Scientific Controversy No. 1: Genetic Manipulations

Since the emergence of life, genes have ruthlessly exploited organisms as vehicles for their own survival. The creature dies, but the genes survive. Slowly, over generations, the gene is duplicated with a notably random mutation, occasionally amplified by natural selection. However, with recent scientific advances, we’re now able to intentionally modify genes in the span of a few hours. No longer hapless carriers at the genome’s mercy, we can control which genes survive. We are now able to eliminate diseases in a stroke, create the ideal baby, or even design a stronger, smarter species. But with what implications for the future of humanity?

Medicine is at a turning point, on the cusp of major change as disruptive technologies such as gene, RNA, and cell therapies enable scientists to approach diseases in new ways. The swiftness of this change is being driven by innovations such as?CRISPR gene editing, which makes it possible to correct errors in DNA with relative ease.

The CRISPR/Cas9 system has been revolutionary in the world of genetic research. However, as genetic engineering moves into human applications, it's now time to ask: what benefits can this bring? And, how far is too far when it comes to altering the human genome?

This disconnect was brought into stark relief at the?International Summit on Human Genome Editing, held in Hong Kong, when exciting updates about emerging therapies were eclipsed by a fresh announcement. He Jiankui, a Chinese researcher, claimed that he had edited the genes of two human embryos, and that they had been brought to term.

Many people, including scientists, are worried about creating genetically modified humans. They're worried about numerous things: genetic mistakes being passed on to the next generation; the creation of designer babies who are more intelligent, more beautiful, or more athletic; and the possibility of causing severe growth abnormalities or cancer.

While these are valid concerns, they don't justify a ban on research. Indeed, such research is a moral imperative for five reasons.

1. Curing genetic diseases

Gene editing could be used to cure genetic diseases such as cystic fibrosis or thalassaemia. At present, there are no cures for such diseases.

Detractors say selection of healthy embryos or fetuses via genetic testing is preferable. But such genetic tests require abortion or embryo destruction, which is also objectionable to some people.

What's more, genetic selection doesn't benefit patients—it's not a cure. It merely brings a different person, who is free from disease, into existence. Future people would be grateful if their disease was cured, rather than being replaced by a different, healthier or non-disabled person.

2. Dealing with complex diseases

Most common human diseases, such as heart disease or schizophrenia, don't just involve one gene that's abnormal (such as in cystic fibrosis). They're the result of many, sometimes hundreds, of genes combining to cause ill health.

Genetic selection technologies can't eliminate genetic predispositions to these diseases. In principle, gene editing could be used to reduce the risk of heart disease or Alzheimer's disease.

3. Delaying or stopping ageing

Each day, thousands of people die from age-related causes. Cardiovascular disease (strongly age-related) is emerging as the biggest cause of death in the developing world. Ageing kills 30 million every year.

That makes it the most under-researched cause of death and suffering relative to its significance. Indeed, age-related diseases, such as?heart disease?or cancer, are really the symptoms of an underlying disease: ageing.

Gene editing could delay or arrest aging; this has already been achieved in mice. Gene editing might offer the prospect of humans living twice as long, or perhaps even hundreds of years, without loss of memory, frailty, or impotence.

4. Stopping the genetic lottery

The fourth reason for supporting gene-editing research on human embryos is the flip side of the designer baby objection. People worry that such technology could be used to create a master race, like fair-haired, blue-eyed "Aryans".

What this concern neglects is that the biological lottery – i.e., nature – has no regard to fairness. Some are born gifted and talented, others with short, painful lives or severe disabilities. While we may worry about the creation of a genetic masterclass, we should also be concerned about those who draw the short genetic straw.

Diet, education, special services, and other social interventions are used to correct natural inequality. Ritalin, for example, is prescribed to up to 10% of children with poor self-control to improve their educational prospects and behaviour control.

Gene editing could be used as a part of public health care for egalitarian reasons: to benefit the worst off. People worry that such technologies will be used to benefit only those who can afford them. Keep reading to find out why they shouldn't.

5. Making disease treatments less costly

Gene editing of?human embryos?could enable greater understanding of disease and new treatments that don't modify human beings.

Gene-edited embryonic stem cell lines that cause or protect against disease could help us understand the origins of disease. Other edited stem cells could help treatment-imagine blood cells that kill and replace leukemic cells.

This knowledge could be used to develop treatments for diseases, including drugs, that can be produced cheaply. And that would reduce, rather than increase, inequality.

Hacking Darwin: Genetic Engineering and the Future of Humanity

Frontiers: What are the ways in which people are able to "hack Darwin" today and over the next 15 years or so?

Cebo: We have always fought against the inherent cruelty of natural selection, one of the two essential pillars of Darwinian evolution. We are now beginning to hack away at the second pillar, random mutation. Our growing understanding of how genes and biology function is opening the door to incredible medical applications like using genome sequencing and gene therapies to fight cancer and other diseases. But the healthcare applications of genetic technologies are only a stop along the way to where these technologies are taking us.

Our ability to select embryos during in vitro fertilizations (IVF)—based on informed genetic predictions of both health-related traits and intimate characteristics like height, IQ, and personality style—will grow over the coming years. We’ll use stem cell technologies to expand the number of eggs that prospective mothers can use in IVF and, therefore, the range of reproductive options for parents. We’ll deploy gene editing tools far more precise than today’s CRISPR systems to make heritable genetic changes to our future offspring. Over the coming decades, Darwin’s original concept of random mutation and natural selection will gradually give way to a process that is far more self-guided than anything Darwin could have imagined.

Frontiers: Changing the nature of what it means to be human has huge consequences. What are the main ones?

Cebo: We have internalized the idea that information technology is variable, which is why we expect each generation of our phones and computers to be better than the last. It’s harder for us to come to grips with the idea that our biology could be as variable as our IT, even though we understand intellectually that somehow we evolved from single-celled organisms to complex humans over the past 3.8 billion years. Starting to see all of life, including our own, as increasingly manipulable will force us to think more deeply about what values will guide us as we begin altering biology more aggressively.

If we want to avoid dividing our species into genetic haves and have-nots—a dangerous reduction in our diversity—or a genetic determinism that undermines our humanity, we’ll need to start living our values. But though we need to be mindful of the dangers, we must also keep in mind that these technologies have the potential to do tremendous good. They may one day assist us in avoiding extinction-level events such as dangerous synthetic pathogens, a warmer climate, the fallout from a nuclear war, or the eventual demise of our sun.

Frontiers: Do we have the ethical framework to handle this? If not, what might it look like if things go wrong?

Cebo: We create beautiful art, philosophy, and universal concepts like human rights, but wipe out millions of each other in wars and genocides, and still today invest massive amounts of our collective wealth in tools of mass murder. The "better angels of our nature" remain the primary drivers in our development of genetic technologies, but the dark side of human nature could also be empowered through these same tools. We need a very strong ethical and cultural framework to increase the odds that we’ll use these technologies wisely, not least because access to them will be decentralized and democratized.

Although the positive possibilities far outweigh the negatives, it would be crazy to ignore the many ways things could go wrong. Like Icarus, we could fly too close to the sun and get burned if we hubristically assume we know more than we actually do. Our gene drives could crash ecosystems. We could use these tools to undermine our common identity as a species and social cohesion. The good news is that while the technologies are new, the values we’ll need to use them wisely are often old.

Frontiers: What sort of regulations need to be in place to "enable" these technologies—and what rules should "constrain" them?

Cebo: Genetic technologies touch the source code of what it means to be human and must be regulated. This job is all the more difficult because technology is racing forward faster than the governance structures around it can keep up. On both the national and international levels, we’ll need enough governance and regulation to prevent abuses and promote public safety, but not so much to impede beneficial research and applications.

To avoid dangerous medical tourism, every country should have a national regulatory system in place that aligns with international best practices and the country’s own values and traditions. We also have to start developing global norms that can ultimately underpin flexible international standards and regulations. These systems must be guided by core values rather than inflexible rules because what may now seem unthinkable, like actively selecting and even editing our future offspring, will become normalized over time. We urgently need to start preparing for what is coming.

Frontiers: This takes the issue of human liberty to a new level (people should be free to change themselves or offspring), as well as the potential for unbridgeable inequalities (not just of wealth or life outcomes, but of capabilities encoded in oneself and family). How must the idea of liberalism adapt to address this? What does the "liberal agenda" look like for the 21st century vis-à-vis "hacking Darwin"?

Cebo: If and when it becomes possible for some parents to give their children enhanced IQs, lifespans, and resistance to disease, we will have to ask what this means for everyone else. Some will see these parents as first-adopters, paving the way for everyone else, like the first privileged people buying smartphones. Others will call them usurpers, laying the foundation for dangerously divided societies.

Whatever the case, differences within and between societies, fueled by competition, will drive adoption of these technologies and present societies with stark choices. Too few regulations could lead to a dangerous genetic engineering free-for-all and an arms race. But trying to ban genetic manipulations would increasingly require the trappings of the most oppressive police states. Some liberal societies may choose to provide a basic level of access to assisted reproduction and genetic engineering services to everyone, not least to save the expense of lifetime care for people who would otherwise be born with preventable genetic diseases.

Societies already struggling to define the balance between parental and state interests in the context of abortion will have an even tougher time drawing this line for parent-driven assisted reproduction. But if we thought the debates over abortion and genetically modified crops were contentious, wait until the coming debate over genetically modified people arrives. If we don’t want this to tear us asunder, we must all come together in a public process to figure out the best way forward.