Responding to CRISPR/Cas9
The prospect of influencing the course of human evolution through technological intervention has been thought about for a long time, but usually in an abstract or theoretical way. But that possibility has become an impending reality at a breathtaking pace in the past few years. Jennifer Doudna and Emmanuelle Charpentier published a paper in Science in June 2012 that demonstrated that CRISPR/Cas9 (if you must know, clustered regularly-interspaced short palindromic repeats, with CRISPR associated protein 9) is a remarkably accurate and relatively easy-to-use tool for editing genes. In October Feng Zhang of the Broad Institute published a paper in Science that demonstrated that CRISPR could be used to edit mammalian genes. Soon after, George Church of Harvard published a paper demonstrating the use of CRISPR in human cells. Excitement spread quickly through the scientific community as researchers realized that this new capability opened doors to a mind-boggling array of new directions for research.
With the thrill of new possibilities came a chill of recognition that there is no guarantee that all the new uses of this technology would be benign. A group of scientists, including leaders in field such as Jennifer Doudna and a few veterans of the 1975 Asilomar Conference at which a group of scientists debated the wisdom of pursuing the possibilities opened by the development of recombinant DNA technology, met in January 2015 to discuss the potential risks associated with this new gene-editing technology. In March 2015 they published an article in Science that asked whether it would be wise to place voluntary restrictions on the use of CRISPER/Cas9 until we had a better understanding of how it might be used. They recommended that leading thinkers in science, medicine, law, ethics, and policy come together to discuss how to proceed.
The members of this group approached a number of institutions to see who would be interested in convening this discussion. Not surprisingly, the National Academy of Sciences (NAS) and National Academy of Medicine (NAM) were among those who were approached. After a frantic round of discussions among leaders of the scientific community and a number of institutions, there was agreement that the Academies were in the best position to organize the event, and NAS president Ralph Cicerone and NAM president Victor Dzau formed an advisory group to guide the effort.
Everyone understood from the outset that this must be an international discussion, and the U.S. academies’ leaders reached out to engage their counterparts at academies in other countries. The advisory group included representatives of the Royal Society of the United Kingdom and the Chinese Academy of Sciences. The advisory group decided that two types of activities were needed. There had to be a rigorous study by an expert committee to collect as much information as possible about the technology and to develop a well-considered assessment of the risks as well as the opportunities.
In addition, the advisory group recognized that news of this technology was spreading fast and raising understandable public concern. The U.S. House of Representatives’ Science Committee organized a hearing so that they could learn from experts about the possible implications. The advisory group decided that the public and policy makers did not want to wait a year or more for an expert committee to deliberate and then announce its conclusions. The repercussions of this technology are potentially so powerful and so widespread that it was necessary to include a much wider range of perspectives and to do so as quickly as possible.
NAS and NAM decided to host a large meeting at their headquarters in Washington, DC. The Royal Society and Chinese Academy of Sciences agreed to cosponsor the event. The advisory committee then appointed a planning group to organize what would become the Summit on Human Gene Editing. They chose David Baltimore—Nobel laureate, Asilomar veteran, participant in the January Palo Alto meeting, and lead author of the Science article—to chair the planning committee. Other members included scientists, physicians, and experts in law, ethics, regulation, and policy from several countries. Although gene-editing advances will have a powerful impact throughout the life sciences and will be applied to plants and animals, the advisory committee decided to focus its attention on the use of the technology with human somatic and germline cells because of the broad public interest in this aspect, and to keep the boundaries of discussion manageable.
The committee began meeting in August 2015 to put together the Summit, which would be held December 3-5. They designed an agenda that included an overview of the science explained by the leading researchers in the world, but that devoted most of its attention to the relevant social, legal, ethical, and policy questions that are essential to understanding how to use or limit this technology. There were speakers from about 20 countries and representatives of many of the world’s scientific academies. Roughly 75 reporters attended the meeting. Participation was open to the public, and registration quickly reached the maximum of 400 people. The entire meeting was webcast and attracted viewers from 70 countries.
The event was recorded and is available for viewing on the National Academies website. To provide a glimpse of the meeting, Issues is publishing the text of presentations by David Baltimore, Alta Charo, Daniel Kevles, and Ruha Benjamin that were made at the Summit. They provide a taste of the quality of the speakers and the remarkable range of topics and perspectives that were circulating during the Summit. On the website, one can find the text of additional presentations plus a statement from the organizing committee on what it learned during the Summit.
There was never any presumption that the Summit would resolve any of the debates. Its purpose was to illustrate the importance of the subject, the variety of voices that need to be at the table, and the need to stimulate discussions across disciplines, cultural and ethical traditions, and national boundaries. We are just at the beginning of coming to terms with a new generation of genetic technology and knowledge that will continue to advance and open new doors.
As a first step in extending the discussion, we include an article by Henry Miller, who argues that the Summit was an unnecessary impediment to the progress of the science and its ultimate use to treat human disease. No doubt there are others who will argue that scientific hubris has already exceeded the boundaries of what society can countenance, that the Summit was a ploy to enable scientists to control the discussion and the ultimate fate of the technology.
The reality is that nothing is decided yet. The study committee organized by the U.S. National Academies is hard at work; similar committees are meeting in other countries; public discussions are taking place across the globe; and we can expect to see future summits that assemble participants from around the world. In its starkest and most dramatic form, new genetic technology offers the prospect of humanity taking control of the direction of its own evolution. If that doesn’t give you something to think about, nothing will.