Promises past and future - Gene therapy and the actualisation of future expectations.

The advent of gene therapies such as Zolgensma, Libmeldy, and Luxturna has given rise to new treatment options for several rare conditions, drastically changing the expectations of affected patients. It has also significantly influenced hopes of medical treatment in general, with an emerging vision of widespread targeted personalised treatment of increasingly segmented conditions. Looking at a newspaper sample from the latest wave of developments in the field (from January 01, 2020 until April 30, 2023), our analysis of current media coverage however finds that this narrative of paradigmatic change operates mostly without regard to the present and its challenges, such as the prohibitive price tag of these treatments and unresolved questions about their accessibility and long-term effects. Drawing on expectations raised in the context of the completion of the Human Genome Project in 2000, the article compares these to current hopes of gene therapy's safety and effectiveness; profitability; and accessibility. Areas of tension are then interpreted as a guide to an emerging 'real-life' understanding of gene therapy's promise, which is, however, mostly visible in discussions of problems with gene therapy's accessibility. Similarly marginalised issues include for instance assumptions of effectiveness that do not acknowledge the long-term uncertainty of treatment outcomes; and assumptions of profitability that run counter to real-life examples of business failure. As a revolutionary future becomes reality for some patients, such questions are becoming harder to ignore - but are crucially often omitted from discussion about projected change.