A review of PERILOUS KNOWLEDGE: THE HUMAN GENOME PROJECT AND ITS IMPLICATIONS. By Tom Wilkie. University of California Press, Berkeley (California). $20.00. xi + 195 p.; index. ISBN: 0-520-08553-1. 1993. This is an engaging and enjoyable book intended for non-specialists who would like a quick overview of the promises and problems of the Human Genome Project and a brief history of how it came about. The author, who has a Ph.D in physics, is currently a science editor for the British newspaper The Independent. He has been following the genome project for some time as a science journalist for New Scientist and has a number of interesting observations to make. The one aspect of this book that diminishes its value for academics is that it has no references. This lack is inexplicable, and can be a source of considerable frustration for the reader. In the first half of his book, Wilkie gives an excellent overview of the origin and development of the genome project and the early controversies surrounding it. He explains in clear language exactly what is involved in gene sequencing and gene mapping, and discusses the limitations of each method. The Human Genome Project is presented as the final step in a long scientific endeavor. This part of the book also contains a lucid history of the development of diagnostic methods for identifying genetic disease. The moral and political consequences of the new genetic knowledge are examined in the remainder of the book. One purported aim of the Human Genome Project is to diminish the suffering and prolong the life of people with genetically inherited diseases. The hope is that early identification of the genetic bases for such diseases, together with suitable therapies, will achieve this goal. The mildest form of intervention is a change in diet. Another approach involves regular infusions of a particular product of DNA-specified synthesis (often an enzyme) that a patient with a genetic defect cannot manufacture. A still more advanced idea is somatic gene therapy, such as implanting a healthy gene in a patient's bone marrow. All these approaches have been attempted, the first two with the most success, but all have their technical limitations, as Wilkie explains with admirable clarity. The most radical idea, germline therapy, which entails manipulation of the reproductive cells, has not been viewed favorably thus far as an acceptable alternative for humans. But the technology is being applied to produce transgenic domestic and other animals. Many people are concerned about the broader moral and political consequences of this new genetic knowledge. One such question asks, who should be given access to information about people's genetic makeup patients, family members, doctors, insurance agencies? And who should set priorities when it comes to developing new therapies and giving people access to them? According to Wilkie, these and similar questions cry out for public discussion. They are too important to leave to any particular group of experts, be they politicians or scientists. Politicians may be too oriented toward immediate concerns, and most scientists are not experienced in dealing with ethical matters. But how can one sensibly discuss the possible moral and political consequences of a project that has barely begun? Wilkie believes we can. He suggests that we may rely upon historical precedents. By selecting good model cases and noting what happened, we can get some sense of possible future scenarios. Looking into several genetic diseases (particularly sickle-cell anemia and thalassemia), therapies, and diagnostic methods, the author reaches a number of conclusions. One is that any procedure can have unintended consequences: Methods developed for one particular purpose might be used later for other purposes as well. This was the case with amniocentesis, for example, which was originally developed to diagnose chromosomal abnormalities, but can also be used to determine the sex of a fetus. Second, the development of therapies is driven more by economic interests than by the objective need to find treatment for disease. Wilkie believes that this is one reason why little attention has been paid to diseases such as thalassemia and sickle cell anemia, which typically affect poor populations. Third, discriminatory decisions have been made in the past based on insufficient or faulty information. Wilkie briefly mentions the infamous sterilization laws (p. 164), but focuses especially on the genetic screening of blacks in the U.S. for the sickle-cell trait in the late 1960s and early 1970s. The problem was that perfectly healthy carriers of the trait were often mistakenly regarded as being afflicted with the disease. This caused personal worries and problems with insurance.