We have had Biotechnology as one of SAMI’s main global Drivers of Change for many years. The invention of the genome editing tool CRISPR/Cas-9, which won its inventors the Nobel prize in 2020, has super-charged the field, with myriad applications in food and agriculture, and medicine. But this headlong rush into innovations has started to raise ethical and regulatory questions, just as Genetically Modified Organisms did some years ago. Currently the EU classifies genome-editing in the same way as GM, whereas the UK – in a Brexit departure – has chosen not to.
Regulators will need to get to grips with the issue. Experience has shown, though, that the the general public also has a view on the ethics of the whole thing, and needs opportunities to both hone and express that view.. A new exhibition at the Crick Institute, Cut+Paste, aims to move this discussion along. Helpfully, it also has an online version that includes the same content as the in-person one.
The exhibition aims to collect views on 6 major applications of genome editing.
But rather than dive straight in, the exhibition takes the visitor through a briefing on the science and some questions. These are not just informative and educational, but also engaging and stimulating, asking people to think about the issues from a personal perspective.
The exhibition opens with the provocative question “genome editing has the power to shape the future – whose vision should it be?”, elegantly drawing the visitor in. It’s a pertinent question too in the light of the fact that five agricultural biotechnology corporations controlled most of the technology needed to develop GM crops, as well as the tissue from which new plants can be grown, for example seeds, plants or leaves.
The second section is a briefing on DNA and the way CRISPR is used to “cut and paste” genes to treat diseases such as cystic fibrosis and develop new ways to fight malaria by editing mosquito genomes. Then visitors are asked which tastes, traits and talents they would like to pass on – love of animals, sense of humour, musicality. While not all of these are driven primarily by genes, their inclusion is a further clever way of widening the appeal.
More interestingly, CRISPR’s applications in treatments of conditions caused by variants in specific single genes are discussed: sickle cell disease and haemophilia B, some inherited forms of sight loss, leukaemia and several other cancers. Although heritable genome editing affecting succeeding generations is not legal in the UK, prospective parents can already examine IVF embryos for ones that have genes signalling disease and implant only those that do not.
This leads the exhibition on to enhancement and “designer babies”. Again, this is currently not legal – and largely not yet technically feasible. This may be most people’s red line. But we do all “enhance” ourselves to some degree: whether it is through education, using drugs such as caffeine to increase alertness, wearing make-up, working out, or cosmetic surgery.
Finally, the visitor is invited to consider the six ethical questions and submit their views.
Should genome editing be used to help solve global health issues?
On the one hand genome edited crops can help prevent diseases, reduce the need for farmed salmon and increase agricultural productivity. On the other it does nothing to address poor diets generally or favour sustainable farming. Genome editing could have many different unintended consequences.
Should genome editing be used to help solve environmental crises, eg with climate-friendly cows?
Farm animals produce around 14.5% of all greenhouse gas emissions. Selective breeding does similar things less effectively, so why not engineer cows that do not emit methane? And we could create drought- or disease-tolerant animals and plants. Alternatively, we could all eat less meat and dairy, and use land for plants and carbon capture more effectively.
Should genome editing be used to cure inherited diseases?
Sickle cell disease is just one of a large number of diseases that could be treated by somatic (non-inheritable) genome editing, improving the quality of life for many. However, it is very expensive and not easily available to the 200,000 to 300,000 children born with the disease in Africa each year.
Should genome editing enhance our minds and bodies?
Gene editing could be used to protect astronauts on flights to Mars from radiation and other hazards. And if drought-tolerant cattle are acceptable, why not drought-tolerant people? What is the line between preventing dementia and improving mental capacity? Using such expensive treatments to give some people greater advantages again increases inequality.
Should genome editing be used on entire species to get rid of infectious diseases?
Gene editing could be used to eliminate certain types of mosquito that carry malaria, saving millions of lives. But what might be the unintended consequences of removing part of the eco-system?
Should we use heritable human genome editing for challenges that could be solved in other ways?
Up until now the exhibition has been very evenly balanced, but here the question as phrased seems to me to be rather loaded. I imagine most people would say that if we could achieve the effect without heritable genome editing then we should. But what if this is the only way known? Would it not then be right to prevent future generations having to live with life-afflicting conditions such as deafness? Disability rights campaigners might argue that we should instead treat the disabled better, but we could do both. Potentially genome editing could move us back into the territory of eugenics and conversion therapy. And as always there could be unintended consequences, and we are in effect treating (unborn) people without their permission. It might mean long-term monitoring of future generations of DNA-edited individuals in case medical problems appear down the line, which would be costly, but mean that innovations could be introduced gradually.
I saw the online version of the exhibition. I thought that overall it is thought-provoking and challenging, and performs the valuable role of allowing people to express an opinion. Of course, those viewing online or attending in person will be a self-selecting group and the results can hardly be taken as representative of the population as a whole. Why not go and have a look and contribute yourself?
The exhibition does quite a good job of thinking through second and third order effects – a valuable futures thinking approach. The arguments about increasing inequalities could be applied to many other areas of medicine, especially as we move towards more personalised treatments. Similarly, arguments about “unintended consequences” could be applied to all scientific advances, admittedly sometimes correctly as with man-made global warming. Tampering with eco-systems is risky; but we have eliminated smallpox and almost eradicated polio – why shouldn’t we use whatever we can to get rid of malaria?
Biotechnology is advancing on many fronts. CRISPR is becoming ever-more powerful with techniques such as prime editing and smaller versions of Cas-9 that can be transported by popular genome therapy vectors to address an even wider range of diseases. Epigenome editing could be even more versatile, in effect dialling a gene’s impact up or down, rather than just switching it on or off.
Away from gene editing, there are advances in laboratory grown meat – already selling well in Singapore. Human organs suitable for transplants can be grown outside the body. Genetically engineered yeasts and bacteria have long been used to produce human insulin.
The Crick Institute’s work in engaging the public is valuable. It points up a number of important questions and reinforces our view about the transformative potential of the technology. Biotechnology will remain one of SAMI’s Drivers of Change across a wide range of potential futures.
Written by Huw Williams, SAMI Principal
The views expressed are those of the author(s) and not necessarily of SAMI Consulting.
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