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[Noah Smith] Gene editing needs to be available to everyone

By Bloomberg

Published : Jan. 28, 2018 - 17:55

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When I was growing up, the idea of re-engineering human DNA was a staple of science fiction. Now, it’s a reality. Adult gene therapy -- editing the genome of a person -- is expected to soon be a treatment option for a number of otherwise intractable diseases. Meanwhile, scientists have successfully edited the DNA of human embryos, raising the possibility that parents might be able to modify their children’s genomes to save them from inherited diseases.

Much of the change from science fiction to science fact has come from a breakthrough technique known as Crispr. Though the technique still has a number of technical snags to work out, consensus in the biology community seems to be that these problems will be overcome.

As one would expect, the ethical and moral implications of this technology are already sparking heated debate. That is good. But there are also economic implications, some of which interact with the ethical issues, and these are worth considering.

Crispr promises to create a large amount of economic value. Beyond simply editing out the genes for cancer, heart disease or arthritis, people might be able to use the technique to improve both their happiness and their productivity. Genetic engineering and gene therapy may allow people to become less anxious, less depressed or less prone to anger. Considering that the anti-anxiety and anti-depression drug markets are already worth tens of billions of dollars, more effective genetic treatments could become an even bigger industry.

If people go beyond fixing identifiable problems, and begin enhancing themselves beyond current human norms, the potential is even greater. Gene therapy might help slow aging, enable greater intelligence, make people more diligent workers or improve physical strength and stamina. We should also not underestimate the demand for purely aesthetic enhancements -- people could potentially use gene therapy to change their body type, their height, their eye color, their hair type, or potentially even their facial features. To get a rough idea of how much profit the technology as a whole might command, it’s necessary to look at the whole array of ways people spend money trying to change themselves -- gym memberships, cosmetics, dietary supplements -- and then imagine how much they would spend for deeper and more lasting interventions.

These gene-therapy industries, if and when they appear, will convey vast wealth to whoever holds the know-how, claims the first-mover advantage, builds successful brands, and patents the technologies involved. Right now, many fear that those first movers will be Chinese. Crispr was invented in the USS. But driven by industrial policy, China -- a nation currently only one-quarter as rich as the US -- has taken the lead in some areas of Crispr research.

That lead is unlikely to mean much, once the engines of corporate and government research really start humming on both sides of the Pacific. But there’s the possibility that ethical concerns could hold back the US and let China take the prize. Already, some writers are drawing comparisons between Crispr and eugenics, a racist pseudoscience that was popular a century ago. The two are not related -- genetic engineering owes nothing whatsoever to racial theories -- but the gut-level association could prove to be an obstacle to US science and industry.

A more important concern is safety. Changing a person’s genes is an inherently risky business, since side effects could surface years after the treatment and be very difficult to reverse. Safety failures could hurt innocent people and set back the industry for decades. In order to prevent this sort of human disaster, the government should be pouring money into gene therapy safety research.

There’s also the question of economic fairness. If Crispr is an expensive commodity available only to the rich, they may be able to give themselves and their children an unfair leg up in the economic competition against the middle class and poor. A future in which rich people are able to make themselves more entrepreneurial, smarter, more socially adept or more charismatic than other people could lead to exacerbation of the recent trends of falling economic mobility and increasing inequality. That could lead to the kind of hereditary caste system seen in dystopian novels -- money buying advantages that allow the earning of even more money.

In order to prevent this kind of unequal outcome, the government should consider making Crispr therapies available for free to anyone who wants them. If the price of Crispr therapy is $20,000, it would amount to less than $100 billion a year -- less than 2 percent of current government spending -- to provide it free to the roughly 4 million 18-year-old Americans who wanted it. This is assuming, of course, that the technology proves to be safe. That cost would be more than offset by productivity gains and increases in human happiness.

As technology changes, governments have to race to keep up with the changes -- to manage them, to accommodate them, and to make sure their benefits are fairly distributed. Gene therapy is no different.

Noah Smith
Noah Smith is a Bloomberg View columnist. -- Ed.