My first introduction to the possible future of genomic editing came while reading Aldous Huxley’s “Brave New World.” The novel begins in the year 2540 at an embryo factory called the Central London Hatching and Conditioning Centre. The director of the facility describes to a group of male students how eggs are modified during the gestation period of development to fit into five distinct castes: Alpha, Beta, Gamma, Delta or Epsilon.
Beginning with Alphas as the predestined leaders of the World State, each subsequent class decreases in intelligence, rank and, by consequence, contribution to the government. As predesignated vocations become more mundane and insignificant, intelligence must be lowered so there will never be resistance to the regimented class system. Under the guise of creating a perfect society, the facility had created a heavily regulated and dystopian world.
In 2021, the sophisticated reproductive technologies illustrated in “Brave New World” do not seem as fanciful as they did when the book was published in 1932. The test tube embryos portrayed in the novel parallel the relatively common process of in vitro fertilization, which manually produces an embryo by combining mature eggs and sperm in a lab. Yet, a key difference remains, given that there is no genetic manipulation of the human genome during IVF. In pre-implantation genetic screening, none of the DNA in embryos is artificially manipulated, but certain embryos can be chosen for implantation based on criteria such as not carrying a specific disease trait. This could soon change with Clustered Regularly Interspaced Short Palindromic Repeats gene therapy, or CRISPR.
CRISPR technology is a fairly new genome editing method which allows specific locations in the human genome to be targeted using guide RNA and a Cas9 protein. Together, RNA and the Cas9 protein cleave a specific portion of DNA which is then repaired by the cell using a donor DNA template containing the sequence of choice. While the manipulation of genetic traits has had enormous societal and economical benefits — as can be seen in the Green Revolution — the altering of human germ cells has numerous ethical and moral concerns. To start, patient consent is impossible and any mistakes made will be hereditary, which may have a detrimental effect following cell specialization.
The ethical limitations of CRISPR gene editing were recently tested by Chinese researcher He Jiankui in 2018. He “manufactured” the first CRISPR-edited babies through two twin girls, Lulu and Nana. The experiment is now known as the Lulu and Nana controversy — the global scientific community has criticized He, claiming he took advantage of the parents’ situation. Lulu and Nana’s father was HIV-positive, so He decided to target the CCR5 gene, which HIV can use as an entrance into cells — despite Lulu and Nana having virtually no risk of contracting HIV. Moreover, the edits made on Lulu were incorrect and incomplete, and the implications will not be known until later in her life. He blatantly disregarded worldwide standards for genomic editing by operating under a shroud of secrecy, not properly obtaining informed consent and miscategorizing the experiment as an “AIDS-vaccine development project.” Despite the amoral grounds of He’s CRISPR-editing attempt, his partial success in manipulating the human genome foreshadows what is to come.
While experimenting with CRISPR-editing techniques is complicated, the possibilities of its development include increased athleticism, intelligence and overall health, which are alluring to many people. Even still, public opinion often draws the line between lessening the prevalence of diseases and picking out traits; after all, ridding the world of muscular dystrophy sounds much better than simply wanting blue-eyed babies. But even when it comes to tackling lifelong diseases, it needs to be acknowledged that only a minuscule fraction of global society will have access to these specialized genetic treatments, let alone be able to afford them. As methods for gene editing are further explored and made accessible, the possibility of particular portions of society carrying the greatest amount of disease prevalence increases.
The monetary cost of healthy embryos is already a barrier for Americans wanting to use IVF, considering each attempt can cost anywhere between $10,000 and $15,000 depending on parents’ insurance and servicing clinic. About 1.7% of births in the United States are a product of IVF, compared to 4% and 5.9% in Belgium and Denmark, respectively, where reproductive assistance is publicly funded. Consequently, Americans without disposable income may not be able to access this method.
Now consider the cost of personally designing a baby. How much would it cost to increase intelligence or decrease heart disease? Many people will not be able to afford these individualized services when taking into account that IVF itself is currently a luxury. Alongside cost, numerous racial and ethnic groups hold a stigma against infertility and genetic disorders which further decreases discussion and awareness of possible options.
In addition to cost and social acceptance, an equally important issue is where the treatment clinics offering these services are placed. Embryo-processing facilities require expensive laboratories and a well-trained staff, meaning they will not likely be found in low-income areas or in most developing countries. The repercussions will cause the carriers of disease to be decided based on location, cultural background and socioeconomic status.
Almost 90 years ago, Huxley clearly warned of the multiple dangers to society that can come with sophisticated technologies like those he described in “Brave New World.” While we are still far from the bleak dystopian life found in Huxley’s novel, we risk the same class characterization by genetics if we do not provide the proper universal regulations and equitable access as designer babies become more of a reality.
Katherine Kiessling is an Opinion Columnist and can be reached at katkiess@umich.edu.