A “Better Baby” with Gene Editing?

Early this year, about a month after the National Academy of Sciences (NAS) International Summit on Human Gene Editing, STAT and the Harvard School of Public Health conducted a poll of adults in the US on gene editing. Their main finding was that an overwhelming majority of Americans (83%) believe it should be illegal to use gene editing to “improve the intelligence or physical characteristics” of unborn babies. A consensus statement from the summit did not propose new laws but did conclude that it would be “irresponsible to proceed [with germline genetic manipulations] without resolution of safety issues and broad social consensus on application.”View Large Image | View Hi-Res Image | Download PowerPoint SlideStem cell biologist and blogger Paul Knoepfler (The Niche, https://www.ipscell.com/), who describes himself as “a bit of a techno nerd,” is sympathetic with these views but sees it as unlikely that society can stop all scientists from using gene-editing techniques to create “designer babies.” In the preface of GMO Sapiens, the term he uses to describe genetically modified humans, Knoefpler says, “Taking a stab at creation of designer babies today would be wildly unethical and dangerous, but since when has that kind of potential for disaster stopped people in the past from doing crazy stuff”?Knoepfler’s goal in GMO Sapiens is to help educate the public so that the public and scientists can engage in an informed discussion of gene editing of human embryos. He wants his book to be “readable (even enjoyable) for a large, diverse audience.” He accomplishes both goals by eschewing jargon and relying primarily on secondary sources referenced by website addresses, well-selected illustrations, and interviews that he has conducted for publication on his blog. This gives the book a journalistic feel, which offers the advantage of easy reading, but the disadvantages are that his choice of experts to interview can seem somewhat idiosyncratic and follow-up on answers is at times limited. In addition, GMO Sapiens has some typos—which themselves illustrate that book editors make unintentional mistakes, and gene editors will likely be no better.But these are quibbles from a non-techno nerd. Criticisms aside, Knoepfler provides useful and accessible summaries of the public debates that surrounded the introduction of GMO foods, IVF, attempts at human cloning, and our current fascination with mitochondrial replacement. The strongest chapters in this book are devoted to using gene-editing techniques on human embryos to make a “better baby.”What characteristics might parents want to modify with gene editing to produce a “better baby”? Knoepfler suggests some of the usual ones (taller, smarter, more attractive, more muscle mass), but also lists some I hadn’t seen mentioned before, such as “better-behaved,” “glow in the dark,” larger breasts or penises (hopefully not both), permanent “bee-sting” lips, reduced body hair, and fewer moles. He mentions plastic surgery as a precedent for many of these, though I think most physicians would consider surgery to be safer and likely more effective than genetic editing in these contexts.That is not to say Knoepfler favors germline genetic editing for trivial or non-disease-related reasons. As he notes in a section on “practical challenges to making a GMO sapiens,” if you begin your project with an embryo, “you cannot sequence its genome without destroying it, but without sequencing it you do not know your starting point sequence” and thus cannot design a CRISPR system to edit its supposed “mistakes.” There seems no way around this (although readers may want to suggest one), with the possible exception of creating duplicates of the embryo via a cloning technique that can be used for sequencing the genome of the original.This is a safety and human research argument, focusing on the individual child to be and its parents as potential decision makers for the child. The arguments that the NAS Summit implicitly called upon scientists and the public to debate are more fundamental: they deal with implications on the societal and even the species level, since germline modifications will be passed to future generations. Knoepfler introduces these broader issues, and the book gives the casual reader wanting an introduction to the debate a taste of the types of questions being considered, interviewing or describing the views of a number of philosophers as well as a lawyer. It does not, however, delve into a deep analysis of the ethical issues at hand, which may have been deemed beyond the scope of a book targeted at a general audience. While the people interviewed do have expertise in the area, there is little in the way of justification for the views expressed, certainly not enough to decide whether national legislation or even an international treaty is appropriate to outlaw gene editing on human embryos. Germline gene editing, for example, confronts us with old, but unresolved, issues of eugenics, discrimination, inequity, and even the possibility of genetic genocide (should resulting children be significantly different than current members of Homo sapiens). Even in the face of these dangers, there are those who welcome the creation of a new species, sometimes called “transhumanists” or “post-humanists.” They have a right to their views but no right or moral authority, it seems to me, to impose their views on either their children or on the rest of humanity.As a scientist, Knoepfler follows the scientific literature closely, and his observations in two separate chapters provide good case-study illustrations of the complex challenge ahead of those who want global regulation of embryo research. It is well known that Sun-Yat Sen University in Guangdong, China is the site of the first use of CRISPR on human embryos—research that prompted last year’s calls for a moratorium and the NAS Summit. Less well known is that it was also at this university that the first experiment (there was prior clinical application in the US but no real documentation or follow-up) was done on mitochondrial transfer, an experiment that ended disastrously in the death of one fetus and two premature newborns and probably set the field back more than a decade. Effective oversight will, of course, have to include all countries capable of using CRISPR on human embryos, but it will also have to be endorsed and enforced at the local level in institutions like Sun-Yat Sen University.The bottom line is that, if you follow one or more blogs, you should read both this book and Knoepfler’s blog. If you are not a blog person, I recommend reading this book as a good introduction both to the subject matter and to the methodology of a science blogger. The blogosphere will likely play an increasingly central role in airing scientific policy debates, and the “designer baby” debate will require species-level global engagement that will be influenced, if not determined, by blogs and other forms of social media.