In the near-term, gene editing is not likely to be useful. Even in the long-term, it may not be very practical.
- Once perfected, gene editing is likely to be useful only under limited conditions.
- Multigenic diseases like schizophrenia and cardiovascular disease are probably too complicated to be fixed by gene editing.
- Embryo screening is a far more effective way to achieve the same objective.
The following is an adapted excerpt from the new book CRISPR People, reprinted with permission of the author.
I see no inherent or unmanageable ethical barriers to human germline genome editing. On the other hand, I see very few good uses for it. That is mainly because other technologies can attain almost all the important hoped-for benefits of human germline genome editing, often with lower risk. Two such technologies are particularly noteworthy: embryo selection and somatic genome editing.
Gene editing vs. embryo selection
The most obvious potential benefit would be to edit embryos, or the eggs and sperm used to make embryos, to avoid the births of children whose genetic variations would give them a certainty or high risk of a specific genetic disease. And here it is time to explain the ways genetic diseases or other traits get inherited. If the disease or trait depends on just one gene, we call it a Mendelian condition or trait, named after Gregor Mendel, the Austrian monk who first discovered this kind of inheritance. If more than one gene is involved, we cleverly call them non-Mendelian conditions or traits. Most of the discussion below is about Mendelian conditions for the simple reason that there is more to say about them.
Mendelian conditions can largely be put into five main categories, depending on where the relevant DNA is found and how many copies of the disease-causing variant are needed to lead to the disease: autosomal dominant, autosomal recessive, X-linked, Y-linked, or mitochondrial. Autosomal dominant diseases require only one copy of the disease-causing genetic variation; autosomal recessive diseases require two copies, one from each parent. X-linked diseases typically require two copies in women (one from each parent) but only one in men (who have only one X chromosome, always inherited from the mother). Y-linked diseases, which are unusual, are found only in men and require only one copy — because only men have a Y chromosome and normally they have only one copy of it. Mitochondrial diseases are inherited only from the mother and any mother with the disease will necessarily pass it on to all her children.
Why take the new, riskier — and, to many people, disconcerting — path of gene editing rather than just selecting embryos?
So, if an embryo has 47 CAG repeats in the relevant region of its huntingtin gene, it is doomed (if born) to have autosomal dominant Huntington's disease. One might use germline editing to reduce those 47 repeats to a safe number, of under 37, and thus prevent the disease. Or if an embryo has two copies of the genetic variation for the autosomal recessive Tay-Sachs disease, it could be edited so that the embryo had one or no copies and would be safe. The same is true of X-linked, Y-linked, or mitochondrial diseases.
If this is safe and effective, it may make sense. But another technology that has been in clinical practice for about 30 years is known to be (relatively) safe and effective and can do the same thing — PGD [preimplantation genetic diagnosis]. PGD involves taking one or a few cells from an ex vivo embryo, testing the DNA in those cells, and using the results to determine whether or not to transfer that particular embryo to a woman's uterus for possible implantation, pregnancy, and birth. The first PGD baby was born in 1990. In 2016, the last year for which data are available, the U.S. Centers for Disease Control and Prevention (CDC) reported that about 22 percent of the roughly 260,000 IVF cycles performed that year in the United States involved PGD (or a version called preimplantation genetic screening, or PGS). That was up from about 5 percent the year before. Anecdotally, from conversations with people working in IVF clinics, it sounds as though PGD or PGS usage in 2019 may well be above 50 percent, at least in some areas of the United States.
If a couple wants to avoid having a child with a nasty Mendelian genetic disease or condition, they could, in a decade or more, use CRISPR or other gene-editing tools to change an embryo's variants into a safer form or, today, they could use PGD to find out which embryos carry, or do not carry, the dangerous variants. For an autosomal recessive condition, on average 25 percent of the embryos will be affected; for an autosomal dominant one, 50 percent will be. Even for dominant conditions, if one looks at 10 embryos, the chance that all 10 will have the "bad" version is one in 1,024. If you have 20 embryos to examine, it becomes one in 1,048,576.
So, why take the new, riskier — and, to many people, disconcerting — path of gene editing rather than just selecting embryos?
Gene editing in somatic cells vs. germline cells
Somatic cell therapy does not change the germline, and it comprises a technology much closer to being shown safe and effective than human germline genome editing. Arguably, the fact that the change is only being made in one or a few of the many tissues of the body would improve its safety over a change that exists in every cell, including cells where a particular off-target change has harmful effects.
On the other hand, genome editing of an egg, a sperm, or a zygote needs to change only one cell. This might prove more effective than changing, say, 100 million blood-forming stem cells or several billion lung cells. Furthermore, somatic cell editing would not necessarily work for all conditions. For some, too many different cells or tissues may have to be targeted. For others, the damage may begin before birth, or even before the stage of fetal development where in utero somatic editing becomes plausible. For diseases with very early consequential effects, somatic cell therapy may be inferior to embryo editing or embryo selection.
Even when somatic editing is possible, human germline genome editing retains one advantage: the process would not have to be repeated in the next generation. If somatic editing is used, that person would still have eggs or sperm that could pass on the disease. If she or he wanted to avoid a sick child, PGD or somatic cell gene therapy might be necessary. If germline editing is used, that child's children will be free from the risk of inheriting the disease from their edited parents. But is this a bug or a feature? It adds a choice — not a choice for the embryo that is, or isn't, edited but for the parents of that embryo. Somatic cell editing continues the possibility of a disease in the next generation — but allows that generation's parents to make the decision. One might — or might not — see that as a benefit.
Gene editing in multigenic diseases
In non-Mendelian (sometimes called multigenic) diseases, no one variant plays a powerful role in causing the disease. Variations in two, or twenty, or two hundred genes may influence the condition. Collectively, those influences might be 100 percent, though the cases we know now add up to much lower certainties. We do not yet know of many good examples, though at least one paper claims to have found strong evidence of that variations of different genes, working together, increase the risk for some cases of autism. And, more generally, we know of many combinations of shared genomic regions that (slightly) increase or lower the risk for various diseases or traits in particular, studied populations. (These have led to the hot area of "polygenic risk scores," whose ultimate significance remains to be seen.)
The biggest problem with human germline genome editing for non-Mendelian conditions is that we do not know nearly enough about the conditions. We believe that many conditions are non-Mendelian, but how many genes are involved? Which genomic variations add or subtract risk? How do the effects of variations from different genes combine to create risks? In a simple world, they would be additive: if having a particular variation of one gene increases a person's risk of a disease by 10 percentage points and having a particular variation of a different gene increases that person's risk by 5 percentage points, then having both would increase the risk by 15 percent. But there is no inherent reason nature has to work that way; the combined effects may be greater or less than their sum. It is even conceivable that having two variations that each, individually, raise a person's risk might somehow lower the overall risk. We know almost nothing about the structure of these non-Mendelian, or multigenic, risks.
It is clear, though, that, in general, PGD would be much less useful for non-Mendelian diseases than for Mendelian ones. The chances of finding an embryo with "the right" set of genetic variations at five different spots along the genome will be much smaller than of finding an embryo with just one "right" variation. If the odds for any one variation are 50/50, the overall odds for any five variations in one embryo are one in 32. If gene editing could safely and effectively edit five places in an embryo's genome (or in two gametes' genomes), it could deliver the preferred outcome. On the other hand, if we can use genome editing to do that in an embryo or gamete, we may well be able to do the same in a fetus, a baby, a child, or an adult through somatic cell gene therapy — unless the condition begins to cause harm early in development, or broadly enough in the body that it needs to be delivered to all the body's cells.
Is gene editing practical?
Right now, there is no non-Mendelian condition for which we are confident we know the exact set of genes involved. Neither do we know the negative and positive effects of different combinations of genetic variants. Until these uncertainties are adequately resolved, human germline genome editing, though in theory better than PGD, will not be safe or effective enough for use. Once they are resolved, in many situations it will be no better than somatic cell genome editing, except for the possible absence of needing to hit targets in multiple tissues or cell types and the absence of a need to repeat the editing for the next generation.
Adapted from CRISPR PEOPLE: The Science and Ethics of Editing Humans by Henry Greely. Copyright 2021. Reprinted with Permission from The MIT PRESS.
Eastern traditions have complex views on how karma affects your life.
- Karma is not simple retribution for bad deeds.
- Eastern traditions view karma as part of a cycle of birth and rebirth.
- Actions and intentions can influence karma, which can be both positive and negative.
The news that Donald Trump got sick with COVID-19 prompted "karma" to trend on social media. The President downplayed the virus, openly mocked the practice of wearing masks, shared misinformation, and held super spreader events for thousands of followers. But what happened to him was not necessarily karma (or at least, we can't really know). Chances are, karma is not what you think it is.
Karma is not just a mechanism by which the universe brings snarky retribution for someone's misdeeds. It's not simple luck or even destiny. It's a Sanskrit word that means "action," "work," or "deed," and it really speaks of the spiritual cycle of cause and effect. The good intentions and deeds you perform result in an addition of good karma, while the bad ones add to the bad karma. Notice that karma doesn't necessarily have to be negative. It's more a law of consequences than a particular reward or punishment.
The notion is linked to the idea of samsara, which also originated in India and means "wandering." It is paramount to Hinduism, Buddhism, Jainism, Sikhism, and Taoism, and refers to the belief that all living beings go through cycles of birth and rebirth, which may continue indefinitely. With the details depending on the religion, the kind of karma you accumulate on the wheel of life or "karmic cycle" can influence both the future of your present life, but also the one you may have coming up. The soul transmigrates after death, bringing Karmic impulses from the life just finished into the new one. Conversely, it's important to note that karma you are experiencing today may be a product of not just your actions in this lifetime but based on what happened in the lives you had in the past.
If you're wondering, being reborn as an animal is looked at as an undesirable rebirth, leading to much additional suffering. Having a human rebirth would land you closer to being able to get off the karmic soul train.
How do you escape samsara? By working towards achieving enlightenment, or "Nirvana." Once you get there through good karmic deeds and spiritual practices, your desires and sufferings will go away and you will find peace and happiness. Of course, your physical body will die and you will no longer be reborn, but on the plus side, you will be awake to the true nature of reality and if you're Hindu, you'd reunite with Brahman, the universal God or soul.
Thanga Wheel of LIfe
Credit: Adobe Stock
7th-century Upanishads described the law of karma causality in this poetic way:
Now as a man is like this or like that,
according as he acts and according as he behaves, so will he be;
a man of good acts will become good, a man of bad acts, bad;
he becomes pure by pure deeds, bad by bad deeds;
And here they say that a person consists of desires,
and as is his desire, so is his will;
and as is his will, so is his deed;
and whatever deed he does, that he will reap.
It's significant to point out, the laws of karma, caused by individual actions, can affect the life you are leading. But what's also recognized are intentions. They are just as important in your karmic profile and the effect they have on you. Unintentional actions do not have that much influence. Even performing a good deed that stems out of questionable intentions can bring you negative karma.
Karmic theory also recognizes two forms of karma — the phalas and the samskaras. A phala is a karmic effect (visible or invisible) that's immediate or within your current lifetime. Samskaras, on the other hand, are invisible effects, that are produced inside you, impacting your ability to be happy or unhappy. This extends both to this and future lives.
While the specifics of karma theory differ based on specific spiritual practice, one thing may be for certain – what goes around comes around.
Tibetan Buddhist Wheel of Life~ Samsara Cyclic Existence
Students who think the world is just cheat less, but they need to experience justice to feel that way.
- Students in German and Turkish universities who believed the world is just cheated less than their pessimistic peers.
- The tendency to think the world is just is related to the occurence of experiences of justice.
- The findings may prove useful in helping students adjust to college life.
Some people believe that the world is a just place where people tend to get what they deserve. The merits of this belief have been subject to debate for a few centuries, and some argue that its bad for you. It is a popular belief in any case and some social psychologists argue that it is a fundamental belief that allows us to function.
But how does this belief, which must surely be challenged every day, affect our lives? A new study published in Social Justice Research suggests that a personal belief in a just world may help us act justly, after finding that it reduces instances of cheating in college classes.
The world is just? That’s news to a lot of people.
The study is the most recent addition to a long line of work focusing on the belief in justice, our behavior, and our reactions to evidence that might suggest injustice occasionally occurs. This study focuses on a personal belief in a just world, (PBJW) rather than a general belief in a just world (GBJW). The difference between them must be highlighted.
GBJW is the stance that justice prevails all over the world and that people tend to get what they deserve. PBJW is more focused on the individual's social environment and their belief that they tend to be treated justly. While several studies show PBJW correlates with a higher sense of well-being and a variety of other positive effects, a high GBJW is associated with less life satisfaction, negative behavior, and callousness towards the suffering of others. This study controlled for GBJW, and focused on PBJW as much as possible.
To assure that culture was not a factor, the study included students at universities in both Germany and Turkey.
The researchers gave students at the four participating universities a series of questionnaires that asked if they ever cheated in class, if they perceived the world to be just, if they though that justice always prevailed everywhere, their tendencies towards socially appropriate behavior, their life satisfaction, and if they felt like they were treated justly by their teachers and fellow students.
The answers were statistically analyzed for relationships. While some of the connections seem trivially true, others were surprising.
PBJW turned out to only be an indirect predictor of if a student was likely to cheat. Both a belief in a just world and a lower likelihood of cheating were mediated by the justice experiences of the students, with more of these positive experiences lowering the rate of cheating and improving their belief in justice. This was also associated with higher levels of life satisfaction.
These effects existed across all demographics in both countries.
What does this mean? Is a belief in justice a self-fulfilling prophecy?
In a way, it seems to be. People who have reason to think the world is just to them tend to interpret events in a way to sustain that belief and behave in a just manner. In a larger sense, the take away from this study is that experiences of justice, both from peers and instructors, is vital to student's wellbeing and understanding that the rules that exist about cheating are part of a larger, legitimate, system.
The researchers, citing previous studies on the perception of justice, note that "justice experiences (1) signal that university students are esteemed members of their social group, which in turn conveys feelings of belonging and social inclusion and (2) motivate them to accept and observe university rules and norms. These cognitive processes may thus strengthen their well-being and decrease the likelihood that they cheat."
The authors also suggest that if you want people (not only students) to act justly; consider treating them with "civility, respect, and dignity."
Sometimes, all it can take to help somebody act virtuously is to treat them well. Likewise, people treated harshly can rarely find reason to play by rules that don't protect them. The findings of this study will certainly add to the literature on how we perceive justice in the world around us, but might also help us remember that there are real consequences to our actions which can be much larger than we imagine.
Price gouging is prohibited in 34 US states and Washington D.C. But two scholars ask whether that's the way it should be.
- Paper products, hand sanitizer, masks, and cleaning wipes—all are in high demand and short supply during the COVID-19 crisis.
- Price gougers are viewed as villains in this crisis—but two scholars argue that price gouging is, in most cases, morally permissible.
- Increased prices prevent unnecessary hoarding. Buyers purchase only what they need when they need it. Also, producers are incentivized to make more. When the supply rises, prices will fall.
At the Safeway grocery store in Southwest Washington, D.C., the toilet paper and paper towels section has been empty for most of the last two months. When the store does restock, supplies don't last long on the shelves. "Do you know if they have paper towels?" a pedestrian outside the store asked a stranger exiting the Safeway in late April. The answer was no: "Still out."
Paper products, hand sanitizer, masks, and cleaning wipes—all are in high demand and short supply during the COVID-19 crisis. Shoppers across the country are facing empty shelves and out-of-stock signs.
But any seller who reacts to current crisis conditions by increasing prices on in-demand products may be committing a crime. Thirty-four states have laws against price gouging. In March, a bipartisan group of state attorneys general wrote a letter urging online marketplaces to crack down on price spikes.
"[W]hile we appreciate reports of the efforts made by platforms and online retailers to crack down on price gouging as the American community faces an unprecedented public health crisis, we are calling on you to do more at a time that requires national unity," the letter said.
A price gouger makes a good temporary boogeyman. One could look at high prices during an emergency and think: They're trying to profit off of my desperation.
What exactly is price gouging, and what distinguishes it from a normal price increase? New York Attorney General Letitia James told NPR that "there's no definitive answer" but "you know it when you see it—[it's] when individuals are taking advantage of the market, particularly when a neighboring store is selling the same product for much less." New York's price gouging complaint form, which consumers can use to report retailers, defines it as "unconscionably excessive pricing of necessary consumer goods and services during any abnormal disruption of the market." However different states might define it, price gouging is widely understood to be exploitative, sleazy, and heartless. Laws against it are popular.
But Michael Munger, professor of political science at Duke University, says that high prices are a crucial part of dealing with scarcity during an emergency.
"If you use the police to keep prices artificially low, it makes the problem of scarcity much worse," Munger says in a short Institute for Humane Studies video on price gouging. Price gouging during an emergency allows more people to get what they need as soon as possible. "And that's true even for those who can't afford the gouger's prices," Munger explains.
How? Increased prices prevent unnecessary hoarding. Buyers purchase only what they need when they need it. Also, producers are incentivized to make more. When the supply rises, prices will fall.
"Price gouging laws keep the shelves empty longer," Munger says.
Matt Zwolinski, professor of philosophy at the University of San Diego, argues in his paper "The Ethics of Price Gouging" that "most, though not all, cases of price gouging are at least morally permissible, if not morally praise-worthy."
"Relative to the baseline of no exchange at all, the gouger's proposal stands to improve the lot of the buyer, not to worsen it," Zwolinski writes. If a buyer purchases a product at an exceptionally high price during an emergency, the buyer has decided that their emergency need justifies the high price. As Zwolinski puts it: "[W]hile the price of generators might rise dramatically in the wake of a disaster which knocks out power to a certain population, so too does the need people have for generators." A seller who raises prices did not create the buyer's increased need; he or she is merely reacting to it.
This doesn't mean, of course, that the price gouger is motivated by altruism. "[T]he fact that there are good arguments to be made for the moral permissibility of price gouging in certain cases does not mean that those who actually engage in the practice are motivated by these considerations," Zwolinski writes. But that's also true of normal market activity: As Adam Smith says in The Wealth of Nations, "It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest." A price gouger makes a good temporary boogeyman. One could look at high prices during an emergency and think: They're trying to profit off of my desperation.
But if we heed the work of scholars like Michael Munger and Matt Zwolinski, we might begin to see price gouging as a rational and necessary part of emergency response. During normal times, a pack of hand sanitizer might cost the same as a bottle of red wine. But right now, during the COVID-19 pandemic, does anyone place nearly the same value on a bottle of wine as on a pack of hand sanitizer? By using the law to forcefully keep prices below what people would pay in an emergency, states enable hoarding. For Americans who would like to buy hand sanitizer—or paper towels, toilet paper, cleaning wipes, or masks—and can't find any, price gouging laws are a cold comfort. Most would rather have the option of paying increased prices than no options at all.
Should pharmaceutical companies pay people for their plasma? Here's why paid plasma is a hot ethical issue.
- Human blood is made up of red blood cells, white blood cells, platelets, and plasma. Plasma is the liquid part of blood. It is used to treat rare blood conditions and has an increasing number of medical applications.
- It is a $26 billion industry, and the US is a major exporter of plasma to other nations. Most nations do not collect enough plasma to sustain therapies for their own citizens. The US has such a large supply of plasma because it pays people to donate plasma—a controversial practice.
- Is it ethical for people to be paid for their plasma? Here, Peter Jaworski, an ethics scholar, explains five key arguments people make against paying people for plasma—safety, security, altruism, commodification, and exploitation—and explains his views on them. What do you think?