BioSpace covers the Intelligence Squared U.S. debate: Will gene editing enable a healthier, more diverse, more equitable population, or will it create market-born eugenics and a dystopian society?
How and when to use gene editing is a pivotal question as society contemplates the future of precision medicine. What type of society do we want? Will gene editing enable a healthier, more diverse, more equitable population, or will it create market-born eugenics and a dystopian society characterized by genetic haves and have-nots?
Those questions were discussed at a private Intelligence Squared U.S. debate. (You can view it now online.) Arguing in favor of using gene editing to make better babies were George Church, geneticist and founder of the Personal Genome Project, and Amy Webb, futurist and author of The Genesis Machine. Arguing against the use of gene editing for that purpose were Françoise Baylis, philosopher and author of Altered Inheritance, and Marcy Darnovsky, policy advocate and executive director of the Center for Genetics and Society.
None defined what is meant by “better babies.” Distinctions were generally ignored between germline – heritable – genetic changes and somatic changes that would affect only the person being treated.
In opening the debate, Church said, “Yes. We should use gene editing to make better babies. Of course things could go wrong,” but he advocated for regulating gene editing so that the benefits outweigh the potential harm caused by such things as off-target effects, high costs and high unknown impacts.
“Do we approve of gene editing that’s already happening, such as CAR T therapy or mRNA vaccines which, via maternal antibodies, protect babies?” he asked. He hypothesized that gene editing could make society more resistant to side effects, “like chimpanzees, which are resistant to HIV and would be a big step to equitable access. Gaucher disease and Rett syndrome should be sufficient to settle the debate.
“Rather than ban gene editing, we should encourage a culture of whistleblowing,” based upon laws for ethical cautious gene editing to make better babies, Church said.
Darnovsky, focusing on heritable, germline editing, countered Church’s argument. “My strong belief is that using gene editing this way is wrong and dangerous. It would be wildly unsafe for those babies and would exacerbate our social and economic inequalities.”
She said parents who carry harmful genetic variants have other options to ensure those genes aren’t passed to their children. Embryo screening and selection, and reproduction using donated eggs or sperm are viable, safe options. “Those options raise questions, too,” she admitted, “but gene editing would amplify those concerns many times over.”
For example, “The perception that gene-edited children are better than others would make inequalities much, much worse,” she said, “leading to a Gattaca-like world of haves and have nots. Reproductive gene editing would be driven not by government policy – like early 20th-century eugenics – but by commercial concerns and peer pressures on parents. Therefore, use gene editing to treat people who are sick, not to design babies.”
Webb disagreed. “There is no evidence to support the claim that gene editing will benefit the wealthy specifically, and there is ample evidence to support the contrary.”
She said, “The natural world is riddled with errors and mutations…and gene editing lets us correct that. It could make us less vulnerable to the approximately 1,500 species of known pathogen. The survival of our species requires intervention. We are part of a huge ecosystem that’s changing faster than we are, on our own.”
Baylis pointed out the lack of definition of the term ‘better.’ In some sense, what constitutes ‘better’ is a fad. It changes. So why should we spend time, talent and treasure on a reproductive goal of building better humans when the resources to invest in science are limited. There are better things we could do with our time, talent and treasure.”
One argument proponents of gene editing espouse is that humanity uses enhancements regularly, Baylis pointed out, but “Gene engineering is fundamentally different. This is tinkering with the elements of human life.” Engineering humans to survive in a different world, whether that’s a heavily polluted planet or in space, “is a drastic response. Just stop wrecking the planet!” she exclaimed.
Baylis presented the potential health enhancement benefits of gene editing as a gateway to functional or cosmetic enhancements. “The world shows us that many people can’t get access to basic healthcare, so why would you think gene editing would be different?” she asked.
Church preferred to focus on the ways gene editing could go right and cited the development of inexpensive vaccines as an example of cost-effective, equitable distribution.
Baylis brought up the specter of genetic determinism as a possible negative outcome of gene editing and, with it, the loss of experiences and challenges that shape us as humans. “We are each frail and fallible and need to embrace building a world of tolerance and diversity,” she said.
“Using gene editing to produce vaccines (or somatic variations) is very different than making changes in future generations. They are apples and oranges,” Darnovsky stressed.
Globally, 70 countries have passed laws against gene editing for heritable alterations, Darnovsky said.
Webb suggested that could change. “The German Ethics Council has started to imagine a future in which regulated germline editing is beneficial. We have left our evolution up to chance and now we have an opportunity to think differently.”
The past is not prologue. “We don’t have enough evidence gene editing will take a dystopian route. We all agree there’s danger here, but there’s also opportunity. We need to come to the table and sort out the regulations,” she continued.
While panelists agreed on the need for well-conceived regulations, Baylis said, “I worry there is a certain hubris associated with gene editing. How do you get the confidence you won’t make a mess of things? It could really go off the rails.”
Webb continued to hold hope for a more equitable future. “For gene editing to occur at scale would take genomic databases that are orders of magnitude larger than we have today. It would need more people to agree to have their genome sequenced and to participate in studies. The databases today are mostly comprised of Caucasians from wealthy countries.”
“You’re making our point,” Baylis pointed out.
“If we take a much longer view, we have the opportunity to bring inclusivity into the process,” Webb countered.
The debaters, both for and against the use of gene editing to make better babies, want to improve future quality of life, but differ on the role gene editing should play in creating a healthier, diverse and equitable future. What’s clear is that the debate will continue for some time.
Author’s Note: Before and after the debate, viewers voted on whether they did or did not agree with the premise that gene editing should be used to make better babies. Initially, 36% agreed, 47% disagreed and 17% were undecided. After the debate, 36% agreed, 55% disagreed, and 9% were undecided. The voting will be open until February 24th so subsequent viewers may vote.
