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Preimplantation Genetic Diagnosis: The Who, the What, the Why and the How


 

We need to talk about…CRISPR

21 August 2017

By Giulia Cavaliere

Appeared in BioNews 914

Picture this - it's the last day in the office before the summer holidays, you're already looking forward to some sunshine and warmth (if you are UK-based as I am, you’ll know both are in short supply), email auto-response set, and all ready to go. Then, all of a sudden: the news. The genome editing technique CRISPR has been used to edit human embryos in vitro (see BioNews 911) – and no, not in China, that's so 2015 – now we are talking about the USA.

That was my pre-vacation experience this summer. I clicked on my news feed and read the article in MIT Technology Review with a mixture of scepticism and curiosity – and a fleeting wish that this had not happened just as I was leaving! Intrigue soon won; this genome editing technique promises to be a game-changer in genetic engineering, with potential and actual applications for human embryos in vitro.

The scepticism, my dominant feeling at the time, was motivated by what is all too familiar to someone working in bioethics (or historians, as Professor Nathaniel Comfort at Johns Hopkins University, Maryland notes here).

There is a pattern to how such scientific 'breakthroughs' permeate society. First comes the partially reported (or leaked, as was the case with the MIT Technology Review article) news. Next come the reactions of the scientific and bioethics communities, with some celebrating the coming of a new Enlightenment and others picturing Hitler coming to town - or even appearing in dreams, as CRISPR co-inventor Professor Jennifer Doudna recently revealed (see a review in this week's BioNews). And then, as Professor Comfort says, 'technology settles into a more humdrum life as another useful tool in the biologist's kit.'

When the journal Protein and Cell published the (in)famous article in which a group of Chinese scientists reported using CRISPR on non-viable human embryos in 2015 (see BioNews 799), it sparked calls for both a worldwide moratorium on human germline editing on one hand, and a moral imperative to continue research with genome editing on the other.

Despite these reactions, with calls for a moratorium even preceding the actual publication of the article, it turned out that the 2015 experiments were not exactly what you would call a success. Out of the 86 embryos used in the experiment, the DNA of only 28 embryos was successfully spliced, and only a few contained the replaced genetic material. In addition, the embryos presented a number of 'off-target' mutations. A year later, the HFEA (Human Fertilisation and Embryology Authority) granted a licence to the Francis Crick Institute in London to use genome editing in human embryos for basic research.

But back to the latest CRISPR report. One would think that both negative and positive reactions would be more moderate, and that the latter would wait at least for the actual paper to be published, before announcing that CRISPR had been used successfully. And the definition of that being limited 'off-target' effects and avoidance of mosaicism in the embryos.

With the noteworthy exception of Hank Greely's sobering comment in Scientific American and a handful of others, once again reactions to the news were predominantly eugenics and scary super-babies versus the relief of all human miseries.

This unfolded while I was on holiday and trying to find the right balance between avoiding CRISPR-related news and being too curious to let go. A sudden thought struck me while I was swimming in the fresh water of the Adriatic Sea: maybe is for the best that I am here and not joining the conversation at this point. I have thought about genome editing a great deal in the past months, especially on the ethics of using it in the context of assisted reproduction and as a potential alternative to PGD (preimplantation genetic diagnosis) in the future, if proven safe by basic research. I have thought about it and I am adamant that I must think more, talk more, and especially listen and read more.

But why the rush? Commentaries on genome editing and other emerging biotechnologies seem to imply that there is a fight to be won here and now. That we need now to eradicate all genetic diseases since, as my dear friend and colleague Professor John Harris at Global Health and Social Medicine at King's College London likes to say, 'therapy delayed is therapy denied'. Or, on the contrary, that it is now that we need to stop, build walls, start moratoria and enact bans before it all goes back to eugenics and so-called natural reproduction becomes a thing of the past.

The problem with this rush is that the conversation becomes a fight for the best argument, the one that will win the sophist-CRISPR-prize, rather than a constructive conversation that takes into account the competing moral views that underpin those arguments, the importance of the details, the context, of listening over speaking, and reflecting over jumping the gun.

Moral psychologists have begun to show that moral judgements are formed automatically and effortlessly thanks to moral intuitions, and that only afterwards does calculating reasoning take place (Greene, Sommerville, Nystrom, Darley, & Cohen 2001; Haidt 2012; Pizarro 2000). This means that when we read about the use of CRISPR to edit human embryos, we immediately and automatically form a moral judgement, and then our calculating reasoning jumps in to find arguments to justify that initial judgement. Moral reasoning, in other words, works as a lawyer that tries to defend the initially formed judgement, rather than as a meticulous judge that collects all the available evidence first (Haidt 2012).

Not only that, we are also much better at finding evidence that supports our initial judgement than finding evidence that may contradict it (what is called 'confirmation bias', Shaw 1996). So, if like me, you think that CRISPR is not the beginning of the end at all, and that we can allow research and then wait to see what happens, you will be more likely to find the articles that support this (i.e your) view more convincing than others. This is all good as far as it goes. The risk is of constructing opposing camps rather than what research both in science and in ethics is all about: a joint effort to advance knowledge.

Luckily, all is not lost. We can change our mind, refine our intuitions, and we can try to resist the urge of camp-forming. What can help us is what moral psychologist Professor Jonathan Haidt at New York Stern Business School calls social persuasion. We can be persuaded and we can refine our initial intuitions thanks to the influence of others. But while we have to keep our ears and hearts sufficiently open, others have to present their arguments and views in such a way that does not erect walls, but builds bridges. A way that tries to engage with a (possibly different) view rather than quickly dismiss it.

As bioethicists, I believe we have a responsibility to join forces in order to favour these conversations, to present arguments that are not trying to be conclusive, but to be open. And we need to start all this right now. That's about the only rush that I feel comfortable endorsing.​

SOURCES & REFERENCES
Science | 14 January 2001
 
Haidt, J. The Righteous Mind: Why good people are divided by religion and politics
Pantheon, New York | 2012
 
Journal for the Theory of Social Behaviour | 12/2000
 
Thinking & Reasoning | 1996
 

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