Bioethics Final Project

CRISPR/Cas-9

Also known as Clustered Regularly Interspaced Short Palindromic Repeats, is a biotechnic tool that cuts and adds genes one desires. Developed by Dr. Jennifer Doudna and Dr. Emmanuelle Charpentier; CRISPR is more precise, cheaper and easier to use in contrast to Gene therapy. Moreover, this tool allows humans to utilize Germline and Somatic Gene Therapy; as presented by the diagram germline gene therapy directly alters the embryo, targeting all cells and impacting the future offspring of the edited embryo, in contrast to somatic gene therapy which only Inserts the gene directly into the individual affecting only them.

Why aren't these methods used today to combat HIV/AIDS?

Somatic gene therapy's biggest flaw is the fact that the cells inserted are temporal and may at any point die off, hence, this method could only strengthen HIV/AIDS which would make them even deadlier and more difficult to cure. On the other hand, germline gene therapy posses many ethical and legal risks - not only are there unforeseen consequences at hand, but also religious objections and ethical/legal concerns, with somatic gene therapy the human affected is able to provide consent whilst with germline gene therapy the embryo may not even be conscious and has no way of giving consent to being altered along with its offspring. Another major issue of germline gene therapy is the fact that mutations may occur at any point of time, there simply isn't enough evidence to gurantee that the altered embryo will be able to resist HIV.

Arguments in support of Germline Gene Therapy on Human Embryos

According to the World Health Organization last year in 2021 over 800,000 people have died from HIV related causes, with 38.4 million people still left suffering from it (World Health Organization.Data on the size of the HIV epidemic. https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/data-on-the-size-of-the-hiv-aids-epidemic) Most of these people are teenagers and adults in their middle ages - people, people with siblings, families, loved ones and friends; reading over the Bioethics Primer, one can clearly point out the regulation/control issue of this problem along with the ethical principle of justice - all of these people deserve to not only be given the right healthcare and treatment, but also an opportunity to prevent this virus from affecting their future offspring, germline gene therapy is an opportunity to eliminate HIV/AIDS once and for all, hence it should be up to an HIV patient whether or not they would like their embryos to be altered and given resistance against HIV. These people are not the only stakeholders in this situation, as the other identifiable stakeholders are those living in South Africa, with women ages 15+ especialialy affected by HIV according to the World Bank, do these young women not deserve a chance to ensure a long and healthy life for their offspring?

"It is not the strongest of the species that survives, not the most intelligent that survives. It is the one that is the most adaptable to change.” - Charles Darwin

So why not follow in the example of Charles Darwin and adapt to the change, accept the technology we're given and use it for good? If the HIV patients consent to germline gene therapy - then their kids could be the martyrs this world needs in figuring out a way of bringing the dream of a world with no disease. Sacrifices are vital, and are always needed in science and medicine, without sacrifices and brave volunteers we wouldn't have overcome and cured the black plague, the italian plague, the spanish flu, cowpox and the most recent Covid-19. No one knew if the covid vaccines would work on their first try, but someone was still brave enough to try for the sake of everyone else. So why not try and be brave to rid the earth of HIV and AIDS once and for all?

Arguments against the use of Germline Gene Therapy on Human Embryos

As lucrative and beneficial germline gene therapy sounds, we need to place our trust in the HIV/AIDS treatments.

Depending on how new the drug is, HIV treatment ranges from 110 to $1,200 which sometimes may be covered by insurance, those who cannot afford this treatment who live in poorer places such as South Africa, are given free HIV treatment, even the HIV tests are free of costs. According to a study posted in the National Library of Medicine by the title of "Survival rate of AIDS disease and mortality in HIV-infected patients: a meta-analysis", those who had received Highly Active Antiretroviral Therapy (HAART) would live 10 years longer with the majority of patients who did not receive HAART treatment dying within just 2. It is these insightful results that debunk the untruths of those who claim HIV therapy to be unsuccessful. Whilst it is not a permanent cure, it's still effective for now.

Another example to backup my claim is the controversial Lulu and Nana experiment that was carried out by the notorious He jiankui, a Chinese biophysics researcher who was an associate professor in the Department of Biology of the Southern University of Science and Technology in Shenzhen, China. He is well known for having edited the genomes of twin baby girls in a heritable way with hopes of them developing resistance to HIV, which not only earned him widespread condemnation for conducting such a risky procedure with little potential benefit, but also prison time for deliberately sidestepping regulations, dodging oversight and using fake ethical review documents all in the hopes of becoming famous.

Many years later, it has been found that Jiankui's experiment is ultimately a failure as the twins developed a mutation he could not have seen coming, which resulted in lowering their life span, meaning that their own offspring will most likely too - have a lower life span than the average. Thenceforth, it is these unintended consequences that be not only taken in consideration but be throughly researched, as bloodlines may forever be impacted and or destroyed by one small error and miscalculation.

My Personal Take

I strongly believe that germline gene therapy could prove useful In the areas that are greatly affected such as South Africa, if HIV patients were consent to the experiment of using germline gene therapy to combat HIV, then it could be tried out and tested with. However, this shouldn't be rushed - genome editing and germline gene therapy should still be researched more in depth, nations need to work together with other scientists, mandates should be passed to regulate germ line therapy and prevent it from being used unethically, background checks on patients wanting germ line therapy should be done, only what’s necessary should be edited, no phenotype enhancements or addition/removal of trivialities such as eye colour, and finally organisations such as UN and WHO need to figure out and set the boundaries for germ line therapy - because while the consequences of germ line therapy aren’t predictable nor controllable, it is something that could play a vital role in creating a disease free world; if people can overlook their desires for perfection and instead use the technology they are bestowed with for good, then in exchange for 5-10 martyrs - we could learn, adapt and save the lives of millions more. When it comes to medicine, sacrifices and martyrs are needed.

But at the same time, I am worried. Worried that people will not listen to each other and instead let their own desires drive them. This could case a large scale of economic disparity as some countries may push to create a nation full of healthy, strong and "beautiful" muscular people. Whilst other nations may strive off idealogies of engineering a perfect superior human race. Fascist ideals would be difficult to regulate and chaos could ensue as ethics get twisted to fit into people's ideals: "Principle of Autonomy we deserve to do whatever we want with ourselves and our offspring", "Religious objections - you cannot play god like this, only god can decide who's born healthy and or smart" with real cases of economic disparity being the drug companies asking you "How much is your life worth? How much are you willing to give for your child's health?"

Ultimately, my mind is made up and what I believe is that we humans are unreliable and untrustworthy of such power. No one can be trusted with this much responsibility. Which is why it is without a shadow of a doubt that human embryos should not be genetically modified in countries with high prevalence of HIV/AIDS. Leave this one for the passionate pure hearted people who will one day come up with a cure with a patent that "is owned by the people"