I think there is a rule in the application of science in medical settings: the first big step is taken by the person least suitable to take it.
Consider, for example, the first heart transplant. It was carried out by a showman surgeon who jumped the gun and did the operation before the problem of rejection was solved. So, who got the publicity, the queue jumper or the man who waited for the science to mature? Which name comes to mind most easily: Norman Shumway or Christiaan Barnard ?
Now we have an absurd, knight’s move intervention from China. He Juankui has jumped the gun by a decade, saying he did this to help a parent with HIV have healthy twins. It is an odd gene to delete, and might only afford partial protection. If you want to control HIV, the public health advice is to use a condom. If you have HIV there are drugs which reduce the symptoms and the transmission rate. Why go for this attempted vaccination which does not necessarily achieve the desired effect? CrispR is just a very sharp knife. It is not a roadmap into the genome. It does not of itself avoid unintended consequences. These are called “off target effects” and have to be estimated by other means. Is it gene surgery? That is showman hyperbole. The technique may have been used simply because it was possible to use it, and the location of that particular gene well-known, and the justifications added later. CrispR is not to blame. It is an excellent gene editing technique, precise and very cheap to use, and could eventually be used to deal with cystic fibrosis and other awful diseases which can be linked to very specific sections of the genome. However, off target effects will take time to reveal themselves. The results might not be pretty.
Fuller accounts can be obtained in other places.
What will this daft episode achieve? It will certainly anger many people. It stands a risk of further inflaming the debate so that all work in the field is tarred with the same brush. One guy’s experiments on a sabbatical could slow up more cautious research in many laboratories around the world.
On the other hand, absurd events can have a paradoxically liberating effect. They make people think. They bring ideas to the surface. Heart transplants did not work at first, but then became far safer. The upstart became a star, but the technique thereby got a massive boost, and overcame a perceived hurdle that the heart was somehow not to be tampered with, the heart of our selves.
This latest episode involves a very odd gene deletion, badly regulated, haphazardly reported, not yet fully revealed (the second twin might not have had an actual deletion), which might hold up better conducted programs to attempt to carry out more reasonable deletions.
On a broader scale, it could well be that CrispR is still a bridge too far, and not something we should meddle with in our own species. The unintended consequences are too serious.
In contrast, pre-implantation genetic diagnosis is looking like a far more acceptable route to take. It would only apply to IVF births, and would not involve any manipulations of the genome. All the parents would be doing is making an informed choice about which of their own embryos had the best chance of a healthy life. Nothing has been changed in those embryos, but a choice formerly done by the throw of a dice can be made on the basis of an informative polygenic risk score. Even if the gains are very slight, doing a little better than chance is a good place to start. Evaluating the benefits of pre-implantation genetic diagnosis will itself take time. Some results will require decades to prove. When the choice really matters, taking the long view seems far better.
The He Juankui intervention is a mess: hinted at, partly trailed, partly kept hidden and vague, an affront to science reporting. It did not leak of its own accord. However, the conversation which follows the event may do some good, and better interventions may yet follow.