February 17, 2022

Use Gene Editing to Make Better Babies

A genetic disease runs in your family. Your doctor tells you that, should you wish to have a child, that child is likely to also carry the disease. But new gene-editing technology could change your fate. It could ensure that your baby is -- and remains -- healthy. Even more, it could potentially make sure your grandchildren are also free of the disease. What do you do? Now, imagine it's not a rare genetic disorder, but a general illness, or eye color, cognitive ability, or athleticism. Do you opt into this new world of genetically edited humans? And what if it's not just you. What your friends, neighbors, and colleagues are also embracing this genetic revolution? Right now, science doesn't give you that choice. But huge advancements in CRISPR technology are making human gene editing a reality. In fact, in 2018, a Chinese scientist announced the first genetically modified babies; twin girls made to resist HIV, smallpox, and malaria. The promise of this technology is clear. But gene editing is not without its perils. Its critics say the technology is destined to exacerbate inequality, pressure all parents (and nations) into editing their children to stay competitive and meddling with the most basic aspect of our humanity. In this context, we ask the question: Should we use gene editing to make better babies?

Main Points

For The Motion
  • The use of gene editing allows for couples to have children when they might otherwise have that option unavailable for them. It also allows for less to be left to chance during the pregnancy.
  • Gene editing will allow for babies to be born with reduced or eliminated chances of inheriting and passing on genes linked to diseases. We have a moral imperative to use technology that will improve the quality of life.
  • It is only a matter of time before gene editing becomes a widespread technology, potentially used by competitors and rivals on the international stage. If we have the technology, we should use it to our advantage to remain competitive.
Against The Motion
  • The use of gene editing to create “better” outcomes in children will inherently create social stratification based on any gene editing, likely reflecting existing socioeconomic status. Additionally, the term ‘better’ is arbitrary and potentially short-sighted, and dangerous.
  • Currently, there exist reasonable alternatives to gene editing for every condition for which gene editing can be used.
  • The technology is still developing, and the long-term effects of any gene-editing could be potentially dangerous with consequences echoing throughout the gene-environment.
  • 00:00:00
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    John Donvan:
    Picture this. A genetic disease runs in your family. Your doctor warns you that if you try to have a child, that child is likely to inherit the disease. But new gene-editing technology could change your child's fate. Critics say this technology will exacerbate inequality, pressure everyone into editing their children to stay competitive, and will meddle with the most basic aspect of our humanity, our DNA. Others say with safeguards against abuse, this technology could benefit us in a host of ways. In that context, we debate this question, should we Use Gene Editing to Make Better Babies?

    Thanks, everybody, for joining us. And today, we are examining the science and the ethics of a new reality. The fact that we humans now have the capability, and perhaps we should call it, the power to change our DNA, all because of stunning and stunningly fast developments in the field of gene editing.
  • 00:00:57
    Yes, there are rules and regulations being written about this all the time to try to catch up to where the science keeps going. And different countries are doing that in different ways. But the core issue surrounding the possibilities presented by gene editing comes down to this; just because we can, does that mean we should? That is the debate we're launching right now. I'm John Donvan. And this is Intelligence Squared.

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    Okay, everybody, you have a duty to perform here now. And that is to judge this debate to tell us which side you feel argued most persuasively.
  • 00:01:59
    We're going to ask you to cast a vote on our motion, Use Gene Editing to Make Better Babies before you've even heard any of the arguments. And then we're going to ask you to vote a second time after you've heard what everyone has to say. And here at Intelligence Squared, we name as the winner of the debate the team whose numbers go up the most, between the first and the second vote in percentage point terms. The first vote is happening right now; here's what we want you to do. Go to IQ2US.org. That's IQ2US.org in a web browser. You will there find a multiple-choice field where you will tell us whether you are for, against, or undecided on the statement, Use Gene Editing to Make Better Babies. I'll give you just a couple more seconds to get that first vote in. I'm watching you do it. Okay, I think you've done it. So, now it is time to meet your debaters.

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    Arguing for the motion, Use Gene Editing to Make Better Babies is George Church renowned geneticist to help develop the first direct genomic sequencing method which led to the Human Genome Project.
  • 00:03:03
    His partner, Amy Webb, founder of the Future Today Institute and author of "The Genesis Machine." Opposing them, Francoise Baylis, a leading bioethicist and philosopher whose research extends to heritable human genome modification. Her partner, Marcy Darnovsky, executive director at the Center for Genetics and Society, who has written extensively about the politics of human biotech. And now here we are all together. I want to thank everybody for joining us for this Intelligence Squared U.S. debate.

    Multiple Speakers:
    It's great to be here.

    John Donvan:
    So, let's move on to round one. And round one is comprised of opening statements from each debater in turn. These statements will be four minutes each. Again, our motion is Use Gene Editing to Make Better Babies. And speaking first in support of the motion, here is George Church. George, the screen is all yours.
  • 00:03:57
    George Church:
    Thank you. The answer is yes, we should Use Gene Editing to Make Better Babies. Unpacking this a little bit, gene editing includes subtracting, adding, or substituting DNA in cells. Our debate topic very notably does not mention heritable or germline. To make better babies means making them healthier, as in how -- is your baby feeling better today? This debate is not about can anything go wrong. Of course, it could go wrong. But rather than banning cars completely, we regulate, we minimize risk via airbags, children's car seats, and speed limits. Benefits must weigh -- outweigh the harm. That's the decision. Similarly, we've been working very hard to minimize potential risks of gene therapy and editing the negatives, off-target effects, slippery slopes, the unneeded enhancements, high costs, and high unknown impact in unconsented future generations.
  • 00:05:05
    This debate is about given extensive safety improvements and testing. Will we accept FDA-approved use of gene editing in babies? In fact, do we approve of gene editing that is already happening to make babies better? For example, CAR T anti-cancer therapies involve gene-editing babies as young as seven months. AstraZeneca and Sputnik COVID-19 vaccines are dental, viral capsid delivery of DNA, which via maternal antibodies protect babies. Note that the cost of these can be as low as $2 a dose, which is a big step towards equitable access, which I know is an issue. Even earlier in life are prenatal gene therapies. These have been tested since 2018 for goiter disease, in which babies would otherwise die in two years.
  • 00:06:01
    Many serious de novo genetic diseases in babies are undetectable in parental genomes, for example, Rett syndrome, which also has a gene therapy and testing. So, we need to do this independent of the parental risk. Any one of these four examples, CAR T, COVID, goiter, and Rett, should be sufficient to settle this debate. But what if we feel obliged to also consider heritable changes or enhancements, despite both topics absent in the debate title? If so, then consider the scenario of a human-specific disease without effective vaccines and with persistent and emerging drug resistance over decades, as for example, HIV and malaria. Germline editing of one or more proteins could make ourselves more chimpanzee-like and hence make us resistant with few or no side effects, as is seen in nature for HIV and malaria.
  • 00:07:04
    Where chimpanzees a resistant to our particular form. Rather than a ban on FDA-approved gene editing, as we have now, in certain cases, we need to encourage a culture of whistleblowing on inappropriate use. Current laws did allow criminal punishment of three people so far, but these laws do not necessarily prevent future abuses of the same nature or prevent covert governmental use. So, this is what we should emphasize we resist while just as emphatically encouraging carefully regulated clinical trials on gene editing to prevent childhood diseases. So, please vote yes, for ethical, cautious gene editing to make better babies.

    John Donvan:
    George, for people who don't know the terminology, can you please just take a moment to define germline for us?
  • 00:07:59
    George Church:
    So, germline gene therapy would be something that affects not just the individual but affects subsequent generations. Heritable is another term. Somatic gene therapy would be something that only affects the current generation, as far as we know. That's the distinction.

    John Donvan:
    Thanks very much, George Church. Our next speaker will be speaking against the resolution here is Marcy Darnovsky. Marcy, the screen is yours.

    Marcy Darnovsky:
    Thank you, and thanks to Intelligence Squared for organizing this important conversation. So, to be clear, I'm going to be talking about reproductive or heritable gene editing, which I think is what most people understand when you're talking about making better babies, and which is what the policy debate that's been going on is really about. So, my strong belief is that using gene editing this way, in an attempt to make so-called better babies, would be both wrong and dangerous.
  • 00:09:00
    It would be wildly unsafe for those babies. Certainly, that's true now, and probably always. And it would have the terrible effect of exacerbating our already horrendous social and economic inequalities. In fact, it would throw open the doors to new kinds of social injustice. And on top of that, heritable or reproductive gene editing isn't needed for any medical reason. That's the justification that's typically given that it's weak at best. Let's take a look at that. Say that you have a harmful gene variant, and you want to make sure your children don't have the disease that it causes. Here's the thing. You can already do that, and you don't have to muck around in your future children's DNA to accomplish it. In fact, everyone with a disease-causing gene can have children unaffected by it by using donated eggs or sperm.
  • 00:09:57
    And very nearly everyone is in that situation can have uninfected children who are also genetically fully related to both members of a heterosexual couple by using a safe and established embryo screening and selection technique. Now, it's important to say that embryo selection isn't itself ethics-free; it does raise thorny questions about what kind of people will welcome into our world. But using gene editing to create future children and future generations would amplify these concerns many times over and would carry additional grave social risks and safety risks. What reproductive gene editing does make possible his attempts at human enhancement. And even if those attempts weren't successful in biological terms, the perception that genetically modified children are biologically better than others would make the already obscene inequalities of our society much, much worse.
  • 00:10:59
    And that is the likely societal consequence of attempts to create better babies, even if those attempts are well-intentioned. Now, some proponents of heritable gene editing, like George Church, for example, are open about wanting to eventually use it for enhancements. But that would mean we'd be putting our efforts toward building a world of genetic haves and have nots. As geneticists Eric Lander, who is now the top science adviser to President Biden, has put it, the so-called best genomes would go to the most privileged. Now, to be sure, enhancing complex traits like IQ or musical talent, those are technically dubious; the traits are just too complex, but supposedly enhanced children would be perceived differently, and they would be treated differently. The wealthy parents who invested money and energy in them would make sure of that. And then, the advantages that come with wealth would be attributed to genetics instead of to privilege.
  • 00:12:02
    I think it's really farfetched to think that lots of people would be able to afford this in a society where millions of people have no access to basic health care. And if you've seen the movie "Gattaca," you know how this turns out. A world in which the genes that your parents are able to afford determine where you go to school, where you can work, even your dating prospects. In the real world, better babies were the project of early 20th-century eugenics. It may have seemed benign when U.S. eugenicists had better baby contests at state fairs. But we know about the ghastly outcomes of that project. Reproductive gene editing, of course, would be different, not enacted by government policy or coerced by state violence but driven by commercial dynamics, marketing offers, peer pressures on parents.
  • 00:12:55
    So, the bottom line, gene editing is a remarkable scientific achievement if used wisely; it carries enormous promise. So, let's use it to treat people who are sick, not to design babies.

    John Donvan:
    Thanks very much, Marcy Darnovsky. Next up on the screen with an opening statement in support of the motion, Use Gene Editing to Make Better Babies. Here is Amy Webb. Amy, it's your turn.

    Amy Webb:
    John, thank you so much. And I would like to appreciate and thank the Intelligence Squared community for allowing us to engage in one of the most important and enduring debates of our time. And Marcy, I really appreciated your thoughtful remarks. In his opening remarks, you heard George make a case for ethical cautious gene editing. And I'd like to venture a little deeper into the reasons why gene editing should not only be allowed but that we ought to champion gene editing right now. We are living through an inflection point in humanity; we can now read and debug the code of life. There are three reasons why we ought to further develop this miraculous technology.
  • 00:14:00
    First, nature is literally full of bugs. The natural world is riddled with errors and mutations. Millions of babies are born each year with errors in their biological code, awful mutations that cause diseases like Tay Sachs disease and cystic fibrosis. Until recently, there was no way to know in advance if an embryo had that mutated code. Gene editing allows us to make corrections in that code and to prevent it entirely. If we can prevent human suffering, we are morally obliged to do so. Second, humans in our current form are vulnerable to external threats like novel viruses. It's plausible that SARS-CoV-2, which causes COVID-19, will become endemic, like influenza, but there are so many other lethal viruses that persist, you George explained just a few of them, HIV for example.
  • 00:15:02
    There's also MERS, the Middle East Respiratory Syndrome, which has a mortality rate of around 35 percent. Gene editing makes us less vulnerable to the 1500 or so species of pathogens to humans that we know today. And the billions of pathogenic viruses' protozoa organisms that, luckily, we haven't encountered yet. Gene editing makes us more resilient. Third, humankind needs optionality. The resolution that we are affirming today is that we should Use Gene Editing to Make Better Babies. The survival of our species requires intervention. Humankind is part of a larger biological ecosystem, earth, one that's changing faster than we are evolving naturally on our own.
  • 00:15:56
    It's improbable that the world's largest economies will ever align on CO2 reduction, geoengineering, or other climate mitigation strategies. Gene editing will, at some point, give us the chance to make edits and upgrades to enable us to live comfortably in our communities. Now today, you are likely to hear our opponents say some pretty scary things. In fact, you've already heard some pretty scary things. Marcy has already talked about wildly scary potential outcomes. A future in which we have "Gattaca"-like haves and the have nots. Where rich people get to create designer babies, the way that you would walk into a Build A Bear Workshop in the mall and select all the traits that you wanted to include in your baby. There is no evidence, and you will hear George and I say this over and over again, that there is no evidence to support the claim that gene editing will benefit the wealthy specifically. In fact, there is ample data and ample evidence to support the contrary.
  • 00:17:00
    I'm here along with George to make the case that gene editing can be safe, but I'm not a geneticist. I'm a quantitative futurist. I'm a social scientist. And I use quantitative and qualitative data to build scenarios that model next-order outcomes. So, I'm here to help you understand the dangers of catastrophizing. There is no way to predict the future it is statistically and mathematically impossible. When we are looking at something with as many variables as the futures of life, where an unknown number of variables under no one person's control are at play. We cannot accurately predict the future, but that does not give us a license to speculate wildly about what might happen, like assuming that gene editing will inevitably lead to catastrophic outcomes. Agreeing with our opponents today is tantamount to robbing our futures simply because we refused to change our mental models.
  • 00:17:59
    Voting yes on this resolution doesn't automatically lead to "Gattaca," to a dystopian future. Voting yes gives us optionality and a chance to improve our wellbeing. Thank you.

    John Donvan:
    Thank you, Amy Webb. And now we go on to our final opening statement. And it will be against the motion from Francoise Baylis. Francoise, the screen is yours.

    Francoise Baylis:
    Thank you. And I really appreciate the opportunity to sort of share some of my views with the audience. I want to say at the outset that in the abstract, I'm willing to be persuaded that we should use human genome editing technology to build better humans. But the problem for me is I've yet to hear what I would consider to be a really robust definition of better. I think what constitutes better in the minds of some is a function of where we are at this moment in time. And so, in some sense, it's a little bit of a fad. Today, this is better, tomorrow, something else is better.
  • 00:18:56
    The other thing I haven't heard really is a really good argument that actually tells us why we should spend our time, talent, and treasure on this particular technology in pursuit of a reproductive goal of building better humans. So, I want to be very clear about this. The time and talent of members of the scientific community and the resources that we have to invest in science are limited. And so, we actually have to make decisions about where we want to make those investments. And that's why I want you to vote against this motion. I think there are better things we could be doing with our time, our talent, and our treasure. So, let me just share with you what are the common arguments that are typically brought forward in, you know, support of the motion? One of them is the right to have genetically related children. It is said repeatedly that there are people, parents, prospective parents, to be more precise, who are at risk of having a child with a serious genetic disease, perhaps even a lethal genetic condition.
  • 00:20:00
    They want to have children; they have the right to have children. The second argument often brought forward is that we use enhancements all the time. Why think we should stop here? And the third argument, which you've just recently heard, is that it's important for humans to take over the human evolutionary story in order to ensure our survival. Well, I want to very quickly go through these and show you why they're not persuasive. First of all, there is no right to have genetically related children. Saying doesn't make it so. There is, in fact, no international agreement in support of this claim. What there is, is a right to reproductive claims, but they are very specific. So, when you hear the words reproductive rights, it's actually about the right of women to control their bodies, to control the timing, the spacing, the number of children that will make up their family.
  • 00:20:58
    So, it's really about access to things like contraceptives or termination of pregnancy. The second claim about we use enhancements all the time is, in one sense, very true. I mean, that's why we send our children to school. That's why some parents give them piano lessons because they've heard it helps with their math abilities. It's why we have things like cosmetic surgery. But I want to suggest that there's something fundamentally different in this context, where you're actually tinkering with that which makes human life. And that's true, whether you're talking about tinkering with the gametes or tinkering with the embryos. And the third point is about taking over the human evolutionary story. Well, I understand that in the context of what we're currently doing, which is wrecking our planet. And so, there are people who imagined that there would come a time when we can't survive here, because the water is polluted, the air is polluted, we've got problems with climate change, et cetera. And so, they really are careful about looking at this as a design project.
  • 00:21:56
    And so, we need to redesign the human so that it can either survive on this planet and would be able, for example, to drink polluted water and not get sick. Or it's a design project where we have to get off of this planet. And we have to be able to survive on another planet or in a spaceship. And I really want to say, gosh, that seems a pretty extreme response when all we could do is not wreck this planet. And so, what I want to say very clearly is it's important to understand that this is cool science. But we should be using science to build a better world for all of us. And I really worry that this ultimately will be a form of personalized medicine that will really promote the interests of a select few. And you and I probably won't be amongst that select few.

    John Donvan:
    Thank you very much, Francoise. And that concludes round one of our Intelligence Squared U.S. debate. And now we move on to the second round. And the second round is much more of a conversation where the debaters address one another directly. They also take questions from me, which is how I'd like to actually start this round.
  • 00:23:00
    I want to go to Francoise because Francoise, Amy is challenging your central claim by saying there is no evidence for it. So, I'd like you to take that on, no evidence for the claim that there would be haves and have nots in this future.

    Francoise Baylis:
    Well, I can actually respond to that very easily because I'm actually the only panelist that lives and works in a country that has government-funded health care. And we provide that health care to everyone. So, we don't even have to talk about fancy technology or enhancement. We can just talk about basic health care; we make that available to all citizens. That's not the case in the United States. And so, why would you imagine that this very complicated, very expensive technology somehow would all of a sudden become available to everyone? They're not hypothetical; there's a whole world that has told us and shown us repeatedly that you can't get access to basic health care. So, why would you think that personalized medicine is now going to be readily available?
  • 00:23:58
    Now, the other thing I do want to say because I think it's important in some of the other comments that have been made is, on the other side, you're hearing a lot about safety and efficacy. And we may not be there yet, but we will be there. And then all we need to do is rely on, you know, appropriate regulations and oversight. I think what's really important to say here is that, for me, this isn't just about safety and efficacy. It's about a worldview. It's about the kind of world we want to build and the kind of humans we might want to have in that world. And so, you know, I want to say really clearly, we already know, for example, how to safely and effectively destroy the rainforest in the Amazon in order that we can have cattle grazing. I wouldn't say that's wrong. We can already safely and effectively if we wanted to destroy the Mona Lisa. I'd still want to say that that's wrong. So, we cannot rely just on safety and efficacy getting us to a point where we then assume that all that matters is governance in the strict sense of applying legislation, guidelines, rules, treaties, what have you.
  • 00:25:05
    What we really need to understand is this is about the kind of world we want to build. We start off by talking about, oh, this is so important, it's going to allow us to treat, and I'm saying that in inverted commas, children with terrible, inherited diseases. And that's not what it gets used for.

    John Donvan:
    George, Francoise is saying there's already plenty of evidence that the equity, maybe to some degree, the ethics have already demonstrated themselves to be slippery and observed only in the breach, that the story is already quite worrisome. And I would like to ask you to take that on.

    George Church:
    I agree. But I was pointing out that these are approved. And if they -- and the -- if, on the other hand, things that are -- that we would like to see, that would be equitably distributed, would be things such were inexpensive.
  • 00:25:58
    That's why I mentioned that the gene therapies that fight COVID are as low as $2 a dose, and they could be lower, and they can be because there's a gigantic economic benefit they can be given away freely and often are. That's the sort of thing that would be acceptable, I think, is something where there's a strong health consequence. And it can be distributed globally. We're not looking for all the ways this can go wrong, as I said, we're looking for the few cases where it could go right.

    John Donvan:
    Well, Marcy, hearing what George has to say, is there really that much difference between your position on this resolution and his?

    Marcy Darnovsky:
    I think there's a huge difference. Yes.

    John Donvan:
    What would that be? Yeah, go for it.

    Marcy Darnovsky:
    Well so, you know, it's really interesting to hear you, George, agreeing that you know germline is such a problematic enterprise. And that's not how I've interpreted your past remarks. So, I don't know if you've changed your mind, or if it's just that for the purposes of this debate.
  • 00:26:59
    We need to be much clearer about our terms. I think it really muddies the understanding if we talk in one breath about making changes to embryos or gametes that will be then present in every cell of every tissue of any resulting child and all future generations that that child gives birth to, that's heritable or reproductive or germline gene editing, using gene editing, to produce vaccines, or even to produce gene therapies that alter the tissues of an existing patient. Those are really different things, apples and oranges; they're considered that way in the debates, are considered that way in policy, and in for the purposes of our conversation today, I think it's really important to keep that distinction quite clear.

    John Donvan:
    Amy, I'd like you to jump in and take on a question that has to do with a more geopolitical kind of presentation here.
  • 00:27:59
    And that is that while it has already been pointed out that governments are not the only agents in this whole process, governments are agents in this process. And we're in a world where we can certainly imagine that certain governments would commit to improving through gene editing, through inheritable gene editing, their citizen's health, their intelligence, their resilience, their physical strength in order to be competitive in the world stage. I want to ask you to take that on. Do you think that that is a realistic scenario? Do you think it is one to be concerned about it? Is it one that you think that we would want to be responding to?

    Amy Webb:
    I think the answer to that is yes. Listen, the United States and China are two of the world's largest economies, certainly in one of the largest innovation ecosystems, where science and technology are flourishing in different ways. And unfortunately, oftentimes, the technology and science become embroiled in politics.
  • 00:28:59
    The development of AI is already part of that strategic race between the two countries. And if we're not careful, gene editing is going to wind up in the same place. Now, you've heard Marcy and Francoise talk about regulatory frameworks that exist around the world. But there is still quite a bit of disagreement in different countries on, you know, how to approach some of this going forward. There's also some alignment in unusual places. So, in Germany, there's the German Ethics Council exists to some degree because of experimentation that took place under the Nazi regime in World War Two, you know, even they have started to come forward and, you know, imagine a future in which germline editing that's regulated that exists within boundaries. So, none of us here today are talking about unbridled experimentation, but a future in which this might be beneficial.
  • 00:30:01
    So, again, this isn't about an enhancement or enhancements sake or optimizing for optimization's sake. We've really left, you know, our evolution up to serendipity and happenstance and chance until this point, and we have an opportunity to just think a little differently. Part of what hearing today --

    John Donvan:
    But your opponents are saying is that it would turn very quickly into enhancement for enhancements sake, that if somebody --

    Amy Webb:
    But we don't have -- yeah, John, I get it. I hear that, and I hear this argument all the time. It's what I call the paradox of the present, we use what we have seen or heard previously and assume that that is what's probably -- it's what's most likely to go forward. I model probabilities for a living. And at the moment, we don't have enough evidence supporting the claim that this will necessarily take a dystopian route. George has already -- look, we all agree that there's a lot of danger here. But there's also opportunity.
  • 00:30:58
    And the opportunity comes through thoughtful use, regulation, and frameworks. To sit back and pull the plug on all of this because we're not willing to come to the table and sort out what the regulation should look like is not, you know, is dismissive.

    John Donvan:
    Well, I'm not sure your opponents are saying to pull the plug on this process. But I just want to check in with them. Francoise, or Marcy, are you -- is your argument, let's stop this?

    Marcy Darnovsky:
    We're not -- no one is arguing that we stop gene editing. We believe, I think I can say for everyone here, that gene editing holds promise. And yes, it does have to be carefully regulated, and the many smart people who have fought over decades about how to regulate it have really come to the same conclusion. There's no disagreement among between countries, there's disagreement within countries, yes, there's disagreement within the scientific community, with many taking the position that is reflected in the motion, Use Gene Editing to Make Better Babies.
  • 00:31:59
    And many equal numbers may be greater, we don't know for sure, taking the opposite position, the position that I take and Francoise's take that we should vote no on this resolution.

    Francoise Baylis:
    Yeah. So, if I can just jump in here, I think it's really important to acknowledge the following. There's a fair bit of diversity between countries right now with respect to using genome editing technology in the lab. And there, you will see some countries that are actually supportive and have legislative structures and governance in place to carefully regulate that kind of manipulation. But you do not see that diversity with respect to taking those embryos and pursuing a reproductive project. We've done that empirical work, and it shows very clearly a, I want to say, unanimous, but it's kind of difficult to say that in the context of we were not able to find documents for some countries. But for the countries we were able to find documents, which is more than half the countries of the world, we were unable to find a single country that actually officially approves, endorses this technology.
  • 00:33:03
    So, that's just a fact of the world today. Could that fact change? Of course. So, the other thing I would like to say, and this is the first time I want to agree with my opponents with respect to the debate, I agree we cannot predict the future; none of us can do that accurately. So, in the absence of having that kind of ability, I think it is reasonable to look at where have we shown talent before. What have we done in the past? And what we have done, and we have done it in spades in the last 20 years or so, is we have blindly gone along a path which has increased inequity to the point, I would say, of crisis. So, why would we think that all of a sudden, that's just going to turn on a dime? We're seeing right now inequities that are at a level that is shocking, and they've been, quite frankly, exacerbated by the pandemic we're living through now.
  • 00:33:54
    So, I do worry about what I perceive, anyhow, to be a certain amount of hubris to say, well, you know, there are lots that's wrong right now with the human genome, and we can fix it. And I'm thinking; really? How do you get that confidence that you won't make a mess of things? And why is it unreasonable to predict that no, everything is not going to go right, it could really go off the rails. It seems to me that both proposals are possible.

    John Donvan:
    Amy, go ahead. You're shaking your head.

    Amy Webb:
    Yeah. Listen, again, with respect to everybody's thoughtful comments here, there is no evidence. So, the issue is that the types of inequity that we're talking about are often brought into this debate, but there is very little evidence that would show that the future is one in which there's less equity because of this intervention. On the flip side, if we are in a position which we are nowhere close to being, by the way, but if we are someday in the farther future, in a position to do editing at scale, what would it have taken for that to be true?
  • 00:35:00
    For one thing, it would take genomic databases that are orders of magnitude larger than we have today. And for that to have happened, we would need more people to agree to have their genomes sequenced and to participate in studies. At the moment, most of the people, most of those databases are fairly homogenous. So, the current situation is that we have mostly Caucasian people from mostly wealthy countries who are in these databases to begin with. If we --

    Francoise Baylis:
    But Amy, you're making our point.

    Amy Webb:
    I'm not.

    Francoise Baylis:
    This is like the proof that there will be inequity.

    Amy Webb:
    I would love to finish my thought because there's something subtle here that I think gets missed in this conversation. If we take a much longer view, over many more years, what we have is an opportunity to bring inclusivity into the current processes. And on the other side of that, if we have therapies, at the moment, we don't have structures in place for who would pay for anything.
  • 00:36:00
    What we know to be true today is that we have a therapy that's been covered by governments and in the United States. We don't have nationalized health care; we have free vaccines. The reason that the inequality exists is not socio-economic. There are data proving that out. It has to do with misinformation.

    Francoise Baylis:
    I disagree.

    Amy Webb:
    Because people -- we're all free to disagree with each other. But please, somebody show me the data to support those claims. Data is what I work with for a living.

    Marcy Darnovsky:
    Oh, my goodness, Amy, there's so much data about social health and economic disparities.

    [talking simultaneously]

    Amy Webb:
    I'm specifically talking about the COVID vaccine.

    Marcy Darnovsky:
    But you can't pick out one example of free vaccines and have that to be a substitute for equity in health care and health conditions.

    Amy Webb:
    I'm not. I'm saying that it's useful for us to use that as an example.

    John Donvan:
    George, I want to come back to you with a question that circulated around a little bit before because you've been in this field, it is your field, you know its potentials and where it's going and the realities of working in the science on a day-to-day basis.
  • 00:37:00
    Do you have any concern to, you know, a version of what your partner Amy said that we're sort of holding ourselves back? I want to put it another way, that we would be left behind competitively in the world market, in being able to develop and control and use this technology?

    George Church:
    I'm not concerned about the competitive market because I think that -- I would like to believe that if any nation leads, the others will follow. And I don't particularly care who leads and who follows up; I want to float all the boats. I am concerned that inaction is not a foolproof strategy, we can really screw up by being slow or inactive in the process, which is exactly what happened with COVID-19. We were slow to adopt net masks, vaccines, distancing, tests.
  • 00:38:01
    And we could do that again with a whole variety of emergency cases. And the gene therapies that were used for vaccines were dirt cheap because millions of people benefited. And I think that's where the future lies, is helping the poorest people and helping them --

    John Donvan:
    Is that helping for better babies? Is a vaccine part of the argument for helping better babies?

    George Church:
    It is because Francoise has asked for a robust definition and I can't give the most robust, but the definition I gave is that they are healthier. They are healthier than our ancestors' babies were, they are healthier than they would have been otherwise --

    Marcy Darnovsky:
    But it's really important, both for this conversation and for our conversation about vaccines, to be very clear that vaccines do not change the genes of human beings.

    [talking simultaneously]

    So, I'm afraid by muddying the water, you're getting us into very deep-water, George. Yeah.
  • 00:38:59
    Francoise Baylis:
    Sure. I just wanted to jump in and say that I think one of the things that are highlighted there is something that I've written and spoken about a lot, which is the difference between wants and needs. And one of the things that I think is important is to understand that we can't always respond to what everybody wants. We do have more responsibilities to respond to needs. And so, I think the thing that's really interesting is where does family making fit in that kind of a conversation? So, I think a lot of people want to become parents. A lot of people want to have genetically related children. I don't think we have a moral obligation to respond to that want. And let me explain it this way. If somebody needs food, of course, I should give them food. If they turn around and say they want a croissant, like, well, no, you have a need for food, you may want some other kinds of food, but that's not where I have a moral obligation to respond.
  • 00:39:51
    And so, in that context, I think it's really important to think about ways that you might offer therapies, perhaps even, you know, genetic therapies, to your child who's born and perhaps has a genetic condition that could be treated, as contrasted with selecting in advance traits that you think are desirable, and then putting this together to try to make what you think is the better baby. And I want to make one more point, which is that there are places that have already started to advertise this. There's a couple of clinics, I think, unscrupulous clinics, and I'm quite convinced that they can't actually provide anything that they say they would provide. But they're proposing to use CRISPR to do things like change skin color, change hair color, and increase breast size. I'm sorry --

    [talking simultaneously]

    John Donvan:
    But Francoise, what's interesting in this debate, I don't think your opponents are endorsing at all those sorts of enhancements.

    Francoise Baylis:
    I totally agree. That's meant to talk about what might the future look like. So, we've been hearing whether or not we can predict the future. And I'm saying, well, here's an example about the present and the ways in which that technology is being marketed.
  • 00:40:58
    So, I think that does speak to what I might anticipate happening in the future, which is that more unscrupulous clinics might offer these kinds of interventions under the guise of building better babies.

    John Donvan:
    And if there were the ability to genetically edit out a risk for Alzheimer's, which challenges cognitive cognition, would that be a good thing to go for? George?

    George Church:
    I think this nicely -- I mean, first of all, there's plenty of -- we're not usually interested in all forms of intelligence, we probably should be. It's very often a very narrow thing that people would want. And they're very narrow types of intelligence have been shown to be fairly easily manipulated in animals. I think the place where we should draw the line is where Francoise was saying about worldview, and what we actually want to do and outcomes rather than the mechanism by which we achieve those outcomes.
  • 00:42:00
    So, what worries me is that we will develop drugs and gene therapies that will address Alzheimer's in adults. And they will be used off-label for enhancing intelligence in adults. And then we will truly have the imbalance in the social divide that we're trying to avoid with this arbitrary line in the sand. I totally applaud the avoiding inequities, and in fact, straightening out the inequities we have right now. But I don't think that saying that you can only fix it if you have enough money to cure Alzheimer's in somatic cells, and you can't do it in the germline.

    Francoise Baylis:
    So, can I just interject? I actually would like to offer a response to both formulations of your question. The first one was, you know, about increasing intelligence and IQ.
  • 00:42:54
    And at the time, in response, I thought the only way I would have to answer that question was to refer people to Jonathan Glover, a philosopher who, when asked that kind of question that, of course, yes, we need to do that. Why? Because we're too stupid to stop wars. And so, what that already tells you is that the focus is on what's the goal, what's the objective? And so, in that context, it wasn't about getting a competitive advantage. It's about how can we make the world a better place, and we're not doing a very good job of it right now. And then you reframed it in terms of Alzheimer's. And one of the things that, you know, I wanted to share is that my mother passed away of Alzheimer's disease, and our family lived with that through a period of about 10 years. It was very difficult, it was very challenging, it was hurtful. My mother was a very strong and powerful woman and I thought this was a terrible way for her to exit this world. And yet, at the same time, I think I'm a better person for having lived through that experience. And I wanted to say that in the context of having challenges that we have to face and overcome, and sometimes they're very deep and hurtful, but they make us who we are, and they make for the rich diversity.
  • 00:43:59
    And I think we ought to be worried about trying to always massage things in the world so that we're better off in some sense. And again, it's that question, what does it mean to be better?

    John Donvan:
    Well, very, very profound way to finish round two, I want to thank all of you for the conversation we just had. And now we move on to round three, and round three will be comprised of opening statements by each debater in turn. They will be two minutes each. And the first to speak in support of the resolution is George Church. George, once again, the screen is yours.

    George Church:
    Thank you. I want to make sure that we're not confused between somatic and germline. I'm using vaccines as an example of something where we can create equitable health care, not as an -- and in some of them do involve gene therapy, but somatic gene therapy. The germline, I consider that there is a possibility that we have not ruled out the germline could have a similar equitable response to emerging emergency use.
  • 00:45:03
    To that point, all humans since 1978, are enhanced relative to our ancestors with respect to smallpox. All of us, not just the rich. Our parents immune cell DNA was altered not the germline. One person in a million vaccinated did die of side effects; subsequent generations were not consented. But are we grateful for this, arguably the only equally distributed technology in history? Yes, I think most of us are grateful. Would we do the same for malaria or another disease like it? Yes, I think we would even if it evolved germline -- sorry, gene editing. Yes, germline, I think the jury is out. Would we use or continue to use gene editing for CAR T, COVID, goiter, Rett, et cetera?
  • 00:45:59
    I would say yes, germline, you decide. But please vote yes; there are reasons to use gene editing to make better, healthier babies.

    John Donvan:
    Thank you, George Church. Our next speaker will be making her closing statement against the motion. Here is Marcy Darnovsky.

    Marcy, your turn again.

    Marcy Darnovsky:
    Thanks, John. So, the motion today is using gene editing to make better babies. And what do we mean by better babies? How do we imagine what better babies would look like? Well, I have a collection of magazine covers that feature pictures of so-called better or designer babies. And these magazines include mainstream weeklies like TIME, women's magazines, like Cosmopolitan, and popular science magazines like MIT Technology Review. And the babies that they used on their front covers are supposed to sell magazines, of course, but they're doing that by illustrating what the imagination today of heritable gene editing looks like.
  • 00:47:04
    And all these babies have some things in common. Every one of them has blond hair, blue or green eyes, fair skin. And I think that reflects a likely future if we allow gene editing to make better babies, and it's why we should keep the door shut. Finally, I want you to imagine a world where newborns are labeled as good or bad, better babies, or not better babies, based on the DNA that was sold to their parents at the fertility clinic. This will be a world where the wealthy buy genetic privileges for their children and pile those on top of their other advantages. And now we can imagine a really different world where children are all born with an open future with their lives full of possibility, where society's resources go for providing all children with clean air, clean water, basic health care.
  • 00:48:02
    So, please vote no on this motion. Voting no is about against opening the door to a new form of high-tech market-driven eugenics. Voting no is in favor of using our social resources to develop new medical treatments for people who are sick. Let's use gene editing to treat patients, not to make supposedly better babies.

    John Donvan:
    Thank you, Marcy Darnovsky. Our next speaker will be speaking in support of the resolution to Use Gene Editing to Make Better Babies. Here is Amy Webb.

    Amy Webb:
    Today's debate was not about designer babies, it was about improving health and health outcomes in a safe future way. Now, Marcy said earlier that we don't have evidence in some cases because we're talking about the future, which I deeply appreciate and agree with. But you also just heard Marcy describe a probable future of Aryan super children, blond hair, blue eyes, we keep seeing them over and over again on magazine covers.
  • 00:49:02
    And what we know to be true is that that's not a foregone conclusion. It's simply artifacts from what already existed; we can develop guardrails to prevent against the future that she's describing. In fact, we do have data and we can build out models, this is what I do, to explore next-order outcomes. I asked you at the beginning to avoid catastrophizing so that we could have an open dialogue, not to use the past to predetermine what the future might look like. And I think we've succeeded today in helping unlock probably how you are thinking right now about what the future of gene editing might look like. We have to be willing to think through alternative futures not using a utopian lens but rather pragmatism. Until now, powerful stories about the futures of gene editing, "Gattaca," eugenics experience experiments, they take up a lot of space in our minds.
  • 00:50:02
    So, what I'd like to leave you with is a different type of story, a story of a family they I used to babysit for. The father was a lawyer, the mother was an economist, they worked really, really hard. They were super successful, and they loved their children more than anything. Their youngest daughter was born with cystic fibrosis. They tried to live normal lives, but it was difficult. They had to paddle her back every day; she was on a strict schedule, took a half-hour to clear her airways. And she was on a breathing machine; there was a ton of different medications. They did this out of love for her. Even knowing that she was unlikely to live into adulthood. That little girl died before she turned 12. I remember I was at her funeral, and it was awful. Who among us would force a family to go through the pain of losing a child? If gene editing, safe, ethical planned gene editing within boundaries gives us the ability to screen and edit embryos to remove the mutation causing cystic fibrosis, why would we deny parents that choice?
  • 00:51:03
    Voting yes on the resolution is a vote for hope, hope for parents who know what it's like to suffer, and hope that future generations will be resilient, living healthier and happier lives than even we are today. Thank you.

    John Donvan:
    Thank you, Amy Webb. And finally, with our last word, our last argument, against the resolution to Use Gene Editing to Make Better Babies, here is Francoise Baylis.

    Francoise Baylis:
    Thank you. I want to end by asking everyone to sort of pull back a little bit from the conversations we've had today, which has focused very narrowly on genome editing in the context of a reproductive project and asking you to vote as to whether or not this technology should be used to make better babies. And I'm asking you to vote no, not simply because of what I've said thus far, and Marcy has contributed also to that argument, but because it's important to think about the world in which we're living and the world we want to use technology to build.
  • 00:52:03
    You know, you've just heard a very dramatic example about cystic fibrosis. And yes, it would be wonderful if children were not born with this. But we've made great strides so that actually now, very few children die of cystic fibrosis; they're typically older adults. And as we continue to offer therapies, they do better and better. And one of the things that are really important if we're actually looking at the data with respect to genome editing, in a heritable context for cystic fibrosis, the data as provided by the international academies commission that just published its report, it could be used in the United States for one case, every 15 years. So, let me take you back to a point I made over and over and over again, what do we want to use our time, talent, and treasure for? These are limited resources. We are social, interdependent relational beings and I worry about us focusing on our genetics and perhaps unwittingly embracing a certain kind of genetic determinism.
  • 00:53:00
    That's not who we are. We are persons, and ultimately, all persons are second persons; we become who we are in society through those relationships. Finally, we are all failing and fragile. We're fallible. And in that context, we really, I think, need to embrace the project of building a world that embraces diversity and tolerance. And I worry that this is not the technology that will do that for us if it's used in the context of a reproductive project. We all want all kinds of technology to help those amongst us who are living with challenges when we have opportunities to be helpful. Please, vote no.

    John Donvan:
    Thank you, Francoise Baylis. And that concludes round three and our Intelligence Squared debate. That was the final round. And now it's time for our second vote. Remember, it's the side that changes the most minds between the first and the second vote that will be declared our winner.
  • 00:54:00
    The second vote goes the same way as the first one did; please go back to IQ2US.org, you'll have the same choices, for, against, or undecided. And as I mentioned earlier, we're going to be keeping this vote open for seven days. And at the end of those seven days, we will announce the winner on our website, IQ2US.org. The competition is over. I want to say to all four of our debaters I think that you set such an example of bringing the technical, complex, nuanced topic. You just brought more light to the conversation for all of us. I'm not sure that anything was resolved here but I don't think this is at the moment of resolution at this issue at all as we're talking about a future for which there is no evidence that we will have the evidence in the future. And perhaps we can have you all back in that future time, a future generation for another debate. But George, Amy, Marcy, and Francoise for an excellent conversation and for doing it the way you did I want to say thank you so much for joining us at Intelligence Squared.
  • 00:54:59
    Marcy Darnovsky:
    Thank you.

    Francoise Baylis:
    Thank you.

    George Church:
    Yes, thank you --

    John Donvan:
    And I want to thank all of you for tuning in. We appreciate your support and your commitment to the kind of discourse we bring at Intelligence Squared. I want to remind you that we are a nonprofit; we are philanthropy. We do these debates to raise the level of public discourse to show that it can be done; that we can have conversations like this way. We would love your support at any time by going to our website, IQ2US.org. And you can make a donation to keep us going there because we would love to keep going. We're now past 200 debates, and we want to at least double, triple, quadruple that.

    All right, to all of our debaters, and to all of you who have watched, thank you so much for joining us for yet another, I think, pretty good IQ2 Intelligence Squared debate. Please tell your friends and watch the rest of our debates, they're all online. For now, I'm John Donvan, and I'll see you next time.
  • 00:55:50
    [music playing]

    [end of transcript]

Pre-Debate

Against the Motion
42 %
For the Motion
41 %
Undecided
16 %

Post-Debate

WINNER

Against the Motion
53 %
For the Motion
39 %
Undecided
8 %

Breakdown

Against the Motion
38% - Remained on the Against Side
8% - Swung from the For Side
7% - Swung from Undecided
For the Motion
3% - Swung from the Against Side
31% - Remained on the For Side
5% - Swung from Undecided
Undecided
1% - Swung from the Against Side
5% - Remained Undecided
3% - Swung from the For Side
CLIPS BLOCK
ABOUT THE DEBATERS
For The Motion
Dr. George Church
Dr. George Church - Professor of Genetics, Harvard and MIT & Founder, Personal Genome Project
Dr. George Church is a geneticist and molecular engineer who is working to revive the extinct woolly... read bio
Amy Webb
Amy Webb - Futurist & Author, "The Genesis Machine"
Amy Webb is an award-winning author and futurist. She is the founder and CEO of the Future Today Ins... read bio
Against The Motion
Marcy Darnovsky
Marcy Darnovsky - Executive Director, Center for Genetics and Society
Marcy Darnovsky is a policy advocate and one of the most prominent voices on the politics of human b... read bio
Françoise Baylis
Françoise Baylis - PhilosopherAuthor, "Altered Inheritance"
Françoise Baylis is a philosopher whose innovative work in bioethics, at the intersection of policy... read bio

Main Points

  • The use of gene editing allows for couples to have children when they might otherwise have that option unavailable for them. It also allows for less to be left to chance during the pregnancy.
  • Gene editing will allow for babies to be born with reduced or eliminated chances of inheriting and passing on genes linked to diseases. We have a moral imperative to use technology that will improve the quality of life.
  • It is only a matter of time before gene editing becomes a widespread technology, potentially used by competitors and rivals on the international stage. If we have the technology, we should use it to our advantage to remain competitive.
  • The use of gene editing to create “better” outcomes in children will inherently create social stratification based on any gene editing, likely reflecting existing socioeconomic status. Additionally, the term ‘better’ is arbitrary and potentially short-sighted, and dangerous.
  • Currently, there exist reasonable alternatives to gene editing for every condition for which gene editing can be used.
  • The technology is still developing, and the long-term effects of any gene-editing could be potentially dangerous with consequences echoing throughout the gene-environment.