One of the most profoundly consequential debates modern science has ever faced is unfolding at this very moment on the global stage. At its heart lies a gene-editing technology called CRISPR-Cas9, which could one day enable scientists to create genetically modified humans.
Those who support CRISPR's use claim that it could be an invaluable tool for correcting genetic mutations that cause diseases such as HIV, cystic fibrosis, and cancer. Those who oppose it raise concerns about its application in human embryos--a process called germ-line editing--which would result in permanent, heritable modifications to the human genome.
This is one of those rare historic moments in which the present decisions will have incontrovertible effects on the future of the population.
Elliot Hosman, Senior Program Associate at the Center for Genetics and Society, joins BTR to discuss the ethical implications of this controversial new technology.
BreakThru Radio (BTR): Can you explain for our readers a little bit about what CRISPR does?
Elliot Hosman (EH): Sure, CRISPR is the cheapest, easiest, most concise gene-editing tool currently available. It relies on programmed molecular nucleuses that go into DNA looking for a particular target sequence. They're able to make incisions at that sequence to either mute genes, or cut genes out, or to replace genes entirely, sort of like a word processor conducting a find-and-replace.
BTR: Is there any concern that by being cheaper and easier to use than the gene-editing tools that preceded it, CRISPR may be more likely to be abused?
EH: I think when money's involved, that's actually when it's more worrisome. I grow concerned about whether a pharmaceutical company or venture capitalist is trying to pour something into it. What would their product look like? Would it prey upon the same anxieties that we currently see some biotech companies exploiting--fear of death, fear of being different, fear of looking different?
I'm more concerned when you have people who have a lot of technical skills with CRISPR who are trying to accomplish things that would be repugnant to many of us, like enhancing human beings.
BTR: Let's look at that. Many people are worried that CRISPR will provide researchers with the ability to alter heritable genes in an irreversible way.
EH: Yes. I think there's an interesting binary emerging in how people understand what CRISPR might someday be able to do. People tend to think that if we did this to human embryos, but we only did it for a certain genetic disease, it would be OK, and that we can distinguish that from any sort of enhancement like trying to make everyone white and blue-eyed. I'm actually really concerned that we can't draw a line between what everyone would agree would be an acceptable use on disease and what would be considered enhancement.
A lot of the social controversy is centered on figuring out what the permissible uses of this technology will be. How do we decide that we know what would be best for a child, and that it would be worth running all of the risks of genetic modification in-embryo prior to them having been born? All of the germ line should be off limits. We really can't make these decisions on behalf of future generations.
BTR: What are some of those risks associated with in-embryo gene-editing?
EH: One issue is that CRISPR often will be looking for a specific sequence, but that it will find something similar and make the cut there instead. Another issue is that once CRISPR is injected into a cell, it doesn't ever leave, and it continues to cut either the program sequence or similar sequences ad infinitum.
But even if the technology were able to overcome some of the immediate safety risks, we have so many social, ethical, and political risks that I really don't think we could move forward just yet. I think often when we're considering using CRISPR on embryos to prevent diseases, it's being talked about as if it would be a medical treatment, and I just don't see it that way. I think this is much more about creating a new kind of human being.
We're saying that before the person is even born with symptoms, we're going to change them in hopes that we're right, and in hopes that there won't be any cascading effects. It opens the door to what I think would be widespread and very socially dangerous ideas about what's good for children. I mean, who would have access to these different technologies?
BTR: It does at a certain point begin to sound like "Brave New World." What kinds of limitations are currently in place to keep labs from jumping the gun and making irresponsible decisions?
EH: Internationally, there's a lot of excitement emerging about this technology from certain sectors of the world. But I think many countries have this very understandable fear of allowing scientists, private companies, and researchers to go forward with this, because it's just so extreme.
We haven't really seen the US take a strong stance. Neither the NIH nor the FDA will fund germline editing, but you see billions of dollars being invested into this area of research, so there is private money there. As far as actual legislation, there aren't any laws in place in the United States that would restrict private research from moving forward with this.
BTR: That's a bit unsettling, isn't it?
EH: Yeah! I think it is, but at the same time, the technology is not that close. At least not for the really frightening scenarios, like changing people's eye colors. Many of these traits have so many genetic and non-genetic causes that it's going to be very difficult to engineer them.
CRISPR still has a lot of bugs that need to be addressed. While people have been working to optimize that aspect of it, it's too narrow of us to focus on the immediate technical efficiency of this tool. Rather, we should be questioning, what is it that we still do not know about the human genome? We should not proceed with something so permanent, particularly right now, when there's still so much that we need to learn.
BTR: Especially with such immense repercussions for social inequity hanging in the balance.
EH: Definitely. I think it's really important to consider that most of these exciting new fields in biomedicine take billions and billions of dollars in research and development. By the time you ever get a gene therapy that's effective in humans--that could actually help people--it costs $500,000 a person, or even $1 million a person.
This is very concerning for me from a justice perspective, thinking about who can afford these treatments. Will the only treatments we develop be those that suit the needs of the rich, since they will be the only ones who can afford them?
It opens the door to a new level of thinking of ourselves as being defined by our genes, or defined by our DNA, or defined by our bodies, and it does so in a way that's incredibly limiting to the human spirit and to our ability to cooperate with people as a human society.
Image via Pixabay
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