Biotechnology, Blogging, Book review., Books, California Proposition 71, CRISPR-Cas9, Democracy, Gene Therapy, Genetic-Modification, Genetics, Human Cloning, Human Genetic Modification, Humanism, In Vitro Fertilisation, Jesse Gelsinger, Libertarian, Libertarianism, Paul Knoepfler, Steven Pinker, Technology
Paul Knoepfler is a scientist and an educator. He conducts research into stem cells and cancer at the University of California’s Davis School of Medicine. He mans a blog about cellular medicine, which manages to be somehow both easier to understand and more in depth than the coverage from most mainstream news sources. His latest book GMO Sapiens: the Life-Changing Science of Designer Babies shows the same talent for communication. In common with any good guidebook, it allows the reader to feel vain at having conquered a forbidding subject.
The reader of GMO Sapiens needs to have acquired the skill of perceiving where the science ends and where the ethics begins. This is, in fact, a very useful skill to have more generally.
For example, Professor Stephen Hawking told the BBC in 2014 that, “The development of full artificial intelligence could spell the end of the human race.” Although the BBC claimed that this remarkable warning had been delivered by one of the UK’s “most pre-eminent scientists,” Hawking is a theoretical physicist, not an expert about AI. He has an intimate perspective upon cutting-edge AI because, in suffering from near total paralysis, he is utterly dependent upon it. The BBC had obscured the vastness of the gap between Hawking’s specific expertise and his nonprofessional personal feelings.
There is a similar sleight of hand to how global warming is often represented in the media. Climatologists can use their expert knowledge to make predictions about the speed at which the climate is changing. Yet they cannot predict that humans will be unable to adapt to climate change, just as we have adapted to every previous fluctuation in the planet’s climate. Whenever scientists do say this, it is an article of faith and it is not, as it is usually implied, associated in any way with their knowledge.
Knoepfler never attempts to disguise his own beliefs as expertise and slip them in amongst the science lesson. He is scrupulous in highlighting which parts of this book are innocent information and which are his own personal judgments. The latter are made as easy to recognise as those luminescent fish in the GM aquarium. Moreover, such is Knoepfler’s commitment to fairly characterising each side of any debate that I have come to completely reject his own point of view, based solely upon opinions published in his own book and blog. Whilst Knoepfler is demanding a temporary moratorium on human germline editing, I, with my natural libertarian bonhomie, thrill more to the philosopher Steven Pinker’s clarion call of “get out of the way.”
GMO Sapiens is in many respects an emergency book. It is unlikely to survive as a guidebook because GM technology is on such a march that in three years’ time half of this book will be out of date. Knoepfler is warning that the public need to think now and think quickly about humanity’s exact relationship to the human genome. He shows that there are no significant remaining obstacles to the production of GM humans: “We know the human genome sequence, we know how to edit this sequence with relative ease and precision… we can do these genetic modifications in a wide variety of organisms.” The genetic modification of human embryos has reportedly taken place already – the technology is so user-friendly that a laboratory in any relatively undeveloped country can access it.
The evolution of the human race could be no longer determined simply by the random couplings of millions of people. It could be instead consciously planned in laboratories, by scientists who want to “edit” certain diseases out of the metagenome, “improve” the species with gene editing, or even clone deceased humans. And Knoepfler doubts that the public is fully aware of the powers which scientists are steadily obtaining. Our society might not be yet democratic enough for there to be authentic majority control over the future usage of these powers. The destiny of humanity could be decided over the coming years and decades, by people who you have never heard of, let alone voted for.
The GM revolution might be comparable in its magnitude to the development of the internet. The public gradually fell in with this, shaping the web’s development through their responses as consumers. Knoepfler thinks, however, that human GM is too dangerous for it to develop in such an anarchic way. The public, for him, should actively decide which products are put before them, rather than passively reacting to whatever appears on the market.
Pitching human GM into US politics might provoke exactly the same noisy culture war as the endless, now ritualised, head-buttings over abortion. Those entering the debates on abortion are soon stranded with totally irreconcilable viewpoints, and human GM is surely bound to generate the same incommensurability. Still, Knoepfler is based in California, which had in 2004 voted to enact Proposition 71, a law which makes stem cell therapy a constitutional right. In this debate, prominent Republicans had switched sides, the public had had the savvy to come to the right decision in the end, and the result was an inspiring advertisement for what modern democracy can do. Proposition 71 doubtlessly informs Knoepfler’s confidence in his educational mission. He wants scientists to be socially engaged; to come out and argue for their own research with the correct mixture of leadership and understanding.
In 1999 the new and experimental field of gene therapy was in search of a breakthrough, but Jesse Gelsinger, an eighteen-year-old participant in a phase 1 clinical trial, was destined to become its poster boy. He died from multiple organ failure after his own immune system attacked the therapy. As if by supernatural vengeance, the field of gene therapy underwent a collapse just as devastating as that which had befallen Gelsinger’s own body. The Gelsinger family and the US Justice Department sued the researchers, federal funding for all clinical trials into gene therapy was frozen, and the Institute for Human Gene Therapy was disbanded.
This story, or at least as today’s parable tells it, is about fanatics who were too hasty and too careless. Even worse, they were ruinously inept at public relations. In the US, entire fields of research can be terminated with the stroke of a pen by the Food and Drug Administration (FDA). When the state and private finance had turned on the gene therapists, they had too few supporters amongst the scientific community and the public.
Knoepfler’s imperative is to ensure that new gene editing technologies will not be left as vulnerable as gene therapy in the event of bad publicity. The public is already wary of human GM, with one poll from 2014 reporting that 50% of US respondents judged it “inappropriate” to alter a baby’s genetic characteristics even to “reduce risk of a serious disease.” It might take only a single news story about a rogue laboratory and a tragically botched usage of gene editing to trigger a comparable shutdown to that which had followed Gelsinger’s death. Paradoxically, a cut in federal funding would roll back mainstream research, whilst rogue units, or labs which are financed by private adventurers, would still have access to relatively inexpensive gene editing techniques such as CRISPR-Cas9. If society turns on gene editing, therefore, the cowboys would have the least to lose. They might even have the field all to themselves.
The answer, as Knoepfler sees it, is to educate the public so that they are conscious of what might be lost through any future funding freeze. Unfortunately, though, there is a streak of the fanciful running over his analysis, which appears at times to express a phobia of the technology, or a distrust of public enthusiasm, or something which is ultimately less than a completely scientific mentality.
Knoepfler’s tour of gene editing begins to resemble a theme park, a mixture of sensationalism and scaremongering, with celebrity clones, glow-in-the-dark babies and gene-altering weapons amongst the lurid attractions. Since the potential uses of gene editing could well include anything, it is surely best to leave such an audit to the science fiction community. Knoepfler should be more concerned with mapping out where the frontier genuinely is. He should be exploring the real-life challenges which are currently inspiring postgraduates, attracting capital, and appealing to prospective parents. The coalition of interests which is needed to clone a baby from a sample of Elvis Presley’s genetic material is never likely to assemble.
Knoepfler’s worrying often comes across as old-womanish rather than ethically steely, perhaps even to readers who are otherwise dependent upon his writing for all of their information. “Will we be wise enough to pause for thought and discussion before making GM babies in the first place? I doubt it,” he pronounces schoolmarmishly. “Do we really want people, willy-nilly, making GMOs?” he snorts. He likens future parents who are designing a baby to customers who are dialling up “a customised pizza.” As if anybody would really take such a frivolous attitude about something so profound! Later, a GM baby is compared to a vanity license plate. Knoepfler is democratic enough, however, to make out his own figure within the scramble of greed and pettiness. “What if you could almost guarantee that your child would outshine all the others in the neighbourhood… Many of us would give in to that temptation.”
The fertility doctor Jamie Grifo has asserted impatiently that, “We don’t know the genes for intelligence and hair color and eye color… most of my patients don’t care about that anyway; they just want to have a baby.” Confusingly, Knoepfler’s alarmist predictions about designer babies are periodically undercut by his doubts about the technology’s viability. At one point he admits that “the level of precision required for clinical use of CRISPR-Cas9 in humans may be difficult or even impossible to achieve.”
It is easier to tweak a mutated gene which causes cystic fibrosis than to engineer a genius, with the latter project perhaps requiring alterations to hundreds or thousands of genes. As Steven Pinker has told Knoepfler in his interview: “The prophesy of designer babies ought to be a relic of the early 1990s, when people thought there was “A Gene For” this or that talent.” If Knoepfler has persisted in keeping the phrase “designer babies” in his book’s title, he is probably referring only to babies who have been “designed” to omit a genetic disease. Nonetheless, this innocuous meaning is obscured behind all of the lurid traditional connotations of the phrase “designer babies,” connotations which Knoepfler simultaneously relishes and discounts.
To concede a little ground to Knoepfler here, he actively campaigns against unlicensed stem cell clinics in the US which sell worthless or even dangerous clinical products to desperate patients. He has witnessed the fraud and exploitation which can occur on a free market for new technology. He might insist that his distrust of the public is in fact a desire to protect consumers, from themselves as well as from unethical practitioners. I am, though, going to require a lot more persuasion before I can believe that there is really a market out there for “customised” babies, or at least the kind of reckless eugenicist market that Knoepfler anticipates.
Knoepfler worries that commercialised gene editing will lead to an undermining of the “parent-child bond,” rampant corporate profiteering, the patenting of genetic material, the mass destruction of unwanted embryos, and a renaissance of eugenics. Yet his own book shows that many of these handcarts to hell have already covered some distance. The apparently dystopian implications of gene editing are manifested in many existing technologies.
Millions of babies, reportedly over a hundred million, have been already aborted for being female. This phenomenal deletion of undesired female material from the gene pool is, and there are no two ways about it, a recognisable mode of eugenics. The “parent-child bond” which Knoepfler thinks sacrosanct is already lost in cultures in which babies are not loved unconditionally, but only because they are male.
Knoepfler would presumably not demand a moratorium on the usage of ultrasound in order to prevent the gender selection of human embryos, so why does he hold newer technologies to a higher standard? In vitro fertilisation (IVF) and a genetic screening technology called PGD (preimplantation genetic diagnosis) already come with a cavalier attitude towards the value of human embryos. In voicing a preference for PGD over CRISPR-Cas9, as a “competing and generally superior technology,” Knoepfler proves himself bendable on disadvantages which he appears to inflexibly condemn in CRISPR.
But is it right to take such a bleak view? Since 1978, five million otherwise-unconceivable babies have been born using IVF and the planet has successfully witnessed the industrialisation of this ethically complex technology. The overwhelming usage of IVF has been sensible and modest; any destruction of embryos has occurred only within the context of significantly increasing the total of human lives. Knoepfler himself revisits the hysteria which had first greeted the invention of IVF and he judges that the technology’s proponents were on the correct side of history. We are left to wonder whether IVF would have been ever developed if it had been subjected to the same ethical tests which Knoepfler is now setting for human GM.
If I am criticising Knoepfler’s risk aversion, you might give the benefit of the doubt to Knoepfler because he is an expert scientist and I am somebody who could not identify my own internal organs if they all fell out at my feet. In fact, the most significant difference between the scientist and the amateur enthusiast is one of responsibility rather than knowledge. If the scientist goes ahead with gene editing, then they will have to live with what they have done, and this could include hundreds of destroyed embryos, severely ill babies, and distraught parents. A writer such as myself, on the other hand, can just make a suitable expression of regret and then prance freely on the next topic. When the enthusiast goes up against the more cautious scientist, they have to reckon with a fundamentally alien mindset. It is rather like a bird being required to think about gravity.
Still, I cannot give the ethical right of way to Knoepfler on this, even after all that I have learned from his book. We live in a period of history which is increasingly risk averse, with many policy decisions, from major infrastructure projects to foreign policy interventions, being subjected to endless delays and prevarication. You sense that exactly the same is happening in this field too. Knoepfler is aware that his sensible, safety-first approach is “less fun.” It is a tremendous disadvantage.
Finally, we have to put forward the libertarian perspective. You might think that a libertarian would be startled by any medical urge to predetermine our characteristics from the very first cell. Eventually embryos are likely to be gestated in artificial wombs, where they could end up as the wards of the state or private companies, rather than as the children of parents. We live in an interventionist political system which is constantly trying to overrule our self-destructive impulses and reduce our environmental impact. Supposing that policymakers could genetically programme us to be more risk-averse, inhibitive, and respectful of government advice.
This is an utterly false analogy because you cannot programme human beings in such a way. If you could, I am not sure that they would remain fully human. We have at last dived down to the moral depths of this book and reached the title. GMO Sapiens – is this either a useful or a valid concept?
By this, I am querying whether somebody who has been genetically edited in vitro, or even cloned outright, is really part of a different species?
The only legitimate way to oppose eugenicists is to reject their mantra of genetic determinism. Knoepfler, on the other hand, at least entertains the prospect that eugenicists might one day design a new race of “perfect” individuals. He flip-flops about on this and I am not sure that he is aware of how successfully he dispels his own fears.
For example, a future laboratory could make all sorts of interventions in a single-celled human being to guarantee Archimedes’ IQ and Hercules’ physique. But, as Knoepfler appears to acknowledge, once this embryo had grown up to be an adult, they would have acquired free will. However high their IQ, the GM individual could always choose to spend all of their time watching TV rather than doing maths puzzles. However magnificent their physique, they could always choose to become a computer games champion rather than an athlete. In possessing consciousness and free will, the GMO sapiens would be entirely unaltered from the old familiar Homo sapiens.
Knoepfler admits that our identities are probably shaped by the interaction between our genes and our environment. Elsewhere, however, he observes that “the formula for human intelligence… could require such a complex genetic recipe as to be nearly impossible to successfully create artificially.” This is not quite a ringing endorsement of free will. We don’t become intelligent because our bodies are following a genetic recipe, but because we have chosen to develop our talents, listen to our teachers, and so on. Knoepfler worries about “insidious negative changes in GM humans that only manifest later in their life, such as changes in personality, leading, for example to narcissism, violence, or suicide.” This is, though, to allow that the decision to commit suicide might be genetically predetermined. Most people would condemn such a belief as a moral capitulation.
“Could genetic modification in some way reduce our humanity?” Knoepfler ponders. If misused it is unlikely to significantly damage us and if used properly it will confirm our humanity. Defeating diseases whilst they are still nothing more than dots of DNA will increase our power over nature and its limits.
[Previously on Tychy: “Stem Cells and the Left.”]