Does Gene Editing Have a Future in Reproductive Medicine?

Gene editing also adds fuel to debates around eugenics. As Business Insider reported, venture capitalists and tech visionaries who call themselves “pronatalists” want to save civilization by creating genetically superior children. Some utopian visionaries seem to think that they already have good genes, while others seek genetic improvements. Silicon Valley entrepreneurs are enlisting CRISPR scientists in a quest to design perfect babies.

Given the potential misuse of the technology, the benefits of using CRISPR in fertility medicine may not outweigh the risks. Collectively, we could decide to put this technology back in the box, and CRISPR gene editing for reproductive uses could go the way of human cloning, and be outlawed. Or, leaders from science and civil society could decide that some uses of gene editing are permissible in human embryos — if CRISPR can produce solutions to pervasive medical problems, for example. But new ethical guidelines and legal codes are needed to govern this technology in the fertility clinic.

To do this well we need to understand the technical risks as well as the social ones.

Dr. He misled the public when he made his 2018 announcement on YouTube: “Two beautiful little Chinese girls, named Lulu and Nana, came crying into this world as healthy as any other babies, a few weeks ago,” he said. In reality, the twins spent their first weeks in a hospital neonatal intensive care unit. Lulu and Nana were born prematurely, by emergency cesarean section at 31 weeks, and initially had difficulty breathing.

The health problems that Lulu and Nana experienced at birth could be a result of known risks of twin pregnancies and conventional in vitro fertilization treatments. Or they could be the result of unknown risks associated with CRISPR gene editing. Today the children are reportedly healthy, but their future is unknown.

Dr. He argues that CRISPR should be used only for medical reasons, even though it can be argued his own experiment blurred the boundaries between clinical medicine and human enhancement. “No one has a right to determine a child’s genetics except to prevent disease,” according to a paper that Dr. He co-wrote on gene editing ethics (the paper has been retracted). But, the paper continued, “everyone deserves freedom from genetic disease.”

Abstract principles about preventing future disease could also create unintended problems. Many deaf and blind people are concerned that people like them will be edited out of existence, rather than society learning to better accommodate them. At the same time, some patient advocacy groups are rallying behind CRISPR cures.

Future access to this technology is also a concern. Gene editing of embryos would probably be prohibitively expensive for most couples. A single round of I.V.F. ranges from $15,000 to $30,000 in the United States, depending on a patient’s needs, while the costs of approved gene therapies for adults are already exorbitant.