Gene editing is likely to have unintended but adverse consequences. An ethical framework is the best guarantor against a worst-case scenario.
We tend to think about innovation in terms of technological prowess; but it turns out culture plays a crucial role. Similarly, we tend to think that technology per se is benign; but it turns out that ethical issues play an increasingly important role in the impact of technology on society. Technology is value-neutral, but its uses are anything but; innovators should, but don’t, worry about the downsides as much as they hype the promised upside.
This issue has come into sharp focus with the announcement of the first allegedly genetically modified babies (GMBs). Chinese researcher He Jiankui announced in late November that he had used CRISPR-Cas9 to edit the foetal DNA of twin baby girls, Lulu and Nana. He said that he did this to make one twin immune to HIV, as their father is HIV+. He also claimed another woman is carrying a foetus that was also gene-edited in his lab. It’s instructive to compare this to other ethical issues.
There have been many concerns expressed about algorithms that ‘go rogue’ and produce ethically deficient results. One classic case is the ‘trolley problem’ where a machine intelligence has to decide on a course of action that results in the death or injury of one set of individuals while saving another set of individuals. In the March 2017 issue of Swarajya, I reviewed Cathy O’Neill’s Weapons of Math Destruction, about opaque big data algorithms deciding on things as diverse as sentences for crimes and teacher promotions based on criteria that may be unfair, racist, or inappropriate for the societal good.
Similarly, we have seen social media, which has its positives, being used to circulate fake news (leading to riots, murders, etc) or to allegedly affect election results (Cambridge Analytica and Facebook got into trouble for this). The era of ‘deep fakes’ is upon us: photos and videos doctored to appear authentic, so that for instance a famous leader may be seen saying things he never did say.
The Chinese Communist Party is using facial recognition and artificial intelligence (AI) to create a ‘social credit’ system, which is in effect a Big-Brother-like panopticon, watching everything an individual does: it may condemn you to gulags, as they are now doing to Uighurs.
But these ill-effects of technology pale in comparison to the can of worms that may be unleashed by tinkering with biology. There is a good reason why the entire world community has come together to ban biological weapons: the horrors that line of research can lead to are absolutely mind-blowing.
Among other things, biology is far more complex than we think, as argued by Robert Sapolsky in Behave: we are creatures not only of nature and nurture, but of even the dimly-understood effects of stress, experiences in childhood, trauma undergone by our Stone Age ancestors, and so forth. Besides, a few centuries of allopathy and Cartesian science have demonstrated that our understanding of cause and effect regarding the human body is less than perfect, much less.
A Pandora’s Box may well open if we tinker with the human body (the precise gene-editing tool CRISPR-Cas9 can be used both with adults and foetuses). The very first concern is that of natural selection and evolution. If a particular gene has made it through millennia of natural selection, it stands to reason that it has some value and confers some benefit. By snipping it out, are we causing unintended consequences elsewhere? For instance, the CRISPR removal of the gene CCR5 that allows HIV to infect human cells in Jiankui’s gene-edited baby girl: what is its side-effect? Does its absence make you more likely to become obese? Or die early? Nobody knows.
Besides, there have been some studies that show that CRISPR is not as clean a ‘surgical knife’ as has been believed: it may cause anomalies in the rest of the individual’s genetic code (CRISPR DNA editing may cause serious genetic damage, researchers warn, Techcrunch, 16 July 2019). Thus it may well be a risk to mess with it: science fiction is full of stories of the kinds of chimeras that may emerge, with grave consequences not only to individuals, but indeed even the human race.
The general concerns about genetically modified organisms (GMOs) that have bedevilled agribusiness apply even more strongly to genetically modified babies, because, in a literal sense, people are ‘playing god’. If some of the modified genes can be passed on to a person’s offspring, then there is the possibility of that modification becoming a ‘gene drive’ affecting entire populations. “In 2015, scientists proposed a moratorium on inheritable human genome edits that would affect the germline,” according to Wikipedia, but that doesn’t apply to non-human species.
There are proposals to attempt gene drives to force desirable characteristics through populations, for instance, a plan to release genetically modified mosquitoes to drive them to extinction in Florida. The gene modification would cause offspring to die before they reach reproductive age. The plan was abandoned because of risks, including the possibility that mutations would change the edit further. But substantial funding for gene drive technology ($75 million from the Bill Gates Foundation, and $100 million from the US DARPA) suggests that we haven’t seen the last of it.
Ethical considerations about public health and the impact on individuals must take priority when policy-makers consider such uses of biotechnology and even pharmaceuticals. It is worth repeating that the risk of unintended consequences looms large. Some may remember the infamous drug thalidomide that was administered to pregnant women to reduce nausea and morning sickness. It turned out that the drug caused many malformed babies to be born, including those without limbs or deformed hearts or eyes.
We keep coming across ethics issues when it comes to medicine. For instance, there is the finding recently (in Too much care? Private health care sector and surgical interventions during childbirth in India, an IIM Ahmedabad working paper by Ambrish Dongre and Mitul Surana) that 900,000 unnecessary Caesarean sections were performed in the private sector in 2016 alone. The motive is quite likely to be money, as a C-section costs Rs 23,978 versus Rs 10,814 for a normal delivery. It may be defensive medicine in fear of lawsuits, too; and some women may want kids on certain nakshatras.
There is also the salutary story of cholesterol. It was vilified for 30 years as the villain in all sorts of heart diseases based on apparently dubious experiments. After urging us all to control our intake of fats, demonising coconut oil, and making an absolute fortune for pharma companies pushing statins, the US medical establishment quietly reversed itself in 2015, and admitted that they had not been able to identify a causal relationship between cholesterol and heart disease. It speaks volumes for the ethics of research scientists, especially at a famous East Coast university in the US.
Then there was the sensational book Bad Blood: Secrets and Lies in a Silicon Valley Startup by John Carreyrou. It is a thriller; it lays bare the shenanigans at Theranos, a blood-testing company, which promised to run an entire battery of tests efficiently and cheaply (not to mention painlessly) on just a couple of drops of blood from a fingertip jab, rather than a big needle being stuck into a vein.
It was the perfect Silicon Valley story, until it wasn’t. Its rock-star chief executive officer (CEO) Elizabeth Holmes, a beautiful young woman who dropped out of Stanford at 19, and her chief operating officer, Ramesh ‘Sunny’ Balwani, an older veteran of tech companies, have been accused in civil and criminal cases of lying, cheating and outright fraud. They face many years in jail if convicted.
The company, once valued at $10 billion, ceased operations in September 2018. They had raised a billion dollars, had an all-star board with the likes of Henry Kissinger, George Schulz and Jim Mattis as members, and inked agreements with major pharma and grocery chains to create testing labs in their stories with Theranos machines. The media doted on them.
And then it all went horribly wrong. Theranos seems to be a Titanic that sank on hitting an ethical iceberg. It failed primarily because its technology couldn’t cut it; but the hype had become so all-consuming that instead of owning up to their deficiencies, Holmes and Balwani kept building an edifice of lies that finally came crashing down. Their story is a case study in ethics (or the lack thereof): when their proprietary machines proved unable to run the tests, they simply ran them on commercial blood-testing, equipped and pretended the answers came from their own devices.
John Carreyrou, who broke the first sceptical story for The Wall Street Journal, and then persevered for three years as the company bullied and threatened him, the paper and his sources, wonders whether Holmes, the CEO, “is a sociopath”, one utterly without morals.
These fiascos raise questions about a worldwide epidemic of lack of ethics. In India, we are inured to the fact that politicians, businesspeople, bankers, journalists, bureaucrats, and alas, judges, are not exactly the paragons of ethics we’d like them to be. The vast apparatus of corruption, rent-seeking and patronage-vending have ensured that India is one of the least ethical places to do business in, with only China being worse. The contrast with Japan, where there is a certain sanctity to contracts signed, is telling. There is also a difference with China: they will do unethical things for the glory of the Chinese nation; Indians will betray the nation for a pittance.
Not to accuse Americans of being overly ethical themselves, but they have a point when they claim that the Chinese have been brutally unethical in their practices such as commercial espionage, theft of intellectual property, cyber intrusions/theft, forced technology transfer and non-tariff barriers. They are fighting a total war.
The recent incident of an American fundamentalist Christian stealthily arriving in a prohibited island in the Andamans is also a cautionary tale. The Sentinelese, who inhabit this island, are known to be hostile to outsiders, and there are Indian laws that strictly prohibit contact, in particular because the islanders have no immunity to outside diseases. (One is reminded of how nineteenth century American colonists committed genocide on Native Americans by deliberately infecting them with malaria and other diseases.)
The American intruder, named John Allen Chau, was a medical technician, and so he knew that even minimal contact with the bacteria in his guts would probably be fatal to the entire small community of 60-100 Sentinelese. That didn’t deter him: he’d rather convert them to Christianity even if that meant they’d all die;
that didn’t matter to him. That man was probably a certifiable sociopath, if not a psychopath.
Plainly, in a world where greed and blind faith are tolerated, we need to create viable ethical frameworks. This is especially true for artificial intelligence, which does not come with a built-in set of ethics or morals or a conscience. Surprisingly, in a STEM (science, technology, engineering and mathematics) obsessed world, it turns out that one of the most important issues today is that of a pure humanities subject. Traditional dharmic principles of ahimsa (non-violence), dama (self-restraint), asteya (non-covetousness), saucha (inner purity), and satyam (truth) suddenly don’t look so bad. Indian innovators may need to take crash courses in Indian philosophy.