Gene editing: will it make rich people genetically superior?
Gene editing: will it make rich people genetically superior?
By Jeff Bessen Wednesday 15 May 2019 7:01 am
At a time when new technology such as gene editing offers
unprecedented control over our own biology, the latest wave of medical
advances, including powerful DNA-editing technology like CRISPR/Cas9, is a
source of excitement and optimism.
CRISPR works like a genetic scalpel to cut a patient’s
DNA, targeting and repairing genes at risk of disease.
This method of gene editing may one day make certain
diseases – including Alzheimer’s, sickle cell disease, and some forms of cancer
– a thing of the past.
While traditional treatments for chronic illnesses
generally address the symptoms, this offers the potential of a permanent cure
by attacking the disease at the source. Once genetic mutations are removed from
a patient’s cells, the cells can resume normal function for the rest of the
patient’s life.
What are the
ethical concerns surrounding gene editing?
Gene editing technologies are not without controversy –
from ethics to whether it will become a plaything of the super-rich.
One main issue of CRISPR lies in its simplicity, which
means it is easier for unauthorised persons to experiment with the technology.
Already, CRISPR has become a favorite of amateur
‘biohackers’, with one man injecting himself with a homemade cocktail in a
misguided attempt to boost his biceps. Another tried (and failed) to cure
himself of AIDS.
And in late 2018, headlines blared that an ambitious
researcher conducted secret gene editing trials in China, making mutations in
human embryos to protect against HIV and then apparently turning those embryos
into twin babies.
Researchers were aghast at the shoddy science and the
premature use of CRISPR in human patients.
While scientists, ethicists, and regulators have called
for a ban on gene editing research in human embryos until the risks are better
understood, it may be impossible to prevent willing patients and unscrupulous
researchers from experimenting with gene editing in humans.
Especially because when cutting-edge therapies do receive
official regulatory approval, they often carry eye-popping price tags.
How much will gene
editing cost?
Spark Therapeutics plans to charge US patients $850,000
for a gene therapy that treats a rare form of genetic blindness in children.
By some estimates, that’s a bargain: analysts expected a
list price as high as $1 million per patient, or a half million dollars per
eyeball.
There’s little reason to expect that the next approved
genetic therapy will be much cheaper.
In a time when new technology offers unprecedented
control over our own biology while global one per cent-ers seem to be the only
ones who can afford access, is humanity at a crossroads?
Are we headed for a future where those with the means
will be able to purchase genetic superiority, leaving the rest of us behind?
This science-fiction outcome is probably less likely than
you think.
What are the
challenges?
First, even if the ultra-wealthy wanted to purchase a
‘genius gene,’ or one for exceptional athleticism or good looks, there is no
such thing.
While some diseases are caused by a single DNA mutation
and are thus good candidates for gene editing therapies, traits such as
intelligence, height, strength, and longevity are associated with hundreds of
genetic factors, and the influence of any one genetic difference is poorly
understood.
It would be impractical to make more than a handful of
DNA changes by gene editing, and thus far, big data approaches have failed to
surface a short-list of mutations guaranteed to make one smarter, faster, or
taller.
In this case, the complexity of our biology may stand in
the way of humanity’s vainest impulses.
But what if, instead of editing one’s existing genome,
you chemically synthesised one from scratch?
DNA synthesis is the process of chemically stitching
together DNA components in the lab, much like assembling letters in a printing
press. As synthesis technology has increased, so have the ambitions of genome
synthesis projects like the Genome Project-Write. Although the leaders have
sworn off the creation of synthetic human cells, by rewriting certain sequences
of DNA, they hope to make cells resistant to certain viruses. (Full disclosure:
I am a volunteer in the Genome Project-Write organisation.)
In principle, one could use genome synthesis technology
to create replicas of Albert Einstein’s cells.
But, in practice, synthesising the genome for a single
person would consume most of the annual DNA manufacturing capacity of the
entire world.
And the challenges of converting synthetic DNA from the
test tube into a viable fetus are mammoth and remain unsolved.
Suffice to say, even the super wealthy are more likely to
be parented by Mother Nature than Dr Frankenstein.
What impact could
gene editing have on your health?
Significant health risks are likely to accompany any
attempt at gene editing, even using improved tools of the future.
That’s because CRISPR is prone to making unwanted and
unpredictable changes to the genome.
For therapy performed in an embryo, these unwanted
changes would be copied in every cell of the developing baby, including cells
destined to become sperm or eggs.
This is of great concern to bioethicists, who warn that
genetic typos could permanently enter the gene pool.
The risks inherent to gene therapy might be acceptable
for patients with deadly or debilitating genetic diseases, but they should give
pause to prospective parents of ‘designer babies’.
Imagine receiving an injection during pregnancy to give
your child blue eyes or blonde hair, and inadvertently raising his or her risk
of developing cancer.
Consider also the alternatives to gene therapy for
promoting the quality of life for one’s newborn.
Pre-implantation screening of embryos and genetic
screening during pregnancy, already widely available, are safer and more
effective routes to a healthy, happy baby.
Is it likely that
the rich will become genetically superior?
The thing is, the rich need not resort to science-fiction
solutions to surpass their fellow man.
Already, the rich benefit from longer life expectancy due
to better access to quality medical care, healthier food, and less demanding
lifestyles.
Evidence suggests that rising income inequality has
exacerbated the disparities in health outcomes of the rich and the poor.
The most visible manifestation of ‘wealthcare’ may be the
perks offered to hospital VIPs – that is, ‘very important patients.’
In the US, hospitals and private practitioners
increasingly offer concierge programs for donors with deep pockets.
For example, at the Ronald Reagan Medical Center at the
University of California in Los Angeles, the holder of a gold wallet card
enjoys a doctor hotline answered at all hours, no waits for appointments, and
valet car service.
The trade publication Concierge Medicine Today estimates
that 12,000 or more private doctors or hospitals offer such boutique services.
Such access is more than just a convenience. The superior
care and peace of mind offered by such programs amount to real improvements in
health outcomes for the well-to-do. Conversely, poverty and disease can form a
negative feedback loop, in which the sick struggle to work and the poor
struggle to access the services they need.
If anything, the ease of using CRISPR may counteract the
hoarding of healthcare by the wealthy.
Much as cell phones are now widely available to all
socioeconomic classes, widespread access to CRISPR may lower medical costs and
expand access to groundbreaking therapies.
While the future of healthcare may unfold in unexpected
and unpredictable ways, one thing is likely to remain the same: not even riches
will allow you to exceed the constraints of your genetic blueprints.
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