THE genome is written in an alphabet of just four letters. Being able
to read, study and compare DNA sequences for humans, and thousands of
other species, has become routine. A new technology promises to make
it possible to edit genetic information quickly and cheaply. This
could correct terrible genetic defects that blight lives. It also
heralds the distant prospect of parents building their children to
order.
http://www.economist.com/news/leaders/21661651-new-technique-manipulating-genes-holds-great-promisebut-rules-are-needed-govern-its
The technology is known as CRISPR-Cas9, or just CRISPR. It involves a
piece of RNA, a chemical messenger, designed to target a section of
DNA; and an enzyme, called a nuclease, that can snip unwanted genes
out and paste new ones in. Other ways of editing DNA exist, but CRISPR
holds the promise of doing so with unprecedented simplicity, speed and
precision.

A dizzying range of applications has researchers turning to CRISPR to
develop therapies for everything from Alzheimer’s to cancer to HIV
(see article). By allowing doctors to put just the right
cancer-hunting genes into a patient’s immune system, the technology
could lead to new approaches to oncology. It may also accelerate the
progress of gene therapy—where doctors put normal genes into the cells
of people who suffer from genetic diseases such as Tay Sachs or cystic
fibrosis.

It will be years, perhaps even decades, before CRISPR is being used to
make designer babies. But the issues that raises are already the
subject of fierce discussion. In April scientists in China revealed
they had tried using CRISPR to edit the genomes of human embryos.
Although these embryos could not develop to term, viable embryos could
one day be engineered for therapeutic reasons or non-medical
enhancement.

That is a Rubicon some will not want to cross. Many scientists,
including one of CRISPR’s inventors, want a moratorium on editing
“germ line” cells—those that give rise to subsequent generations.
America’s National Academy of Sciences plans a conference to delve
into CRISPR’s ethics. The debate is sorely needed. CRISPR is a boon,
but it raises profound questions.

The only way is ethics

These fall into two categories: practical and philosophical. The
immediate barrier is practical. As well as cutting the intended DNA,
CRISPR often finds targets elsewhere, too. In the laboratory that may
not matter; in people it could cause grave harm. In someone with a
terrible disease, the risk of collateral damage might be worth
running. But for germ-line applications, where the side-effects would
be felt in every cell, the bar should be high. It may take a
generation to ensure that the technology is safe. Until then, couples
with some genetic diseases can conceive using in-vitro fertilisation
and select healthy embryos.

Moreover, awash though it is with gene-sequence data, biology still
has a tenuous grip on the origins of almost all the interesting and
complex traits in humanity. Very few are likely to be easily enhanced
with a quick cut-and-paste. There will often be trade-offs between
some capabilities and others. An à la carte menu of attributes seems a
long way off. Yet science makes progress—indeed, as gene sequencing
shows, it sometimes does so remarkably quickly. So scientists are
right to be thinking now about how best to regulate CRISPR.

That means answering the philosophical questions. There are those who
will oppose CRISPR because it lets humans play God. But medicine
routinely intervenes in the natural order of things—saving people from
infections and parasites, say. The opportunities to treat cancer, save
children from genetic disease and understand diabetes offer
justification to push ahead.

A harder question is whether it is ever right to edit human germ-line
cells, to make changes that are inherited. This is banned in 40
countries and restricted in many others. There is no reason for a ban
on research or therapeutic use: some countries, rightly, allow
research on human embryos, as long as they are left over from in-vitro
fertilisation and are not grown beyond 14 days; and Britain has
allowed a donor to supply mitochondrial DNA at conception to spare
children needless suffering, even though the change will be passed on.
And CRISPR deals with the objection that germ-line changes are
irrevocable: if genes can be edited out, they can also be edited back
in.

A deeper quandary concerns the use of CRISPR to make discretionary
tweaks to a person’s genome. There comes a point where therapy
(removing genes that make breast cancer or early-onset Alzheimer’s
more likely, say) shades into genetic enhancement. Some might see
being short or myopic as problems that need fixing. But here, too, the
right approach is to be cautiously liberal: the burden is on society
to justify when and why it is wrong to edit the genome.

CRISPR, happier, more productive

It is not too soon to draw on these principles to come up with rules.
Some countries may have gaps in their legislation or poor enforcement,
letting privately funded scientists or fertility clinics carry out
unregulated CRISPR research. The conservative, painstaking approach
taken by Britain’s Human Fertilisation and Embryology Authority in its
decision on mitochondrial DNA is a model. Regulators must also monitor
CRISPR’s use in non-human species. Changing animals’ genomes to spread
desirable traits—mosquitoes that cannot transmit malaria, for
example—could bring huge benefits. But the risk of unanticipated
consequences means that such “gene drives” should be banned unless
they can be reversed with proven countermeasures.

If CRISPR can be shown to be safe in humans, mechanisms will also be
needed to grapple with consent and equality. Gene editing raises the
spectre of parents making choices that are not obviously in the best
interests of their children. Deaf parents may prefer their offspring
to be deaf too, say; pushy parents might want to boost their
children’s intelligence at all costs, even if doing so affects their
personalities in other ways. And if it becomes possible to tweak genes
to make children smarter, should that option really be limited to the
rich?

Thinking through such issues is right. But these dilemmas should not
obscure CRISPR’s benefits or obstruct its progress. The world has
within its reach a tool to give people healthier, longer and
better-quality lives. It should be embraced.

-- 
Avinash Shahi
Doctoral student at Centre for Law and Governance JNU



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