of establishing an entire new discipline of biomedicine than by a shared devotion to perfecting the craft of gene therapy to weave new and different stories of biomedical triumph over disease. It is likely that someday there will be no field of gene therapy per se, but rather a set of exquisite therapeutic interventions finely tuned and differentially selected for human medical needs. To the casual observer, these will be merely further stories of the success of modern medicine, but to the discerning eye, the real credit will go to the artists who are even now—as the ASGT meeting demonstrated—working hard to perfect their craft.