Semipublic Intellectual Sessions: “What Comes After CRISPR?”

December 6, 2021   •   By Julien Crockett, Kevin Davies, John Dupré, Hank Greely, Eben Kirksey, Amy Webb

On November 5, 2021, the Los Angeles Review of Books (LARB) hosted five scholars to discuss genome editing technologies, the systems within which they emerge and are deployed, and what they teach us about the values of our society. This panel was organized by Julien Crockett and Michele Pridmore-Brown as part of LARB’s Semipublic Intellectual Sessions. 

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IRENE YOON: Good afternoon! Thank you so much for joining us for the final satellite session of our Semipublic Intellectual conversation series here at the Los Angeles Review of Books. I’m Irene Yoon, LARB’s Executive Director, and it’s my very great pleasure to welcome all of you and our wonderful guests Kevin Davies, John Dupré, Hank Greely, Eben Kirksey, and Amy Webb for today’s discussion “What Comes After CRISPR,” moderated by LARB’s Science and Law Editor Julien Crockett.

As you all may know, this panel was inspired in part by John Dupré’s fascinating review “Caveat Editor: Competing Takes on CRISPR” that we published here at LARB last spring, and we’re very excited to be able to gather these brilliant thinkers across the fields of law, philosophy of science, anthropology, and the study of the future to help further animate the many questions and issues raised by CRISPR technology.

Though this marks the conclusion of our Semipublic Intellectual Sessions, we hope you’ll join us for our next event on December 9 at 5:00 p.m., which will be LARB’s birthday and special edition anthology launch party, featuring readings, toasts, and giveaways to cap our celebration of LARB’s 10 years. We’ll be announcing tickets and further details in the next few weeks, so stay tuned!

As for the format of today’s discussion, Julien will introduce our guests and moderate the conversation for the first half of the evening, and then we’ll transition to questions from you, our audience. If you have any questions that you would like to ask our panelists, please drop them in the Q&A function at the bottom of your Zoom screen, not the chat. Please feel free, however, to use the chat to introduce yourselves, and where you’re joining us from today. Lastly, closed captioning is available. You can turn it on by clicking on the closed captioning button likewise at the bottom of the screen.

JULIEN CROCKETT: Thank you, Irene. Thank you all for joining. It’s quite an honor to introduce and moderate today’s session on CRISPR. We’re very lucky to have with us such distinguished guests who have written fascinating works from very different perspectives that together provide a nuanced snapshot of our current understanding of the CRISPR story. Over the next hour and a half, we’ll cover the topics of innovation and governance and also hear from our panelists about the many individuals who have already been affected by this technology. My hope is that we’ll come away from this discussion not only with greater clarity over CRISPR, but also with better frameworks for understanding emerging technologies and the complicated systems from which they arise. I’ll begin by introducing our guests in alphabetical order and then we’ll get started. First, we have Kevin Davies, who is the author of Editing Humanity: The CRISPR Revolution and the New Era of Genome Editing. He is a molecular geneticist turned science writer, the founding editor of Nature Genetics, and currently the executive editor of The CRISPR Journal. Next, we have John Dupré, who, as Irene mentioned, authored the review that inspired this panel. He is a professor of philosophy of science at the University of Exeter, and the director of Egenis at the Centre for the Study of Life Sciences. We have Hank Greely, the author of CRISPR People: The Science and Ethics of Editing Humans. He’s a law professor and director of the Center for Law and the Biosciences at Stanford University. We have Eben Kirksey, the author of The Mutant Project: Inside the Global Race to Genetically Modified Humans. He’s an American anthropologist and a member of the Institute of Advanced Studies in Princeton, New Jersey. And last but not least, we have Amy Webb. I just received the galley for her forthcoming book, The Genesis Machine: Our Quest to Rewrite Life in the Age of Synthetic Biology. She is a quantitative futurist, the founder of the Future Today Institute, and professor of strategic foresight at NYU’s Stern School of Business. So, let’s begin. Before we get to the sticky stuff, I wanted to start with defining what we’re talking about. I’ll direct my first question to John, and as with every question I ask, I invite and encourage all the panelists to jump in after John responds. So, John, CRISPR is often defined as a tool to edit genes. Can you please describe some common misconceptions that come from talking about CRISPR in this way? And what may be a more appropriate way for talking about CRISPR’s function?

JOHN DUPRÉ: Well, I wouldn’t say that that was necessarily inappropriate because what the problem is depends on what you mean by genes. So, CRISPR is a technology for editing genomes, which means replacing bits of DNA sequence in the genomes of organisms — pretty much any organism. The problem is when you say genes, people sometimes think genes are somehow connected to some part of the phenotype, the observable characteristics of the organism. So, when we read about genes in the press, you tend to hear genes for this or genes for that — you know, genes for intelligence, genes for height. This is a very unfortunate way of thinking about genes. Most genes, when they’re for anything, they’re for producing one of a whole suite of proteins that function in all kinds of ways in the organism. When you change them, you change some of the chemistry of the organism and correct errors that mean that a protein isn’t properly made. This can have great potential for medicine, but the misunderstanding is when you start thinking of a kind of map from the genome to the organism that you can somehow almost play like a musician on the keyboard of the genome to make changes in the performance of the organism. But, of course, it’s a wonderful technology, and at the moment, where it’s mostly wonderful is in scientific research, which has been transformed by the availability of this way of manipulating genes. Since you focused on what I thought was wrong, you probably don’t want me to say what it actually is in any more detail.

EBEN KIRKSEY: I might jump in on part of your question, Julien, just about editing. So, that’s one metaphor that we can apply to CRISPR, and in my opinion, it’s really important to mix our metaphors. I think each of the metaphors that get applied to CRISPR reveals aspects of how it works. Editing, though, implies that you can sort of cut and paste text. If you write a sentence, you just backup the cursor and rewrite it and improve it, but CRISPR doesn’t exactly work like that. It’s really good at scrambling the text. It’s really good at producing knockouts, in an older idiom. I think the idea of gene surgery is a good one because that implies that you can make a mistake. You know, when a surgeon performs a surgery, sometimes there’s an unintended cut — there’s a scar and CRISPR can also leave a scar. I also like to use the image of the drone. You give the drone coordinates, GPS coordinates, and sometimes it takes out the terrorists, sometimes it takes out the target, sometimes it takes out the whole wedding party, and sometimes it goes astray and hits another target unintentionally. So, again, I think it’s important to mix the metaphors to really get up the complexity of what’s happening on a molecular level.

JD: It might be good to speak of drones because, of course, it can find lots of wedding parties.

AMY WEBB: I was going to offer one more metaphor. I’m not meaning to extend this too much, but the person who I co-wrote my latest book with, Andrew Hessel, is a geneticist and microbiologist. So, he refers to CRISPR as more of a ransom letter. Imagine a magazine or a newspaper, and you cut out the letters. Technically, the letters go in an order, and they do spell something that’s really messy looking, and maybe not super easy to understand. It is also imprecise sometimes. So, anyhow, however you understand it is important because that’s what we’re going to be talking about on the panel. People are starting to use the word CRISPR as a sort of shorthand for lots of different things in the same way that people use the term artificial intelligence as a shorthand to mean many different things. And I think it’s really important that we’re all on the same page talking about this critical technology going forward.

HANK GREELY: I’d add two more things. Although, first, I have to note that Eben’s implicit assumption that editing is always precise and editors never make mistakes is something all of us authors surely agree with. But CRISPR was bigger and smaller in that, yeah, we focus mainly on the — I’ll call it for now — gene editing side of CRISPR, but the thing is getting used for all sorts of different purposes, including rapid diagnostic tests. It’s really turning out to be quite a Swiss Army knife to use another metaphor of a tool. Then on the other side of it, there are lots of other ways of gene editing and genome editing, some of which predated CRISPR, and a lot of which are coming on now strong. I think in 10 years, we probably won’t be using CRISPR-Cas9 nearly as much because we’ll be using its descendants or its parallels or other things.

AW: I think that’s important about the Cas9 bit because there’s many different ways that CRISPR gets employed, and we’ll probably get into that at some point, but this is a moving, evolving technology.

KEVIN DAVIES: Can I just give a quick snapshot of how far CRISPR has come? It is just 22 years ago this month that the term was first coined, so maybe just 60 seconds on what CRISPR is in nature. It has nothing to do with gene editing, per se. It was discovered to be part of a bacterial immune system. That bacteria evolved hundreds of millions of years ago, and scientists only discovered it less than 20 years ago. So, that’s astonishing. And as I think most of the viewers will know, it culminated in 2012 with a landmark paper from Jennifer Doudna and Emmanuelle Charpentier collaborating to tweak that system and develop this new form of gene editing, which, of course, won them the share of the Nobel Prize in Chemistry last year. And as Hank said, there have been other forms of genome editing, some that predate CRISPR. CRISPR was not the first gene editing technology, and it most certainly will not be the last. I think the whole panel would agree that CRISPR can be imprecise in some ways, but it’s simply a prelude to new, evermore precise forms of genome editing. We may touch on these later on — base editing, prime editing, and probably other forms of the technology that haven’t even seen the limelight of peer-reviewed publications yet. It’s important that even since 2012, and this Nobel Prize–winning discovery, we have already seen patients treated with terrible, classic genetic diseases and essentially be cured using CRISPR-Cas9 technology. So, it is pretty remarkable how far this technology has come just in the medical space in such a short space of time.

JC: Okay, that’s great. I actually wanted to ask my next question to you, Kevin — somewhat on this topic — which is just what does CRISPR bring that previous technologies don’t? Is there something that it does where there’s pretty much a lack of alternatives?

KD: It’s not so much that it can do things that other technologies that preceded it could not do. It was just so much cheaper and easier to use that even researchers around the world who were dabbling in some of these other technologies, as soon as CRISPR came along, they threw that out and turned to using CRISPR-Cas9. That’s one reason why it’s now become almost a household name, because labs and companies around the world, even in many cases high school students, are able to indulge in doing sort of rudimentary CRISPR experiments. Many biotech companies have been founded around CRISPR technology, and many more will be. As we said a minute ago, we’ve already seen progress in treating sickle cell disease, liver diseases, hereditary forms of blindness, and a long list of literally thousands of genetic diseases that are or will soon become amenable to at least attempts to treat and potentially cure these diseases using CRISPR-Cas9. I think that the next versions of genome editing that take some of the elements of CRISPR, and then apply different types of chemistry on that sort of scaffold or structure, they’re going to be even more precise. One of the knocks that some of the other guests have touched on with CRISPR is that it actually cuts — the Nobel Prize Committee called it genetic scissors — it literally cuts the double helix on both strands. Newer forms of genome editing are going to show much more finesse, and just nick a strand in order to make a much more precise chemical change to change the sequence to the desired sequence that we want to introduce.

JC: And then Amy, I want to direct my next question to you. Your book is very optimistic about the bioeconomy. Can you please tell us what the “bioeconomy” is and what you see as the most exciting application coming from it?

AW: Sure. My hunch is you may not have gotten to the following chapters, which are all about how all of this goes horribly wrong.

JC: I’ll have more questions — don’t worry.

AW: Right. So, from my vantage point, CRISPR is one of many biotechnologies that I would put under the broad umbrella of synthetic biology, and which, again, is analogous to the various technologies that fit under the umbrella of artificial intelligence. I would argue that the place that we’re in right now is akin to the very first telephone call that was made in New York City and Chickering Hall. It was such a magical moment. There were people who had gathered in the audience, and there was a telephone on stage, and, obviously, there was somebody who was nowhere in the building who had made this phone call. It was incomprehensible to people that it was possible to send a voice through a transmission wire and have it be received on the other end. In fact, the people got mad and they came on stage and they demanded to pull back the curtains to see where this other person was — where the voice was coming from. Of course, it took a little while for us to get to the transcontinental telephone wires and the communication satellites that eventually resulted in the internet as we know it today, but that was the beginning stages of a complete revolution in our economy, in society. So, what I would say is that we’re kind of at the Chickering Hall stage of this science. Just like there’s no way to put a valuation on telecommunications right now — it’s kind of a basic fundamental technology — I don’t think there’s going to be a way to place a value or to do a true valuation on the bioeconomy that will, I think, exist at some point in the future because it too will become fundamental. But we’re at the beginning stages of this, and I would also hesitate. I would also say here that a lot of the forecasts around AI I think are pretty misguided in terms of timing and how some of the definitions are being made. I should have probably noted this at the beginning — I don’t make predictions. We build models to look at plausible potential outcomes, and we can sort of track trajectories’ momentum, but I would never say in the year 2036, this is what CRISPR looks like. The math doesn’t work out, but here’s what I will say. What I’ll say is that there are a lot of moving parts here and sometimes biology has a habit of doing what it wants to do, regardless of what we want it to do. So, we’re on this longer-term trajectory. There’s a ton of money in the investment space being thrown up this tiny little tangent. Some of you who are in the UK, were any of you at Waitrose, the grocery store, when there was that company doing DNA samples for people who walked in, by any chance? Okay, not too long ago, there was a startup at Waitrose, which is a grocery chain. When you went in, they would take a DNA sample and then you would get a wristband in response, and that wristband supposedly was your genetic profile. You could go through the grocery store and scan different objects — red, yellow, blue, or red, yellow and green — and it would tell you, “Yes, based on your genetic profile, you should eat this,” or based on your genetic, right. You guys are all laughing because that’s like horoscope eating. That’s insane, right? There’s no scientific backing there, but I will tell you that that is now an established business. Forget the fact that people are like, “Yeah, sure. Take my DNA for me while I’m at the grocery store.” But there’s a whole bunch of businesses in that space. It gives you some sense of some of the investment that’s going in. In the ’80s, there was this AI winter when some big, huge promises failed to materialize and funding dried up. I hope that we take a more measured approach in this space, which is a very long way of saying, “Yeah, I see a lot of upsides here.” I also hope we all exercise tremendous patience and think very seriously about dual use and, of course, IP.

JC: John, did you want to say something?

JD: Well, I could. Lots of things come to mind. I guess, as Amy was talking, I couldn’t help seeing a lot of downsides too, particularly from the parallel with AI. I mean, it seems like this is a rather alarming kind of comparator to stake one’s vision of CRISPR on, looking at currently the way AI mainly functions as running social media to manipulate people at an industrial scale. Of course, technology is what we do with them, and we don’t have to do bad things. As Kevin says, we’re doing some very good things with this one so I’m not suggesting we should focus entirely on the downside, but I think we need to be aware of it, and particularly the way that the current political economic structures we have don’t necessarily do very good things with technological innovation. The other thing, I suppose, which partly comes back to your first question, I do think it’s important to maintain some caution about how we think of the potentials here. I do think we’re always in danger of — I think, again, we overstate the future of this. We tend to push, what I would call, the reductionist view of human life in a certain way that encourages people to have thought that manipulating genomes and possibly another chemical or two is the way to make progress in human life. The example that I think we should always come back to is when you start hearing people saying, “You know, if we manipulate our genes, we can all be much smarter.” Well, there’s no reason to think we can be much smarter by manipulating our genes, but the important thing is we actually know perfectly well how to make people much smarter. If we gave kids a decent diet and decent education, they would be much smarter. There’s no reason to think that manipulating genes has an even remotely comparable potential for improving education and the health and well-being of our children. So, I certainly don’t mean to in any way diminish the excitement of the technology, but I do think it’s important to keep these kinds of balancing thoughts in the forefront of our thinking at the same time.

AW: The challenge, of course, is we can want education to be better, but we have a geopolitical problem. We know that China has put a part of its sovereign wealth fund — it is part of its five-year, multiple five-year plans — in synthetic biology, including CRISPR, and also artificial intelligence. We know that there are well-documented studies coming out of the PLA hospitals, coming out of He Jiankui, where some of that work is being done. When the twins were edited, the research was built on something that had been done in mice, not around HIV, but around increasing cognitive ability. So, I think the issue is that we have to acknowledge that there — no?

EK: There’s been a lot of work done on CCR5; I can go into the He Jiankui case if you want, now or later, because I ended up getting access to documents and the lab and talking to the parents. But one history that you can understand that informs that experiment is the earlier work on CCR5 done by a company in California called Sangamo, which was trying to basically cure HIV. They didn’t get a cure for HIV, and they produced a very beneficial treatment for people that had been living with the virus for a long time but whose immune systems were still damaged. So, most people with HIV these days, if you have access to highly active antiretrovirals, if you don’t have health problems, your life expectancy is very similar to normal, but the group that was treated in San Francisco were immunological nonresponders — basically living with AIDS — and they found a good treatment. They took white blood cells out of the body, they knocked out CCR5, put them back. Some of the people in the experiments had all their cell counts go up to normal for the first time since they were diagnosed with HIV — so, profoundly useful medical intervention — but then the dynamics of the biotech innovation economy kind of got in the way. A key scientist involved in that experiment went to jail for insider trading, the price of the stock collapsed. The company decided that HIV was no longer a lucrative investment for them. The HIV positive community had volunteered for this, had willingly put their bodies on the line for a very risky experiment, but basically saw the promise evaporate — the promise of long-term care and treatment. There were some reports in the media suggesting that Dr. He Jiankui was trying to enhance the intelligence of Lulu and Nana that simply aren’t true based on the documents that I’ve reviewed from the laboratory. From talking to the parents, the parents were very much motivated by the idea of producing a cure for HIV, but they’re also living with serious discrimination. So, in China, if you want to have a baby and you’re HIV positive and you don’t want to infect your partner with the virus, you’re prevented from using reproductive technologies. You can’t get techniques like sperm washing or in vitro fertilization. So, one of the main reasons that these couples signed up for the experiment was a very simple one. They wanted a healthy baby. They didn’t want to pass the virus on to their wives. So, it’s misleading to characterize that experiment as an attempt to enhance intelligence.

AW: We might have divergent views, because from my point of view —

EK: I think it’s not about views. It’s about sources. So, if you’re speculating about the intention of Dr. He Jiankui, I think it’s important to look at what he was actually saying. What happened?

KD: The paper that he submitted to Nature, voluminous excerpts of which were posted by MIT Tech Review, and which was never formally published, makes it absolutely clear: He was trying to cure HIV. It has nothing to do with increasing intelligence, even though there have been some high-profile papers documenting a link between potentially modifying that gene and studying cognition in mice in a maze, or what have you. But his paper was all about treating families with HIV. Not just individual families, but he had visions of curing the entire country, of almost eradicating HIV, which was kind of outrageous and nonsensical. But that, I think, was the motivation — not anything to do with intelligence.

AW: Here’s what I would say. What I would say is this conversation that we’re having demonstrates the need for there to be more clarity and transparency and understanding in how all of this works. I’ve got a different take on this. I lived in China for a while, but that’s fine. We’ve all got different views on something that is clearly, you know … We’re kind of in this situation because we don’t have clear guidance yet on under what circumstances the technology gets used, by whom, for what purposes, what reporting looks like, etc., etc.

EK: I think Kevin is right. The purpose of this experiment was very, very clear. One of the narratives that I tried to write against in the book is the narrative of the rogue scientist. One of the reasons that he chose CCR5 as his target is that he had input from a relatively influential Chinese Communist Party official. Initially, Dr. He was going to target a different gene. He had a hammer. He was looking for a nail, and he was going to target a gene associated with cholesterol and try to produce people who wouldn’t have problems associated with cholesterol. But this Communist Party official took him to an AIDS village, a place where people basically contracted HIV in the 1980s. There were these get-rich schemes where you would donate blood and the needles for reuse. So, you have whole impoverished villages. One of the main reasons that he switched his target to CCR5 is that he had input from this elder figure in the Communist Party. I think the intention was quite clear, along the lines that Kevin was just outlining, to cure HIV, even though it’s a high-power techno solution for what, in many ways, is a social problem. It’s a social problem about who has access to antiretrovirals. It’s really a social problem relating to stigma. Again, HIV isn’t a major illness if you have treatment, but you might lose your job in China. This is one of the reasons why the parents wanted this atmosphere of secrecy to surround her identity.

JC: I’d like to move on now to the topic of governance, and what happened after the He Jiankui affair. Hank, your book is explicitly focused on this topic. What I’m curious to hear from you is, were you surprised when you first heard about what He did? And what line did you feel like he crossed?

HG: Yes, I was surprised. I’ve been involved in discussions about human germline genome editing for at least three years, going back to a meeting that Jennifer Doudna organized in January of 2015. I thought that the knowledge of the potential risks and the risk-benefit ratio on this as well as the “as close to scientific consensus” that I’ve seen that said this is a bad idea now — some people say it’s always a bad idea; some people say it’s a bad idea now — would deter this kind of work. So, I was surprised to see it happen. I think the reactions were often over-the-top, as is often the case with these new biological discoveries. I remember how we jumped from Dolly the sheep to armies of cloned lawyer slaves in the space of about a nanosecond. So, I was surprised that it happened and then I was heartened by the extent of the response. I think it’s going to be really interesting to see what develops in terms of governance in the next few years. I am not an optimist about international governance. I’m not an optimist about international treaties and their effectiveness as well as how well they can be negotiated. I think we will see lots of — and already have seen lots of — national governance activities. How it will come out I think will vary from country to country. But really, to me, the biggest line he crossed — I don’t actually think the germline line is all that important. The human subjects research violations are enormous, the biggest of which was the risk-benefit mismatch, high in both known and unknown risks for very low benefit. In fact, with one of the babies, I don’t know which one, she’s heterozygous. So, the potential benefits — and this was known before the embryo was moved into a uterus for potential implantation and pregnancy — she wasn’t going to get much, if any, HIV benefit from it, but she was still at risk as being the first human baby to be born after this gene editing. So, I thought the risk-benefit stuff was bad, informed consent looked bad, breaking Chinese law on HIV positive men in assisted reproduction was bad. Even though I entirely agree that this is a wrongheaded, bad, stupid, evil, mean law, going ahead and straightforwardly breaking the law — bad idea. I think there were a number of lines that he crossed. I think he was reckless.

EK: Might I add to just one point? In part, it relates to what Hank just said but also a question in the chat as to whether I think Dr. He’s experiment was ethical. In regards to the participant consent, I think there’s one thing in there that I find profoundly ethical. In contrast to all the gene therapy clinical trial participants who I interviewed, there was a benefit that was given by the lab, which was an insurance policy for the first 18 years of life for these children. There were some profound missteps that were made along the way independent of whether or not they should have been using heterozygotes or monozygotes. Even just doing twin pregnancies isn’t the best practice in reproductive medicine these days. So, one of the profound ethical missteps that Dr. He made was misleading the world about the health of these twin babies. In the book, I write about how they spent the first weeks of their lives in the neonatal intensive care unit. Dr. He, when Kevin and I were in Hong Kong, released a video saying they were as healthy as any other babies, which was untrue. One of the babies was still in the neonatal intensive care unit when he made that statement. They had trouble breathing at birth; they were on incubators. It’s a difficult thing to parse. We don’t know still if those health problems at birth are a result of known risks of IVF and twin pregnancies or unknown risks associated with CRISPR. But back to the participant consent. Ultimately, he wasn’t able to fulfill his promise of an insurance policy and that was because the insurance company balked. They didn’t want to issue a policy, not because they knew about the experiment, but because they didn’t want to issue a policy to children that were born prematurely, born unhealthy. I think he omitted not only on YouTube but also in his summit presentation and the paper he submitted to Nature. The premature birth was not mentioned. I think the health and well-being and welfare of these children born in complex, unfortunate circumstances — for me, that’s one of the things that should be at the center.

KD: Can you say anything about their well-being today?

EK: It’s a complicated thing to speak about in part because of the intense pressure to surveil them. There’s a sense from the parents, and these are all the participants in the experiment — there were many failed implantations and failed pregnancies before this one was carried to term. Basically, if any of their identities are revealed, they’re at risk of losing their jobs. Some of the participants are members of the Communist Party, active party officials. Others work for the military, and they’re not out to their employers as HIV positive people. Some of them maintain dual identities: one that they use to get their HIV medicine, which is free in China, and another identity they use for employment. As a result, the families are not wanting to have ongoing government surveillance and get routine reports, I think which is something the international community wants; it’s something the government of China wants. That’s been something that the families have resisted. Based on the information that I have, I can say that routine medical checkups with a family physician don’t report any serious problems. They were released from the neonatal intensive care unit at a point when, by most accounts from talking to experts on neonatal development, it was a good outcome. They were released before 42 weeks, which would have been full term. From a neonatal perspective, things looked pretty good for babies born that prematurely. But we don’t know much other than they’re alive. They’re reasonably well — walking, talking human beings. They’re not Franken-babies. I think, in many ways, it’s the public reaction. What happened 40 years earlier with Louise Brown, you know, the Pope was outraged. The scientific community was outraged. People called Louise Brown the first so-called test-tube baby or IVF Baby. They called her a Franken-baby. So, these babies aren’t monsters — they’re human. I think time will tell if they want to become public figures, and that’s going to involve very complicated dynamics that don’t just involve them, that involve their father’s HIV status.

AW: I think what Hank said was really important, though, about informed consent. I’m not sure who else was in the room when you were speaking with some of the parents, but it’s highly improbable that they would have divulged exactly what they knew and when they knew it, given what the stakes were. By all accounts, they weren’t fully informed.

EK: Actually, no, not by my account. The informed consent process was quite rigorous. They were recruited through a national HIV positive network of largely gay and bisexual men. There are people who filled out a survey about their status, about if they were interested in learning more about an experiment involving reproductive medicine. They whittled down the list. I forget the exact length of the longlist, but those that made it on the shortlist were about 20 couples. They initially sent a postdoc and an embryologist. These couples were recruited from throughout China. They had a PowerPoint presentation, and they showed it to those people in their homes. Then they were brought to Shenzhen for a second part of the consent process. Michael Deem was there from Rice University, a member of the Chinese National Academy of Sciences. I got to see videos of those informed consent processes and serious, rigorous questions were asked. I think a shortcoming was they downplayed the potential of public controversy. They downplayed the idea that this was a first-in-man kind of experiment, that this was going to have profound historical significance. They also implied that it had government support, which in some ways it did, but in some ways, as Hank mentioned, this was breaking a number of laws. The socio-legal context is quite complicated. The laws that they knew they were violating basically regulate the conduct of IVF clinics. So, the IVF clinics risked losing their license, but the clinics weren’t fully across what was going on. Only some people at the clinics were.

HG: The point here is, I think, one of the frustrating things about writing about this is the stuff on the public record, which for most of us is all we’ve got, doesn’t necessarily reflect very well what actually happened in terms of the consent. All most of us have to go on is the consent form, which was online for a while, and as consent forms go, it really, really stunk. So, bad consent form. Mainly about finances more than about anything else. But what was said in the meetings, I don’t know.

AW: And then what was reported with handlers after the meetings are just, you know … Having lived and having spent a lot of time there, it will be difficult after the fact for anybody to know what actually happened.

EK: I went through the video and listened to it and had it translated. Part of that I report verbatim in the book. One thing I found remarkable, Hank, from the documents that were online was the photo op. He asked for rights to put the pictures of these babies on billboards, on elevators — I think cars were in there. That just stands out as something highly unusual. But then, of course, he couldn’t pick up the babies and the parents couldn’t pick up the babies because they were in the incubator. So, that moment that Steptoe and Edwards had, that other people who’ve done adventuresome experiments in reproductive medicine had, you never got that photo op.

KD: One of the criticisms in the immediate aftermath of He Jiankui’s appearance in Hong Kong — Eben, I’m curious if you agree or not — but it came from a senior Chinese bioethicist who was also on the program, who must have been, I think, as shocked as everybody else because we had only heard about this news breaking 48 hours earlier. He said (paraphrasing slightly), “How can you attempt to change the genes of the human species without consulting other members of the human species?” It really speaks to the extraordinary secrecy that He Jiankui conducted, although he did confide in — Eben will have a more accurate number than me — but he did confide in some very prominent members, particularly in the States and a few faculty colleagues of Hank’s at Stanford because he did his postdoc in a one-year postdoc at Stanford. But that was extraordinary. And even though He Jiankui is now, I think, wrapping up his second year in jail, he has in his work — for all of the condemnation, the deserved condemnation that has rained down on him — definitely inspired some people who are itching to try to attempt similar types of experiments. There was a Russian geneticist named Denis Rebrikov who wanted to do something very similar but for couples with hearing loss in an attempt to use gene editing to let them have a biological hearing-enabled child. In the immediate aftermath of Jiankui’s presentation in Hong Kong, a fertility clinic in Dubai emailed him to say, “We are fascinated by your methods and techniques. Are there any training materials that you care to share with us as we contemplate offering this for our clients?” So, even though the world bodies and commissions tried to put a halt on this and say, “Not so fast. This should not proceed,” for many, many reasons, I don’t think anyone could be 100 percent certain that somebody isn’t going to try this again.

EK: It wasn’t just Dubai writing either. There were many clinics from around the world that I learned about that were writing him after that. One of the profoundly unethical things I think he did was after the birth, before the summit, he didn’t focus on the science. He didn’t focus on the health and well-being of these children. He was focused on business deals. In the book, I report a trip that he made to the Hainan province, which is China’s special medical tourism zone. He also went to Bangkok, and this is with John Zhang of the New Hope clinic in Manhattan. John Zhang was a close advisor of his. They met with the vice governor in Hainan and outlined these plans for a new clinic with 100 doctors, a total of 300 staff — they toured facilities. The governor’s office basically said, “How can we help you? Can we give you any incentives to do this here?” The document that they presented as a proposal was to cater to medical tourists but was also to be a site of research innovation in the biotech economy. The governor’s office was quite excited. Meanwhile, the lab members back in Shenzhen are trying to make sense of the genomic data, like, “Did we have any off-target effects?” The experiment to see if they were resistant to HIV was never done and that stalled his travel and business deals. It’s an example of the disruptive values of the innovation economy — move fast and break things — being interpreted in a Chinese context and going incredibly wrong. In those weeks between the birth and the summit, that’s where you really see it play out.

JC: That’s a great launching-off point. I wanted to direct my next question to John. In your review, you focus a lot on the fact that you don’t think that He Jiankui was a rogue scientist. More, he was the product of a system. I’m curious, when you look at your students, for example, how do you create a culture where people don’t have that move fast and break things mentality?

JD: Can you just repeat the question?

JC: I’ll try to make it clearer, too. Eben was talking about this move fast and break things mentality that exists with the innovation economy. And Hank talked about how he wasn’t optimistic about international regulation. So taking it a step down, I’m thinking more at the level of students who are being brought up within the system to create things. How do you minimize the likelihood of creating this goal, for example, for people to think it’s okay to break the rules and create something that they think they will be honored for, but that is in fact very dangerous for society?

JD: I suppose the reason that I was trying to brush the question away is because not being a scientist, I don’t have students who are liable to do this kind of thing. Myself and the sort of students I have tend to sit around criticizing what people do without being in much danger of having to do it ourselves. As I was thinking of how to address it, I was probably wanting to pass the question more to Eben. Something that really came through so much in all of the books that I was reviewing was the extent to which all of this scientific activity, as reported, was embedded in a particular kind of business context. Basically, we’re talking about massive corporations making profit-driven decisions. I think talking about individuals going rogue is really just the wrong way to think about the problem when what we have is a rogue system. I think we have a system that promotes actions that are not socially desirable because social desirability isn’t the driving factor. We have no systems, really. We have marginal systems, like we sit around and talk about ethics, which is good — we should talk about ethics. But in a sense, ethics isn’t central to what we’re doing. Politics aren’t central to what we’re doing. We’re not really in a system that’s looking at these activities primarily in terms of their social value or whether they’re things that are good for people. And if we don’t do that, I think in a sense, we’re really just coming in and kibitzing the train wreck. We’re really not going to do much about stopping the next train wreck, which is again why, it seems to me, AI is currently a train wreck. It’s a little further down the track and very likely we’ll have a similar train wreck when big corporations manage to make the first trillionaire from this technology. I really wouldn’t be focusing — if I had these students who are about to go out and do the science — I really wouldn’t be focusing on the moral compass of the individual scientist. I would be focusing on the social and economic structures within which they were going to do their work and which will largely determine the kind of work they do, as particularly Eben’s book tends to suggest was true of He.

EK: One word that you use, John, which I think is more important than ethics, is values. I see, both Hank and Kevin, in your books you are critically interrogating values as well. That was one of the key questions I set out to answer. It’s whose values are driving these gene editing experiments. So, Kevin, in your book, you’re quoting George Church looking at equity. These prices of the new gene therapies are basically producing this radical new era of medical inequality. Hank, you’re also interrogating a broader array of values than purely pure profit and pure market values. I think maybe this is a shortcoming. He was trained at Stanford. Not knocking Stanford, Hank, but there are some people who work there that seem to be particularly good at capitalizing on market values. I think it’s so important to think about these questions with a broader range of values than just making money.

HG: I certainly think that the values are very important. If we could get scientists to internalize the concern about the social consequences of their work, that would be a good thing. At the same time, there are other mechanisms that can control, to some extent, what happens, including the law. It didn’t work in China in part because the Chinese law on this was very limited and vague and in part because China’s still in the process of implementing a real legal and regulatory system after 40 years of party diktat. They’re only in their third or fourth decade of really trying to have law permeate the society, in a sense. Institutional review boards with ethics reviews, the Food and Drug Administration, the HFEA in the UK — these are things that can limit what gets done. They will not be perfect in part because laws get broken. Murder has been illegal for a long time — still happens. In part because people will go to places that don’t have such laws. I don’t think it’s going to be possible to stop the next person who wants to do this. I do think, and I wish I had focused more on this in the book, He was in sort of an unusually favorable situation because he had a lot of money that he didn’t really have to account closely for. He had money from the governments that brought him back to China; he had money from his business investments. He didn’t have to write a grant application to say, “I want to do this.” Not a lot of scientists are in that position, but some will be and some will get that sort of backing. So, I think there are legal solutions that can mitigate antisocial uses of these technologies if we ever get an agreement on what’s antisocial and what isn’t, what should be banned and what shouldn’t. I think that’s likely to vary from place to place.

AW: We don’t even have a clear definition, though, in the US because that’s the coordinated framework that governs right now. That’s more about products than process.

HG: Well, that doesn’t govern humans.

AW: No, it governs the products that would come out of it. Right.

HG: On the human side, the FDA has asserted jurisdiction, which I think it probably has, but it’s not entirely clear.

AW: Right, but the challenge is editing any type of organism gets into this thorny area of who’s got jurisdiction when the organism itself is hard to contain in general. We’ve got competing viewpoints from different countries, some of which see this as fundamental to their ability to survive and thrive and dominate.

JC: I think it’s a good time to turn it over to the audience questions. I see we have three open questions and then I have lots of others. If anyone sees one that they want to jump on, please feel free.

EK: I just answered one about this in a sort of a context of global equity. The questioner noted that we’re all kind of representing European and American views on these technologies. For starters, I think that’s in some ways what makes the He Jiankui story interesting. Doctor He’s story is a story of the China dream in part. He was born in an impoverished village. He didn’t have reproductive medicine when he was born. His village had no electricity. They didn’t have a telephone. He came out with the umbilical cord wrapped around his neck. He saw in a generation someone go from being born in an earlier idiom what would be called a Third World context become someone at the forefront of reproductive science and medicine, pushing the envelope of earlier versions of these technologies, going past rules and norms — lines that other people had drawn in the sand. Thinking about this from the perspective of other countries, one of the places I visited in the book was Indonesia. A transgender performance artist there named Tamara Pertamina talked about ways that this might be used in the context of a place where there’s very little regulation, where you can buy all kinds of treatments that are outlawed in places like the US and Europe. For example, skin lightening treatments that are incredibly toxic and dangerous are widely used in Indonesia with this aspiration where people are trying to make themselves more beautiful. I talked to Tamara, who did this performance project called the CRISPR Sperm Bank where she imagined the ways that people might try to change their children in the city of Yogyakarta, Indonesia. She was asking before Dr. He’s experiment about CCR5, the gene for HIV resistance, about blue eyes, blonde hair, other traits that people might think of as being attractive or valuable. She was trying to interrogate these eugenic ideas and ideas of internalized loathing and colonial imaginaries that promote certain kinds of people as being more desirable or more beautiful. In short, yes, I think decentering the conversation away from Europe and the United States is really important as we’re approaching these issues. Thinking about these other systems of values that might animate the use of these technologies is very important.

KD: Can I flag Marcy’s? It’s more of a statement than a question and a plug for a very, very important journal article in a very important journal. Marcy says many people in many countries believe the decision about whether to permit heritable genome editing such as the experiment that He Jiankui performed is extremely important. Seventy countries and a Council of Europe treaty already prohibit it, she writes. This is a strikingly high level of global agreement. She cites a paper that she and her colleagues recently published in The CRISPR Journal, which I encourage people to download. There’s been an awful lot of hand-wringing and debate and commissions gathering in windowless rooms to debate over how should heritable genome editing proceed, if at all, in the wake of what happened with He Jiankui three years ago. I think the most important report to date was from the National Academies of Sciences, which was issued about a year ago. A real blue-ribbon committee of scientists and ethicists and legal minds and so on really looked at the science of where we stand with editing human embryos and, along the lines that Hank mentioned earlier, saw no reason to just put a barrier up and say there’s no context in which germline editing should not potentially go forward, if it is safe and if it is approved by the various jurisdictions. The scenario that they gave where they could see a potential path for this happening is if a couple with a serious recessive genetic disease, say two sickle cell patients — it’s a recessive disease, so they’ve inherited two sickle cell mutations — they would not be able to have a healthy child: their child is destined to have sickle cell disease. No other fertility technology, such as preimplantation genetic diagnosis, would help them in that situation. Perhaps in that scenario, rare though it would be, some form of CRISPR or other genome editing might be worth pursuing down the road. But today, if you were to try that, the jury would absolutely say don’t even think about it because we don’t know enough about how to edit human embryos safely just purely from the technical level. There have been three major reports posted in the last 18 months from all of the three leading non-Chinese, European, or American groups with expertise in studying the genetics and development of early human embryos and all have reported major DNA rearrangements when they’ve tried to perform the safest type of CRISPR gene editing experiments. I think the bottom line is that we have an awful lot more to learn about how to even attempt to do these sorts of studies safely before we even wrestle with the medical and ethical and societal issues.

HG: I see John’s fingers are up. I want to talk too, but, John, you’re first.

JD: After you.

HG: I looked you up, John. You’re actually eight days younger than I am exactly. So I’ll take age. I’m going to also talk about Marcy, but also anonymous attendee one: why is there no real ethical difference between germline and non-germline editing? My position on this set out in the book is one that’s guaranteed to make me unpopular on both sides. I don’t think there is a really important ethical difference between the two, although I think there are ethical differences. On the other hand, I don’t think there are going to be very many uses for human germline editing that can’t be done safer and easier in other ways. So, neither side is going to be very happy with my position, but I do think that the ethical difference is relatively limited. The big ethical difference is you’re affecting future humans in a very direct genetic way, at least the first generation potentially, but not certainly future generations. That’s the difference. On the other hand, I’m a parent. I did that all the time. It’s my duty to try to change the next generation, and nature changes the genome with every generation. I don’t have the same bases, the same sequence that my parents had and I didn’t pass on the same thing with my children. Human decisions, the human culture, things like agriculture and medicine, change the frequency of different alleles in the human population by changing the environment, which the genes are reacting against. I don’t find the kid thing that important. People sometimes say, “Well, they didn’t get a chance to consent,” but I don’t remember the consent form I signed before I was born and which parents I would be born to and where and so on. On Marcy’s point, though. In much of the discussion, some people say certainly not now because it’s unsafe, but maybe in the future for some reasons. Some people say certainly not now because of safety and never in the future because we think that the germline line is a really important one. I disagree with the second position, but I don’t think it’s an unreasonable position. I think that decision is one that should be made by countries and cultures and peoples and not by scientists and technicians and regulators. I think if a country wants to do something I disagree with and what they they’re doing is not a violation of some important rights, so be it. What I expect to see is a mosaic of different countries with different rules one way or the other on this. I think it is really important for us to view this as a social question with a social solution, and that should be informed by technical and scientific knowledge, but not as a scientific and technical question to be answered solely by scientific and technical knowledge.

JC: I’d like to flag a question by Michele Brown. Bringing us back to earlier in the discussion, can Amy say more about what she sees happening with regard to China trying to hack intelligence, CRISPR and non-CRISPR related? I thought she had more to say.

AW: I have a lot to say on that. My previous book was about the features of artificial intelligence, which respectfully, John, isn’t just within the domain of social media, but is in fact the third era of computing. We all use some components of AI all day long, every single day. The challenge that I see going forward is that when we tend to talk about biotechnology and CRISPR specifically, we tend to think about designer babies. There’s an entire world beyond that that involves agriculture and materials and other things that we require for life. The bottom line is that we have scarce resources, many more people on this planet, and a complete inability to resolve our current challenges that we’ve caused. At the COP26 event, there will be some tacit agreements, PR, very public agreements, and the proof will be in in the actual steps that are taken to mitigate changes, which is my way of saying it’s highly improbable at this point given the geopolitical situation we find ourselves in. The great decoupling and the forces of change that have to do with macroeconomic factors and issues related to supply chain and big tech — it’s just inconceivable to me that we’re going to come to an agreement in this area when we can’t seem to get agreements in other areas. So, what does that mean for what we’ve been talking about? If it’s plausible that we’re probably not going to take the drastic steps we need to secure our global supply of food, to deal with climate migration, to deal with all of these changes over the next X amount of time then this is a place where we could potentially solve some of those challenges, meaning edit tomatoes. Right now, somebody has already used CRISPR to edit tomatoes to have additional functional capabilities — “make you relax,” I think, is the key component. I’m looking at a future where we’re going to need to bring farming indoors at scale. We’re going to need to be able to produce protein without the need for livestock and enormous amounts of space. The outlook for us being able to weather what’s very likely on the horizon within the next longer period of time is going to require us to focus more on developing these technologies, which are tethered to profit. That creates new tensions in certain places, and it creates a motivation for some countries to try to push ahead. China has been. Again, anybody who has spent any time there, you will get one version of a story and then you will get what’s actually happening. My position on what’s actually happening is that we’re about to see the fastest rise of a middle class that has ever happened in modern human history. There are not enough resources to go around. This is part of the backbone of the Belt and Road Initiative and why there’s a lot happening now between China and Africa. This creates new sets of tensions. My concern going forward — certainly with AI, and absolutely with synthetic biology — is that these are technologies that we need. Right now, they’re kind of interesting to talk about. They’re going to be consequential to our survival in the farther future, which creates a motivation for certainly China to pour in massive amounts of wealth and to monkey around a little bit with some of the regulations and restrictions to make sure that it is in a position to do both what’s best for the party, for the CCP, and all of the people who live there. There’s a lot of people in that country. We have a very different take in the West. Typically, what happens in Europe is that innovation is in the realm of policy and regulation. This sets us up for a challenge going forward. My concern is that if we can’t resolve some of these differences … I was in a National Academies meeting. I was sitting next to Feng Zhang just before some of the patent law stuff was hitting and the big public problem was brewing. We were there talking about some national security issues. We have fundamental challenges going forward.

Again, my feeling is that we’re at the Chickering Hall stage — the beginning. It’s the beginning of a new type of economy. It’s the beginning of new types of geopolitical challenges. I forget who mentioned Dolly the sheep earlier, but the world collectively lost its mind. Hank mentioned it. President Clinton had to call a press conference. The Pope spoke out, and people went bananas. In the years since, we don’t have demon spawn sheep, right? We’ve got pharmaceuticals and other things that came of it. We have a multifront challenge ahead of us.

JD: Responding to that, I don’t doubt for a moment that biotechnology has a huge role to play in solving big problems. I think that the trouble is that we tend to let the technology drive the solutions rather than figure out which directions we want to go and then see what biotechnology can do to help us. Actually, later this month, the Nuffield Council on Bioethics will release a report on genome editing in farmed animals, which I would say would be interesting because I’m part of it. I think it’s very clear that there are opportunities, but we also are looking at horribly dysfunctional systems that exist. If we just let the technology feed into the systems, it’s as likely to entrench systems that we really need to change as to provide better systems.

AW: And that’s where we are right now. You were describing our current problem in AI. AI has been on a trajectory of development since the 1800s. The term was coined in 1956, so this is not new. Aside from military application, and even there, it’s been a little ignored. It’s been its own thing. Suddenly, the financial sector got excited, and now we’re talking about regulation. That is a terrible setup for the United States and certainly for the EU. China does not have the same problem. There is a top-down plan. Listen, they’re not always great at executing those five-year plans, but they have an incredibly powerful leader right now who has a pretty good track record of fulfilling those plans, and he’s backed by party members who are in lockstep. My concern is exactly, John, what you’re describing. We get 10 years down the road and after the fact, Washington decides to come in and try to regulate — break up Big Bio, or something like that.

JD: Just where I think you would disagree with earlier — of course, I’m not saying that I think AI is a bad thing in any way at all inherently, but I think that the places where its use is by far the most intersecting with our lives, it seems to me, is harming our lives. That’s very often what happens if you just let the technology grow, as large corporations find most profitable.

AW: Right. The other issue is people don’t want flexibility. We want NIST to tell us, “These are the standards.” We want a single set of standards and then nobody wants to revisit that as new information is gleaned. Nobody wants to be regulated as they’re innovating, right? That stifles innovation. However, if we don’t invite a real discussion with actions to follow then you wind up on these parallel tracks until at some point, something goes wrong. Facebook is going wrong right now, and people are upset with Amazon. Now, we have regulators who have stepped in and decided that they should break up Big Tech as though that is something that can be done. It cannot because of how some of these companies operate. What I would like to see happen, which I know is challenging, is to take some of these conversations about ethics and IP and regulation and make them tangible, not in a way that stifles innovation and development and research but in a way that makes all of this much more concrete to those who may attempt to regulate down the road.

EK: I just wanted to return to part of Michele’s question, which was about intelligence. This is something that a number of our books touch on — Kevin writes about it — and it’s what’s called a polygenic trait. That means many, many genes and all kinds of other things. John talked about the importance of diet and the importance of education. There are a lot of companies out there that are starting to sell people on the idea that you can enhance a baby. Kevin, I just want to read a beautiful quote that I found, if I can find it again, in your book: “If you’re buying into that fantasy, you’re going to be angry.” There’s lots of polygenic traits. Height is another one that both Kevin and I discuss in the book. It’s controlled by a whole bunch of genes. George Church is saying in Kevin’s book that even though it’s a polygenic trait, we can still address it with just one gene — human growth hormone. But for me, it also comes back to an idea of what a good gene is. If you go back to that idea of eugenics, good genes, it actually came about before there was even a concrete idea of the gene. Mendel talked about these factors when he was breeding the plants and then the idea of the gene came. 1911 I believe is when it first appeared in print. But these days, good genes are basically eugenics. It went wrong with the Nazis; it went wrong with some sterilization campaigns. It’s really, really difficult to identify what a good gene is and what a bad gene is. I think this is one of the places where things got messy with Dr. He’s experiment. Is CCR5 a good gene? Is it a bad gene? Should we all get rid of it? John, you had your hand up.

JD: I just want to say very quickly because this comes back to what I wanted to say about germline editing. I think there are very few good genes and lots of bad genes, so where there really is a future for genome editing in medicine is genetic disease because these are Mendelian genes, typically, and you can fix them. They are, to use a metaphor, errors that can be fixed. Good genes are another matter altogether because there aren’t just little mutations, typically, that make you smarter or whatever. These are much more complex traits and they have many other effects if you try to mess with them. This is why I think, actually — maybe just to be a little bit more contentious than Hank managed to be — it seems to me that germline editing is actually generally more defensible than somatic editing. Germline editing seems to me, if you’re just looking at genetic disease, why would I want my grandchildren to get the nasty disease I’ve managed to stop my children from getting? I mean, why not? Who wants bad genes anywhere? I don’t think that we have much use for cystic fibrosis disease genes — I don’t think. There may be some side effects, some polygenic effects that are good, but it’s not a nice thing to have on the whole. Of course, the other thing is that it seems likely that because all of these things are subject to safety, if we don’t know how to do them, we shouldn’t do them. I think one of the premises right at the beginning of this discussion was that we are on a track to basically get this technology working so that we could make genomes look pretty much the way we want them to. That’s a bold claim, but it’s plausible now. If we can do it then we probably should fix bad genes. We should fix them in the germline so we don’t have to keep fixing them all the time. Of course, it is actually likely to be safer because you’re not going to get the mosaicism that you’re likely to get when you try to do somatic editing.

EK: Maybe to further on that and also point to some other correspondences between Kevin’s book and mine, goodness and badness is judged in context. I’m six foot two, six foot three on a good day, which confers some social advantages, but when I get on an airplane it’s horrible. What is the optimal height? Do we all want to be my height? Do we all want to be six foot seven? One of the other things that Kevin and I both write about is the profound disagreement between members of the disabled or differently abled community in the medical establishment about what constitutes a medical condition and what constitutes diversity. Kevin quotes some people saying, “Don’t edit me out.” I feature someone who doesn’t have a genetic disability but whose body was produced by a medical accident. His mother took thalidomide when she was pregnant. Gregor Wolbring is now a biochemist, a disability theorist, and an activist. He has a lot of very interesting things to say about what constitutes normality. First of all, Gregor doesn’t want to walk. He doesn’t want to have legs and hands like the rest of us, but he’s curious about maybe flying, expanding the possibilities of what might get to count as a normal human body and living.

JD: I do agree. We’ve got to be very careful about which are the bad genes, but I think still there’s a line. I don’t think anybody really wants Huntington’s, do they? I know there’s some complexities in the experience of discovering you haven’t got it in a family. Even there, we’ve got to be a little careful, but it really would be good not to have it around, I think.

KD: We touched earlier that there are other technologies that can be used to try to prevent the spread of some of these disease genes. It’s not all about gene editing.

EK: Hank, you make that point very strongly in your book as well that people should have the right to refuse this technology, whether in a reproductive context or another context.

HG: Yes, and I also think that if we’re looking down the generations, presumably this will get easier to do back and forth. So, if somebody doesn’t like a change in their germline, they can edit it out for the next time around — as well as improvements in somatic cell gene therapy to make the diseases less bad, but it will be interesting to watch. I only wish I was going to be around in 80 years to see what happens.

JD: More days than me, anyway.

That’s a subject for a whole other 90-minute debate, Hank.

JC: I think there’s time for one more question. Hank, something I wanted to ask you about is given the ease with which people can now use this technology, and given that the FDA is not currently set up to go after millions of biohackers, will the FDA change? What do you think is a system that could work if there even is one?

HG: With respect to humans, I’m not that worried about it because you need an IVF clinic, which has a lot of people with investments and licenses and professional standing. Some of them are cowboys — John Zhang from his clinic in New York is certainly one of them — but most of them are not going to be sticking their necks out very far. I do want to go back to something that I think Amy was referring to and endorse it. I think the big issue here is not going to be human gene editing. It’s going to be in nonhumans. It’s going to be the other 99.99999 percent of organisms on Earth. The consolidated framework as a regulatory scheme basically sucks. That’s actually too kind to it. We are willing to take much greater risks with nonhumans than we are with human babies. We will see an explosion of this. We’re already seeing an explosion of it in nonhumans. I think that’s going to be much more important and is not getting nearly enough attention. So, that’s your next 90-minute program, Julien.

JC: I guess with that, we’ll close.

I just wanted to say thank you to all of our amazing guests for coming and speaking with us and having a delightful conversation. I also want to say thank you to my colleague, Michele Pridmore-Brown, who’s the science editor at the L.A. Review of Books. She was terrific in helping me put this together. Thank you to Irene and the rest of the L.A. Review of Books staff for helping to put this and the series on. Irene, I’m not sure if you’ll be coming back to close on this. Otherwise, thank you, everyone.

IY: Yes, thank you so much, Julien, for organizing this wonderful event. Thank you to all of our amazing panelists for taking the time out of your day to have this wonderful conversation. It was really fascinating and illuminating. So, thank you. Thank you to all of you who tuned in. I know that there are also a lot of people who signed up and are excited to catch up via recording, which we’ll be sending out in a little bit, and, hopefully, a transcript as well so people can continue to engage with all of your really wonderful contributions today in a number of different formats. Thank you all so much again. I hope you have a wonderful rest of your day and weekend. Thank you. Thank you everyone.

EK: Thanks for organizing.

HG: It was fun.

EK: Yes, lots of fun. Let’s do it again.