Imagine that you could had the option to improve your reasoning skills and memory, not just with a cup of coffee but by editing your genome. Maybe even beyond that of today’s geniuses.
And what if you could do that for your children?
What if you could improve their likelihood of being resilient to life’s slings and arrows?
Would you want that option?
Not long ago, this was science fiction. But today, gene editing is possible, and recently it has become much easier with new technologies such as genome sequencing and Crispr. These are helping to develop practical, clinical applications.
Of course, intelligence can be used for ill as well as for good but the benefits to society of a world with, for example, better memory and reasoning ability—what we call intelligence---are nonpareil. Virtually all human accomplishment from dishwashing to the iPhone, from curing disease to wise leadership, is enhanced by reasoning ability. If even a modest subset of the world’s population were more intelligent, there would likely be great increases in everything from how the average person resolves disputes to middle managers leading more wisely, from psychologists trying to help someone with depression to scientists developing gene therapies to increase altruism.
Are ethical and safety concerns so great as to mitigate against the potential benefit?
In today's The Eminents interview, I talk with George Church about such questions. He is a professor of genetics at Harvard Medical School and director of the Personal Genome Project, director of the National Institutes of Health Center for Excellence in Genomic Science, and member of the National Academy of Sciences.
MN: First, let's define terms. What is “gene editing for human germline augmentation?”
GC: Let’s take that a piece at a time:
Gene editing is our ability to change any piece of DNA for anything we want, and it has become especially easier over the past three years.
Today, there already are 2,000 clinical trials in which people with a disease are being treated by gene therapy. Gene editing is merely a form of gene therapy in which a medically troublesome piece of DNA is precisely replaced.
Germline therapy means that the gene editing occurs prenatally, so that not only helps the person early, which can be invaluable---an ounce of prevention is worth a pound of cure--but passes on that improvement to others.
Regarding augmentation, we’re so augmented already. We’re unrecognizable to non-technological human tribes—from walking on the moon to GPS.
MN: But it’s the intersection of augmentation with germline that makes people nervous. People worry that affecting future generations’ genomes engenders greater risk than just affecting one person.
GC: We should and do worry and take action for decades to ensure safety and efficacy on every new medical treatment. For example, in the 1970s, in-vitro fertilization was labeled as scary “test tube babies,” tampering with the natural order of things and risking developmental abnormalities. As soon as its good risk/reward ratio was clear in 1978, we accepted it as a matter of course.
Gene editing will likely be the same. We’re already seeing the first signs of people with AIDS and leukemia having their life extended thanks to gene-editing therapy. And with so many animal and human trials underway for years with FDA oversight, on an even broader set of gene therapies, we’re unlikely to be caught unaware of any giant, lurking liabilities.
MN: So the issue comes down to ensuring that the benefit/risk profile is good?
GC: Yes, and ensuring that the benefits of these therapies don’t just accrue to the rich.
MN: Isn’t that simply a matter of covering gene editing under Medicaid and other health care for the poor just as we do with so many other procedures?
GC: Yes for the industrialized nations but we also need to work with researchers in developing nations with technologies even more affordable than vaccines.
MN: But what about augmentation?
GC: Remediation versus augmentation is a subtle distinction. It would be wrong to assert that improvement from the “normal” is unimportant. Is not improving the average human condition a worthy enterprise? It’s less controversial with regard to exceptional resistance to infectious disease, for example, as accomplished with smallpox vaccines. And as gene therapy is enhancing normal resistance to such diseases, we’ll come to accept other sorts of augmentation, including protection from decline of cognitive functioning. The decision to fund research or implement a clinical solution really should come down to whether the risk/reward ratio is good.
MN: Some would say that researchers shouldn’t focus on factors such as intelligence or motivation because they’re too complicated: So many genes are likely involved and those likely interact with myriad environmental factors.
GC: You don’t need to understand all of a problem’s causes before you can intervene For example, we don’t know all the factors affecting human height but we can increase it by using human growth hormone. We don’t know all the factors affecting immunity to a disease. Immunity is affected by thousands of genes plus environmental factors. Yet we can influence immunity by using a vaccine—That enables what would have been seen as superhuman—being able to walk with impunity through a ward of smallpox patients. In fact, almost all medical treatments are for conditions we don’t fully understand.
MN: Do you see the public resisting gene-editing for augmentation for a long time?
GC: Not if we’ve shown a good-enough benefit/risk ratio. For example, we’ve already demonstrated that, in a synthetic biology environment, modifying a single gene improves cognitive functioning in mice. So it’s reasonable to assume we’ll develop gene editing that will be useful in slowing human dementia. If we can show a good benefit/risk ratio in such people, young people will want the therapy for themselves and for their children, prenatally, changing their germline.
MN: Is there a legitimate argument against doing research on germline augmentation, say for intelligence, motivation, and freedom from mental illness?
GC: One valid concern is that we not reduce biodiversity. Most parents might want their child to not have autism, dyslexia, or narcolepsy. But mild, high-functioning such people can be highly contributory to society. But that objection is more of a nuance concern than anything that would outweigh the benefits of human gene-editing for augmentation.
MN: What about the current moratorium on human clinical use of gene editing?
GC: That’s a misconception.There’s no more of a moratorium on that than for any other new medical treatment. Like for all drugs, gene-editing treatment requires a series of clinical trials to prove safety and efficacy. There’s no moratorium, although you may not get government funding.
MN: That puts a pretty big kibosh on such research, no?
GC: Not really. When there was a moratorium on federal funding for stem cell research, states, pharmaceutical companies, and health care entities jumped in with billions of dollars for research. I think the same thing could happen with gene editing. For many new pharmaceuticals, modest federal funding investments (millions of dollars) have to be followed by much larger corporate and hospital investments (billions of dollars.)
MN: Some people associate gene editing with eugenics.
GC: We need to be cautious but the context has changed completely. The eugenics movement involved government-forced sterilizations. Gene therapy is about giving people more choices. Wouldn’t it be unethical, inhumane, to prohibit people with the Tay-Sachs gene from choosing a non-abortion way of addressing the problem, that is, gene editing of sperm or eggs rather than abortion? This is not about forcing parents to do that but about giving them the option after safety and efficacy testing. That’s very different from the forced eugenics employed in many countries including the US and Sweden up until the 1970s.
MN: Okay, then do we have a moral obligation to give people the option to edit their genes to enhance someone’s cognitive function who isn’t retarded but more like the people who appear on Judge Judy? Pushing it further, do we not have a moral obligation to allow prospective parents to edit the genomes of the future children even of the George Churches of the world because the benefits to humankind would, as I said in the introduction to our interview, be so enormous?
GC: If we’re not comfortable with enhancing people’s diverse cognitive abilities with gene therapies, we could also consider banning a wide variety of interventions, ranging from caffeine to advanced education methods. Our active work to reduce cognitive decline in an aging population is likely to produce a wide variety of treatments with unexpectedly broad applicability.
MN: Is there a dilemma George Church is facing?
GC: I worry about dying before my late-blooming prime, but my lab is working on it.