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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

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.
  - Nihilartikel 9y ago
    Not everyone will be able to afford it until a robust private financing infrastructure and means based state or federal subsidy program is instituted!
  - ghurtado 9y ago
    All of your arguments could apply to cosmetic surgery just as well. I don't agree with your wholesale assertion that all of those who are unable to afford cosmetic surgery (larger breasts, hair implants...) are suffering, however.
    - strgcmc 9y ago
      Cosmetic-only editing is pretty analogous to cosmetic surgery, I grant you that. But if cosmetic surgery made you smarter, then clearly all who couldn't afford it would suffer (relative to those who could). We don't worry about that because cosmetic surgery doesn't have that potential (or does it? I dunno), but with gene editing I think it's a very real potential. That's not to say I'm wholesale against it, nor would I support banning research or anything along those lines. But I think it's clear that it will be a huge shock to society if/when this becomes practical, and I don't think our society is particularly good at dealing with this kind of change that can only exacerbate existing issues of inequality.
      - ghurtado 9y ago
        Completely agree. Let's hope that as a civilization we have enough sense to sort out making it available to everyone by then, at minimum in the most obvious areas (preventing disease, avoiding birth defects, etc...)
- LeifCarrotson 9y ago
  > So can we please stop with the deification of the default and get on with progress? Well said! I fear, though, that a problem with this admonition is that some ascribe the default state to a deity. However, I'm not sure that the characteristics you mentioned are of the same quality. Hair color, gender, and other traits are neutral in quality - especially if there's risk in the procedure, it would seem wrong to select these superficial changes to fit the parents' preference. And while it would be nice to look into the future and determine what the human being created would prefer, we can't do that. A propensity towards colon cancer or a propensity towards drug addiction being added or removed would be another class of traits, having a quality based on removing observed defects. I imagine this class is the most likely to be experimented with first. The third class would be traits which are relative to baseline humans. Increasing intelligence, perhaps, would be the change that could most universally be described as an unalloyed positive change. What hypothetical future human would mourn their unborn mirror self and wish they were less intelligent? Perhaps the acuity of their vision and other senses would also be desirable. You might also consider changing aspects such as their respiratory or cardiovascular capacity - some humans like Chris Froome or Michael Phelps are extraordinary examples of not just training but innate talent, and wouldn't it be nice if we went beyond reducing the risk of heart disease to make everyone innately talented at breathing? And then you get into issues like whether or not to make them stronger (who's healthier, Froome or Phelps?), or taller, or more good looking (who decides what that looks like?). It would be great if we could help our kids be healthier. And I (and most people) would like it if my parents had made me smarter. But the technology opens the door to dangerous possibilities.
  - ethbro 9y ago
    Every technology ever has opened the door to dangerous possibilities. Caution is merited, but inaction carries culpability in the preventable negative outcomes solved in a potential future that we deny through fear. And not disagreeing with your content, as I agree and think it's well written, but statements like "nice to look into the future and determine what the human being created would prefer, we can't do that" are part of what doesn't parse with me about this debate. As with the anthropic principle, life has no a priori preferences. It becomes and then it is. Before it is, it doesn't want anything. After it is, it wants to be as it is. Because what is it is its identity. There's a caveat for physical disabilities, and yes, that's a slippery slope as you've outlined. But how could one want to be another? If I told you that I could make you smarter, right now, with 100% certainty and safety, but that afterwards... you wouldn't be you as you are now... would you say yes? Possibly, but I feel there's a certain inherent unease with that question. What happens to me if I become other? My point being that this works in reverse too. If I am now as I was made, how would I feel about the choices made in my making? My assertion is that I wouldn't particularly care, because I am the result. So to wish otherwise would be to wish for the termination of my current identity. If there's a debate to be had, then let it be one the social or individual merits of the actual change sought, rather than in making changes or not.
- eli_gottlieb 9y ago
  As a five-time would-have-been infant mortality case, I emphatically agree with you. Mastering our environment and ourselves to turn them towards our purposes rather than their mere natural flow is what being human is. That's how our species rolls! Besides which, the Neolithic Revolution was 10,000 years ago if some damned primitivist really wants to make appeals to the natural order, rather than to the potential benefits and detriments to human health and happiness.
eggie 9y ago
> This means that they will judge the risks/harm to the benefits and make a judgement, and receive informed consent. We should remember that it's not just the individual whose genome is edited that may be harmed, but all of their descendants. > And can’t you just sequence or test one of the cells from the morula stage? This isn't sufficient. It has been observed (in mice) that editing the germline by directly editing the embryo will result in chimerism in the fetus. This happens because the editing is not 100% efficient in one cell division. So while some cells have the desired modification, others do not, while others still have completely different off-target edits. The resulting fetus may have the right edits in most cells, but the wrong ones in some particular tissue. It could be perfectly healthy except that it carries some alleles that are lethal when they occur in the liver, heart, or brain. It is impossible to avoid this by sequencing a single cell from the blastocyst, and probably it can't be avoided by sequencing any small number of cells. > 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. This technique does not appear to be safe, and it is not easy to control. If it were, I'd think it would be pretty cool. But, I don't see how we could do one-step editing with many edits unless the efficiency of the editing process is ~100%. And, given that the technique involves cutting the genome and hoping that the repair systems of the cell correct the cuts to templates that we've provided, it is very unlikely that it ever will be, because much of the editing process is outside of our control. I look forward to another editing technique that is more precise. Or, to growing humans from cell culture. Both of these methods would provide the precision and safety that is required.
- LeifCarrotson 9y ago
  > It has been observed (in mice) that editing the germline by directly editing the embryo will result in chimerism in the fetus. This is an implementation detail to be overcome, not a problem with the general concept. And this study seems to have overcome it. > The earlier Chinese publications, although limited in scope, found CRISPR caused editing errors and that the desired DNA changes were taken up not by all the cells of an embryo, only some. That effect, called mosaicism, lent weight to arguments that germline editing would be an unsafe way to create a person. > But Mitalipov and his colleagues are said to have convincingly shown that it is possible to avoid both mosaicism and “off-target” effects, as the CRISPR errors are known.

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.
- Nihilartikel 9y ago
  Not everyone will be able to afford it until a robust private financing infrastructure and means based state or federal subsidy program is instituted!
- ghurtado 9y ago
  All of your arguments could apply to cosmetic surgery just as well. I don't agree with your wholesale assertion that all of those who are unable to afford cosmetic surgery (larger breasts, hair implants...) are suffering, however.
  - strgcmc 9y ago
    Cosmetic-only editing is pretty analogous to cosmetic surgery, I grant you that. But if cosmetic surgery made you smarter, then clearly all who couldn't afford it would suffer (relative to those who could). We don't worry about that because cosmetic surgery doesn't have that potential (or does it? I dunno), but with gene editing I think it's a very real potential. That's not to say I'm wholesale against it, nor would I support banning research or anything along those lines. But I think it's clear that it will be a huge shock to society if/when this becomes practical, and I don't think our society is particularly good at dealing with this kind of change that can only exacerbate existing issues of inequality.
    - ghurtado 9y ago
      Completely agree. Let's hope that as a civilization we have enough sense to sort out making it available to everyone by then, at minimum in the most obvious areas (preventing disease, avoiding birth defects, etc...)
LeifCarrotson 9y ago
> So can we please stop with the deification of the default and get on with progress? Well said! I fear, though, that a problem with this admonition is that some ascribe the default state to a deity. However, I'm not sure that the characteristics you mentioned are of the same quality. Hair color, gender, and other traits are neutral in quality - especially if there's risk in the procedure, it would seem wrong to select these superficial changes to fit the parents' preference. And while it would be nice to look into the future and determine what the human being created would prefer, we can't do that. A propensity towards colon cancer or a propensity towards drug addiction being added or removed would be another class of traits, having a quality based on removing observed defects. I imagine this class is the most likely to be experimented with first. The third class would be traits which are relative to baseline humans. Increasing intelligence, perhaps, would be the change that could most universally be described as an unalloyed positive change. What hypothetical future human would mourn their unborn mirror self and wish they were less intelligent? Perhaps the acuity of their vision and other senses would also be desirable. You might also consider changing aspects such as their respiratory or cardiovascular capacity - some humans like Chris Froome or Michael Phelps are extraordinary examples of not just training but innate talent, and wouldn't it be nice if we went beyond reducing the risk of heart disease to make everyone innately talented at breathing? And then you get into issues like whether or not to make them stronger (who's healthier, Froome or Phelps?), or taller, or more good looking (who decides what that looks like?). It would be great if we could help our kids be healthier. And I (and most people) would like it if my parents had made me smarter. But the technology opens the door to dangerous possibilities.
- ethbro 9y ago
  Every technology ever has opened the door to dangerous possibilities. Caution is merited, but inaction carries culpability in the preventable negative outcomes solved in a potential future that we deny through fear. And not disagreeing with your content, as I agree and think it's well written, but statements like "nice to look into the future and determine what the human being created would prefer, we can't do that" are part of what doesn't parse with me about this debate. As with the anthropic principle, life has no a priori preferences. It becomes and then it is. Before it is, it doesn't want anything. After it is, it wants to be as it is. Because what is it is its identity. There's a caveat for physical disabilities, and yes, that's a slippery slope as you've outlined. But how could one want to be another? If I told you that I could make you smarter, right now, with 100% certainty and safety, but that afterwards... you wouldn't be you as you are now... would you say yes? Possibly, but I feel there's a certain inherent unease with that question. What happens to me if I become other? My point being that this works in reverse too. If I am now as I was made, how would I feel about the choices made in my making? My assertion is that I wouldn't particularly care, because I am the result. So to wish otherwise would be to wish for the termination of my current identity. If there's a debate to be had, then let it be one the social or individual merits of the actual change sought, rather than in making changes or not.
eli_gottlieb 9y ago
As a five-time would-have-been infant mortality case, I emphatically agree with you. Mastering our environment and ourselves to turn them towards our purposes rather than their mere natural flow is what being human is. That's how our species rolls! Besides which, the Neolithic Revolution was 10,000 years ago if some damned primitivist really wants to make appeals to the natural order, rather than to the potential benefits and detriments to human health and happiness.

eggie 9y ago

> This means that they will judge the risks/harm to the benefits and make a judgement, and receive informed consent. We should remember that it's not just the individual whose genome is edited that may be harmed, but all of their descendants. > And can’t you just sequence or test one of the cells from the morula stage? This isn't sufficient. It has been observed (in mice) that editing the germline by directly editing the embryo will result in chimerism in the fetus. This happens because the editing is not 100% efficient in one cell division. So while some cells have the desired modification, others do not, while others still have completely different off-target edits. The resulting fetus may have the right edits in most cells, but the wrong ones in some particular tissue. It could be perfectly healthy except that it carries some alleles that are lethal when they occur in the liver, heart, or brain. It is impossible to avoid this by sequencing a single cell from the blastocyst, and probably it can't be avoided by sequencing any small number of cells. > 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. This technique does not appear to be safe, and it is not easy to control. If it were, I'd think it would be pretty cool. But, I don't see how we could do one-step editing with many edits unless the efficiency of the editing process is ~100%. And, given that the technique involves cutting the genome and hoping that the repair systems of the cell correct the cuts to templates that we've provided, it is very unlikely that it ever will be, because much of the editing process is outside of our control. I look forward to another editing technique that is more precise. Or, to growing humans from cell culture. Both of these methods would provide the precision and safety that is required.

LeifCarrotson 9y ago
> It has been observed (in mice) that editing the germline by directly editing the embryo will result in chimerism in the fetus. This is an implementation detail to be overcome, not a problem with the general concept. And this study seems to have overcome it. > The earlier Chinese publications, although limited in scope, found CRISPR caused editing errors and that the desired DNA changes were taken up not by all the cells of an embryo, only some. That effect, called mosaicism, lent weight to arguments that germline editing would be an unsafe way to create a person. > But Mitalipov and his colleagues are said to have convincingly shown that it is possible to avoid both mosaicism and “off-target” effects, as the CRISPR errors are known.