7 ms·

We would need a very particular set of conditions for embryonic editing to be justifiable under a medical dogma that aims to "do no harm." Both parents would ne

by eggie 9y ago

We would need a very particular set of conditions for embryonic editing to be justifiable under a medical dogma that aims to "do no harm." Both parents would need to carry a large common set of recessive deleterious alleles, as this would make embryonic selection of non-carriers very difficult. Then we would need the editing system to be so reliable as to not introduce off-target mutations. In a preimplantation setting, we can't easily observe if non-desired mutations have been introduced in some cells, as this would require sequencing every cell in the developing embryo. Serious disease introduced through chimeric errors in the editing process would be a real possibility, and there is no feasible way we could guard against this result using sequencing as it would require destruction of the embryo. A more realistic scenario would be to develop a human embryonic stem cell culture that has been edited as desired and then implant this into a developing blastocyst at a point at which it would take over the and develop into the fetus. This is done with mice and there is no reason it wouldn't work for humans. I think that most people would find this much more abhorrent than directly editing the germline. However, it would be much safer for the engineered proband and would not require a "perfect" editing system that we do not have.

deleted 9y ago
[deleted]
alextheparrot 9y ago
I'm not certain where the premise that our medicine must "Do no harm" comes from. Chemotherapy, for example, is known for being extremely toxic and harmful, yet the justification is that it often yields better outcomes than no treatment. Why can we not use the same justification for editing DNA? Honestly some therapies cause mutations by design, as some cancers are less capable of DNA repair. I do see one argument, hinging on the difference between an embryo and an adult aged many years. If your argument is that better techniques may exist at the embryonic stage, then I submit to the medical community to ascertain the appropriate course. However, I don't think offsite mutations pose a significant enough risk that one can say that, on aggregate, gene editing won't "do some good".
- chiefalchemist 9y ago
  "Do no harm" speaks to intent, as in harm can't be the intent. Making great discoveries doesn't justify doing harm. Mengele (the Nazi) comes to mind.
- JeffreyKaine 9y ago
  Where it comes from: https://en.wikipedia.org/wiki/Hippocratic_Oath https://en.wikipedia.org/wiki/Hippocratic_Oath
  - Dylan16807 9y ago
    But in that sense it's not literal at all. Again, chemotherapy.
    - robotresearcher 9y ago
      And surgery, and injections, and stitching wounds, etc. Obviously it's net harm, not no harm at all.
      - pryce 9y ago
        It's not simply 'net' harm, as we would regard surgeons as breaking this principle, if they were to murder a homeless man and distribute his organs to 5 otherwise terminal patients. Medical ethics is its own field precisely because overeager and overconfident solutions are fraught with problems.
        aethertron 9y ago
        If the principle is understood to be applicable with regard to each individual, that would seem to accord with opposition to organ theft.
        Double_a_92 9y ago
        net harm per person then :D But what about if somebody donates a kidney...? Hm
kazinator 9y ago
> Both parents would need to carry a large common set of recessive deleterious alleles, ... And, for the time being, bags and bags of money! Which currently makes this a vanishingly hypothetical problem of ethics.
- vitus 9y ago
  We saw this combination historically in European royalty, which was plagued by inbreeding. One particularly well-known instance: https://en.wikipedia.org/wiki/Haemophilia_in_European_royalty https://en.wikipedia.org/wiki/Haemophilia_in_European_royalt... As for more modern times, surely the wealthy are especially cognizant of genetics, right? "Historically, populations of Qatar have engaged in consanguineous relationships of all kinds, leading to high risk of inheriting genetic diseases. As of 2014, around 5% of the Qatari population suffered from hereditary hearing loss; most were descendants of a consanguineous relationship." -- https://en.wikipedia.org/wiki/Inbreeding#Prevalence https://en.wikipedia.org/wiki/Inbreeding#Prevalence
  - mhalle 9y ago
    The hemophilia example you mention is a relatively weak one (e.g., no hemophiliac and carrier were known to have had offspring). See https://skeptics.stackexchange.com/questions/23648/was-inbreeding-responsible-for-haemophilia-in-royalty https://skeptics.stackexchange.com/questions/23648/was-inbre...
devrandomguy 9y ago
The problem with not editing the germline, is that that could easily be used to implement a DRM scheme. The recipient of this sort of editing might have a very high chance of only producing disabled or dead offspring, as they themselves would have been, without intervention. They, and their descendants, would have to procure this same treatment in order to procreate.
- rubatuga 9y ago
  I can’t imagine anybody in their right mind would create a genome that had a DRM. Furthermore, would you sign up for a procedure like that? Also it’s a violation of somebody’s human rights to stop them from reproducing! What is really happening is that normal copies of the human genome are being incorporated. Which are then passed on to your sperm/ovum.
  - abecedarius 9y ago
    It's already done for some genetically-modified crops. I don't know about the state of practice for animals.
    - yohui 9y ago
      While the technology exists, so-called "terminator genes" have not been implemented due to opposition from anti-GMO activists and other groups: https://en.wikipedia.org/wiki/Genetic_use_restriction_technology https://en.wikipedia.org/wiki/Genetic_use_restriction_techno...
      - abecedarius 9y ago
        Huh, thanks for the correction.
      - e12e 9y ago
        On the other hand, if you make a fish-pig that lives off algae and tastes like bacon, perhaps "terminator genes" is a sensible protection to avoid accidental destruction of the biosphere? (The "terminator genes" could end up going both ways in terms of containing engineered species).
rubatuga 9y ago
The medical dogma never comes down to do no harm, at least today. The Hippocratic oath is largely symbolic today. The main goal of a physician is to ensure the well being of their patient. This means that they will judge the risks/harm to the benefits and make a judgement, and receive informed consent. Anyway what’s abhorrent about the blastulation method? Furthermore, I don’t think there is a need to only let those with a large number of recessive deleterious alleles use it. It should be more open to let people edit the genome of the embryo to remove even one or two dominant or recessive deleterious alleles. There’s no reason that if the technology exists, is safe, and is regulated that it should be only used for people with a huge number of genetic defects. And can’t you just sequence or test one of the cells from the morula stage?
- ethbro 9y ago
  As one of the earlier male in vitro embryos successfully carried to term in the US, I'll claim a unique perspective on the scientific creation of life. As a living, thinking human, I am grateful for everything that was done so that I may live. If the fertility lab had mixed chemicals differently, or deleted a propensity towards colon cancer, or changed my hair color, there's no way in hell I would have mourned my "unborn" mirror self. I would have been just as grateful to be walking and talking and living! The slippery slope isn't on the action, it's on the intent behind the action. Designing blond babies isn't evil. Designing babies susceptible to drug addiction is. So can we please stop with the deification of the default and get on with progress?
  - deleted 9y ago
    [deleted]
  - strgcmc 9y ago
    Designing blond babies because society slightly prefers blonds, takes an implicit preference and makes it explicit. Not everyone will be able to afford all the "premium" upgrades on designing their babies (and you can bet that cosmetic features will be premium). People who can't afford blond babies or cute-nosed babies or skinny babies or w/e the hell the fad is, will find that their children grow up to be second-class citizens. Blond babies might be grateful to be born and not mourn their unborn non-blond selves, but there still exist plenty of less fortunate other babies who do get born non-blond and will suffer as a result.
TheCoelacanth 9y ago
That interpretation of the Hippocratic oath would also forbid cosmetic surgery. Clearly that's not a very widely accepted interpretation.

by eggie 9y ago

deleted 9y ago

[deleted]

alextheparrot 9y ago

I'm not certain where the premise that our medicine must "Do no harm" comes from. Chemotherapy, for example, is known for being extremely toxic and harmful, yet the justification is that it often yields better outcomes than no treatment. Why can we not use the same justification for editing DNA? Honestly some therapies cause mutations by design, as some cancers are less capable of DNA repair. I do see one argument, hinging on the difference between an embryo and an adult aged many years. If your argument is that better techniques may exist at the embryonic stage, then I submit to the medical community to ascertain the appropriate course. However, I don't think offsite mutations pose a significant enough risk that one can say that, on aggregate, gene editing won't "do some good".

chiefalchemist 9y ago
"Do no harm" speaks to intent, as in harm can't be the intent. Making great discoveries doesn't justify doing harm. Mengele (the Nazi) comes to mind.
JeffreyKaine 9y ago
Where it comes from: https://en.wikipedia.org/wiki/Hippocratic_Oath https://en.wikipedia.org/wiki/Hippocratic_Oath
- Dylan16807 9y ago
  But in that sense it's not literal at all. Again, chemotherapy.
  - robotresearcher 9y ago
    And surgery, and injections, and stitching wounds, etc. Obviously it's net harm, not no harm at all.
    - pryce 9y ago
      It's not simply 'net' harm, as we would regard surgeons as breaking this principle, if they were to murder a homeless man and distribute his organs to 5 otherwise terminal patients. Medical ethics is its own field precisely because overeager and overconfident solutions are fraught with problems.
      - aethertron 9y ago
        If the principle is understood to be applicable with regard to each individual, that would seem to accord with opposition to organ theft.
      - Double_a_92 9y ago
        net harm per person then :D But what about if somebody donates a kidney...? Hm

kazinator 9y ago

> Both parents would need to carry a large common set of recessive deleterious alleles, ... And, for the time being, bags and bags of money! Which currently makes this a vanishingly hypothetical problem of ethics.

vitus 9y ago
We saw this combination historically in European royalty, which was plagued by inbreeding. One particularly well-known instance: https://en.wikipedia.org/wiki/Haemophilia_in_European_royalty https://en.wikipedia.org/wiki/Haemophilia_in_European_royalt... As for more modern times, surely the wealthy are especially cognizant of genetics, right? "Historically, populations of Qatar have engaged in consanguineous relationships of all kinds, leading to high risk of inheriting genetic diseases. As of 2014, around 5% of the Qatari population suffered from hereditary hearing loss; most were descendants of a consanguineous relationship." -- https://en.wikipedia.org/wiki/Inbreeding#Prevalence https://en.wikipedia.org/wiki/Inbreeding#Prevalence
- mhalle 9y ago
  The hemophilia example you mention is a relatively weak one (e.g., no hemophiliac and carrier were known to have had offspring). See https://skeptics.stackexchange.com/questions/23648/was-inbreeding-responsible-for-haemophilia-in-royalty https://skeptics.stackexchange.com/questions/23648/was-inbre...

devrandomguy 9y ago

The problem with not editing the germline, is that that could easily be used to implement a DRM scheme. The recipient of this sort of editing might have a very high chance of only producing disabled or dead offspring, as they themselves would have been, without intervention. They, and their descendants, would have to procure this same treatment in order to procreate.

rubatuga 9y ago
I can’t imagine anybody in their right mind would create a genome that had a DRM. Furthermore, would you sign up for a procedure like that? Also it’s a violation of somebody’s human rights to stop them from reproducing! What is really happening is that normal copies of the human genome are being incorporated. Which are then passed on to your sperm/ovum.
- abecedarius 9y ago
  It's already done for some genetically-modified crops. I don't know about the state of practice for animals.
  - yohui 9y ago
    While the technology exists, so-called "terminator genes" have not been implemented due to opposition from anti-GMO activists and other groups: https://en.wikipedia.org/wiki/Genetic_use_restriction_technology https://en.wikipedia.org/wiki/Genetic_use_restriction_techno...
    - abecedarius 9y ago
      Huh, thanks for the correction.
    - e12e 9y ago
      On the other hand, if you make a fish-pig that lives off algae and tastes like bacon, perhaps "terminator genes" is a sensible protection to avoid accidental destruction of the biosphere? (The "terminator genes" could end up going both ways in terms of containing engineered species).

rubatuga 9y ago

The medical dogma never comes down to do no harm, at least today. The Hippocratic oath is largely symbolic today. The main goal of a physician is to ensure the well being of their patient. This means that they will judge the risks/harm to the benefits and make a judgement, and receive informed consent. Anyway what’s abhorrent about the blastulation method? Furthermore, I don’t think there is a need to only let those with a large number of recessive deleterious alleles use it. It should be more open to let people edit the genome of the embryo to remove even one or two dominant or recessive deleterious alleles. There’s no reason that if the technology exists, is safe, and is regulated that it should be only used for people with a huge number of genetic defects. And can’t you just sequence or test one of the cells from the morula stage?

ethbro 9y ago
As one of the earlier male in vitro embryos successfully carried to term in the US, I'll claim a unique perspective on the scientific creation of life. As a living, thinking human, I am grateful for everything that was done so that I may live. If the fertility lab had mixed chemicals differently, or deleted a propensity towards colon cancer, or changed my hair color, there's no way in hell I would have mourned my "unborn" mirror self. I would have been just as grateful to be walking and talking and living! The slippery slope isn't on the action, it's on the intent behind the action. Designing blond babies isn't evil. Designing babies susceptible to drug addiction is. So can we please stop with the deification of the default and get on with progress?
- deleted 9y ago
  [deleted]
- strgcmc 9y ago
  Designing blond babies because society slightly prefers blonds, takes an implicit preference and makes it explicit. Not everyone will be able to afford all the "premium" upgrades on designing their babies (and you can bet that cosmetic features will be premium). People who can't afford blond babies or cute-nosed babies or skinny babies or w/e the hell the fad is, will find that their children grow up to be second-class citizens. Blond babies might be grateful to be born and not mourn their unborn non-blond selves, but there still exist plenty of less fortunate other babies who do get born non-blond and will suffer as a result.

TheCoelacanth 9y ago

That interpretation of the Hippocratic oath would also forbid cosmetic surgery. Clearly that's not a very widely accepted interpretation.