CRISPR used to genetically modify viable human embryos for the first time

If we truly want to eliminate disease though it's not enough to cure disorders, sometimes you have to be able to prevent them, and sometimes they're going to be genetic. Not allowing scientists to use every tool in their arsenal is condemning a lot of people to a lot of pain. I agree that humans aren't always going to make the right calls, but us doing our best might be better than doing nothing.

So would it be ethical if it was done in a single payer healthcare system?

We ethically should.

> Doctor: So do you want the $500 edit to ensure your child won't have diabetes. How about the $2,000 Autism edit? Then the gender change edit is to late to perform. We could do artificial semination and guarantee the gender of your child.

That's a straight up violation of the Hippocratic oath and blackmail/racketeering combined. We should enforce it strictly, vigilantly, and put doctors who attempt to do this in jail away for a very long time.

I understand your main argument stems from affordability of the procedure and that's a valid concern, but keep in mind that current societies already ration health care, either by availability/wait times (UK?) or wealth (USA). You won't be able to prevent the wealthy from modifying their offspring anyway and the unfairness of having them do it vs 99% not being able to afford do is not enough of a reason to stop progress, not even close. The goal should be to make this procedure routine, as affordable as an ultrasound or a tooth extraction or a cancer screen.

How do you address this with policy? The same way we should be addressing inequality right now.

Let me posit this question to you: if genetic enhancement would be available to 100% of the population, would you still have ethics concerns?

I am definitely not 100% on board with editing embryos, but income inequality is the weakest possible criticism. You could argue against literally anything on the grounds that it could lead to inequality: IVF, adoption, education, medical care, technology, owning a computer, being on Hacker News.

Just because something is being doled out injustly doesn't mean it shouldn't be doled out at all.

There is something significant about humanity no longer being bound by the tyranny of natural selection. We a species who have the power, however limited, to shape the landscape to our will and desire. Now we can also conquer our own biology. To be this is poetic, utopian even.

>Doctor: So do you want the $500 edit to ensure your child won't have diabetes. How about the $2,000 Autism edit? Then the gender change edit is to late to perform. We could do artificial semination and guarantee the gender of your child.

I don't have a problem with any of that.

It's sad the first comments are always stuff like this. So you want millions of people to suffer genetic diseases because income inequality?

Ethics or not, some country will do this, and they'll leave everyone else behind economically in a few generations.

So instead you're fine with saying "your child will have cystic-fibrosis; she will grow up her entire life unable to breath without pain and likely die before the age 25".

Today rich people pay for better access to care through out all stages of life. That doesn't mean we should ban heart surgery (for example) because the rich can disproportionally afford to get it and catch conditions early enough to treat.

The "natural is ethical" argument disgusts me and I think you really should consider how much we already depend on progress before you argue for going back to the stone ages.

Personally, I think we absolutely should. We know of genetic defects that cause disabilities and by leaving them there through deliberate inaction we essentially inflict a disability on a child. We also prevent potential advancement of our species.

Cost is a terrible reason to prohibit this and your argument can be applied to nearly all other medical procedures. They all cost money and sometimes that makes them inaccessible to people who need them. This is a different problem to genetic modification.

As for your article, going through the "cons" section, it mainly raises things that need to be thought about rather than reasons not to do it. My opinions on a few sections:

- "making irreversible changes [to people and] all their descendants would constitute extraordinarily risky human experimentation": The changes are only irreversible to the first generation, the same process that introduced the change can removed it in the offspring. The change being irreversible isn't alone a good reason to prevent it. Again, there's precedent for this in existing medicine. If a limb or organ has to be removed, that certainly isn't reversible. If there's a choice between my child definitely being born with a known defect and a child maybe possibly being born with an unknown one, I'd likely take the latter. However I do believe we should understand things better before we go making frivolous modifications to hair colour and such without understanding the consequences.

- "By definition, germline gene editing would not treat any existing person’s medical needs": You're going to refuse to treat someone simply because they're not born yet? Again, acting through inaction. The same benefits brought by treating infants are brought by treating them before they exist.

- "Would germline gene editing be justifiable, in spite of the risks, for parents who might transmit an inherited disease? It’s certainly not necessary. [...] They can do [PGD] too [...]": PGD and CRISPR differ in process but as I understand it, not in result, so I don't believe you can say one is okay but not the other. As for the other section here suggesting you can use third-party sperm or eggs, yes, you can. It isn't strictly necessary to use gene modification techniques if you're happy having someone else's child but it still amounts to selecting for desirable traits.

- "PGD itself raises social and ethical concerns about what kind of traits should be selected or de-selected. These questions are particularly important from a disability rights perspective (which means they’re important for all of us).": I'm not sure I quite get the disability rights perspective. I believe this only really applies to people who believe that life begins at conception, who would argue that selecting candidates that don't have a disability over ones that do amounts to some kind of genetic genocide. Personally I don't buy that. Why should we leave things to chance when we can give the parents the choice to do what they think best for their child?

- "From a policy perspective, how would we draw the distinction between a medical and enhancement purpose for germline modification? In which category would we put short stature, for example? We know that taller people tend to earn more money. So do people with paler skins. Should arranging for children with financially or socially “efficient” varieties of height and complexion be considered medical intervention?": Again, there's precedent for this in existing medicine. Treatment for things like dwarfism and albinism are covered as medical procedures while treatments for mild sunburn and not being able to reach the top shelf are not.

Ultimately the article raises a lot of things to think about but I don't believe any of them are good reasons not to pursue genetic modifications to humans at all.

Does anyone really want to give birth to a baby with down syndrome?

Or we could socialize healthcare for all then treat gene edits like this as we do vaccination. We offer only those edits which would prevent chronic and termination disorders in life but leave anything else that's merely socially undesirable like neuroatypic "disorders." I know this suggestion isn't bullet proof, but it's better than letting crackpots do this in the shadowy corners of society creating all kinds of changes which lead to more suffering for the people that would bear these gene edits (I can imagine there being some weirdo rich couples that wouldn't mind turning their future kids into Nosferatus despite the adverse social impact that would have on them).

>We ethically shouldn't do this. We should not edit human embryos.

That ship may have sailed in a society where you can legally kill the embryo or cut 1/3 of the skin off a newborn infant's penis.

Is the gap between rich and poor really so important that we should refrain from curing diseases to avoid making it larger?

Making a rich child immune to diabetes or autism doesn't hurt poor people. It's strictly a net gain.

What's fundamentally different between this and, say, prenatal vitamins or good nutrition? Should we ban women from taking folic acid because it gives an advantage to people who can afford it?

Let's say an in-vitro preventive for diabetes could be developed but is blocked because of concerns about gene editing. That means thousands or millions of children will contract diabetes who wouldn't have if the preventive had been available and will die prematurely. How is that a good thing?

I can sort of buy the arguments for purely cosmetic changes like selecting sex or eye color or whatever. I can vaguely grasp the arguments against selective intelligence or physical strength enhancement. But to refuse to prevent diseases? Why?

Bioethicist like you are literally the worst people on earth.

There is a reason why the initial papers are coming out in China. Granted, China's biotech is young and getting better every year, but there is a cottage industry of trials initiated in China due to laxer review and ethical standards there; a trial like this in the US would have taken years of paperwork to clear the FDA.

Granted... the FDA and other pharmas do spend a lot of time, money and manpower to monitor clinical trials in China because eventually, the pharmas attempt to use these trials, conducted "over there" at lesser costs, to get approval for clinical use in the US through the FDA...

I don't really know what you mean. Genes encode to proteins, if a disorder is genetic it generally means one or more genes are incorrect, encoding to the wrong proteins. If genetic expression was significantly random, how would we identify genetic disorders to begin with? How would they be hereditary?

Yeah, its reminding me more of the ones with bad ending though.

[Potential Spoilers] The society of Gattaca not only embraced germ-line modification, it also created a caste system around genetic viability. The main character was unable to pursue his chosen field because the society decided that people in that field needed to be genetically tailored for that field.

I think our moves toward creating a more pluralized society, where people that have been historically deemed "genetically inferior" (the disabled, non-white people, trans people, women) have made slow and steady gains, are such that erasing that progress would require more changes to society than simply allowing genetic modification.

Genetic engineering an easy scapegoat, a slippery-slope argument that lets us jump too fast to the dystopic ending of our choice. A storyline that reduces societal, intra-personal progress to individual genetic choices is missing a big chunk of the puzzle.

But is diseases really the type of diversity we want though? Some mutation that is generally bad does turn out to be good in some cases [1] but I am still not 100% convinced that the disease causing mutations is diversity that needs to be preserved.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499995/

That sort of sounds like a familial prion disease but really - I don't see that as a legit concern. The enzyme is already present in Strep pyogenes which is practically ubiquitous. A lot of us have that same bacteria colonized in our throats.

I never used CRISPR when I worked in a molecular lab, just a TOL2 system which was pretty cool in its own right. But CRISPR needs a DNA probe (probes are attached to CRISPR to target very specific sequences of DNA for editing) and a way to deliver itself into the cell. I didn't read the paper myself, but I'm guessing they just do a little microinjection of CRISPR into the embryo.

And these gene edits for various hemoglobinopathies (G6PD and thalassemia), while impressive, are very simple. These are very specific mutations that when fixed, should yield a normal/working protein and a healthy phenotype.

There are substantial ethical issues with vaccination as a general thing; there are specific cases where the facts have supporter a fairly broad (though not universal) consensus on the general best approach, but that doesn't change the fact that there are ethical issues in the area of vaccination.

The real ethical concerns are what lies beyond just removing nasty inheritable diseases, which is the possibility for designer babies. But also the possibility for weaponizing CRISPR, either to create nasty viruses, or make a gene editing weapon. But beyond all that, it's the worry that a few people get to make a decision that will impact the genes of future generations. And with a gene drive, you could guarantee that all descendants would have the desired modification.

are you kidding. I know tons of asian parents who want blue eyed babies and would pay thousands for it.

FYI: I don't know if English is your first language but you are using commas excessively. All the commas in the first four sentences should be removed and the final comma should be 'of'.

EDIT: Also, the second sentence should be "This should not stop us (humanity)."

Gattaca is a movie filled with terrible science (there is no evidence of a simple gene change for intellectual ability, etc) and characters that are terrible people (NASA today doesn't allow people with heart conditions to go to space, no genetic dystopia required, because having astronauts die in transit is suboptimal to the mission).

I really wish that movie didn't get brought up every time gene therapy makes another advancement.