Bioethicists and bioconservators

Excessive caution is one of the most pernicious principles
Interview with Ronald Bailey, biotechnology ethics expert

Sergey Nemenevich, Meduza

On July 19, Ronald Bailey, a scientific correspondent of Reason magazine and author of the book "Biology of Liberation: Scientific and Moral Arguments in Favor of the Biotechnical Revolution", will give a public lecture in Moscow. It is organized by the InLiberty project with the support of Medusa as part of the "Return of Ethics" project. On the eve of the lecture, Sergey Nemenevich talked with Bailey about the ethical aspects of biotechnology – for example, about how moral genetic therapy is and what will happen if people can significantly increase their life span.

– Is it true that you put an equal sign between bioethicists and bioconservatives?

– Yes, in many ways. I want to emphasize that bioconservatives can represent completely opposite parts of the political spectrum. It may be the left, it may be the right, but they are united by one thing, the desire to stop technological progress, albeit for different reasons. The bioconservatives on the right are afraid that biotechnologies will disrupt the social order, interfere in the organization of society, and the left-wing bioconservatives are afraid that biotechnologies will further increase the existing inequality.

– Those who are engaged in bioethics think about the ethical limitations in which new research and technologies should exist. Do you think that no ethical framework is needed?

– Some, perhaps, are still needed. Of course, you need to make sure that the technology is safe, harmless to humans. If there are serious doubts about this, you need to stop. If you give people a medicine that does not cure, but cripples, it is unethical. This kind of framework is needed, a framework like the medical rule "do no harm". But they should not prevent us from moving forward.

Humanity is always mastering a new technology, realizing its advantages and disadvantages, through trial and error. How well can we predict everything in advance? I think excessive caution is, in principle, one of the most pernicious principles, because in essence it boils down to "if only something doesn't happen" – if I don't have absolute proof that something won't go wrong, then I don't need to start. But such an absolute proof simply does not exist in nature! Experience has taught us that if we move gradually, then when faced with some dangerous development of the situation, we can take a step back and forbid ourselves to go in that direction. But trying to anticipate all potential dangers in advance is, in my opinion, just unethical.

– This principle of "do no harm", which, as you say, can be limited – does it apply to an individual or to society?

– This is the right question. Basically, to an individual. You know, I have extremely liberal views, namely: if a basic set of private and public values is recognized and respected, then a society in which an individual chooses the path to prosperity for himself and his family is good. Any attempts to plant a collective ideology are immoral.

– If we turn to the history of biotechnology of the last 40 years, the discussion of ethics has always played a significant role in it. In 1975, the best geneticists gathered at the Asilomar Conference to discuss the ethics of experiments with recombinant DNA. The ethical framework for working with stem cells is formulated. Etc. More recently, a couple of months ago, George Church and other leading biologists called on scientists around the world to unite on a project to synthesize the human genome, and most of their manifesto is devoted, again, to ethics. And you say that this is all unnecessary talk.

– Well, let's remember the story. You mentioned the Asilomar Conference – fine. So how did it end there? I'll tell you – it didn't end with anything. They wrote down a set of some rules according to which research with recombinant DNA was to be conducted from now on. And many, many participants of the conference were outraged – "this is nonsense, we have just slowed down progress that could bring healing to many people." In fact, by slowing down the progress in biotechnology, you are causing people very concrete harm, because you are depriving them of new drugs and treatments that could save them – and all this in the name of ephemeral ethical doubts, which ultimately turn out to be sooo exaggerated. There, at the Asilomar conference, people went to the blackboard and told that new technologies would allow contagious cancer to escape from scientific laboratories! A contagious cancer, just think about it! Our imagination is so arranged that it is much easier for us to imagine possible dangers than to estimate the potential benefits. And, of course, in the end it turned out that the technology had so many useful uses that all worries were immediately forgotten. The discussion of ethics only delayed this moment.

– Once there were people who believed that eugenics was also a kind of biotechnology that should be given a chance.

– No, no, this is another case. I am absolutely firmly against the fact that the state, at least in any situation, could decide exactly how and which of the citizens should give birth to children and which ones, and this is precisely eugenics. There was a moment when the US government decided that it was necessary to sterilize mentally ill people, criminals and so on, during the 20th century it affected about 200 thousand people. And everyone knows well how the use of the same approach by Nazi Germany ended – this is a real tragedy.

On the other hand, if the parents themselves decide that they want to give birth to healthier or smarter children, it is worth trusting them to make such a decision themselves, usually parents want only good things for their children. Even if they make a mistake in something, they will definitely make less mistakes than some government commission. And if state birth control is, strictly speaking, eugenics, then private reproductive choice should be the right of every person.

– Let's summarize: your view on bioethics – the fewer restrictions, the better?

– Yes, but not without reservations. If your technology has not been tested, for example, if the effectiveness of a new drug is currently questionable, if there is no confidence in its safety, it is unethical to prescribe it to patients.

How to determine the security measure? For example, for therapy related to reproductive function, it should be at the level of natural childbirth, that is, 1-2 percent of postpartum disorders. Such a level can be set, for example, for technologies related to editing the genome of an unborn child.

– And what if the violations manifest themselves not in the child, but in the next generations? How many generations do I need to check?

An interesting question. Let's go back 40 years, when it was only possible to fertilize "in vitro". What did people think about it? Of course, they were against it – it's against God's providence, the connection between parent and child will be broken and so on. All these fears turned out to be in vain, now there are from three to five million people "born in a test tube" living on Earth. And, imagine, parents love them just as much as children born in a traditional way. There is a forecast that in 40 years half of children in America will undergo a detailed genomic analysis before birth, and doctors will use genetic editing methods to correct all DNA disorders so that children are born healthy – this is at least. Half of the children! In 40 years – in just a generation and a half! This is an experiment of such a scale that we will be able to quickly make sure that the technology is absolutely safe. And all this is due to the fact that we have a better understanding of how genes work, how cells work, progress is faster than we could have imagined. The society of the future, in which healthy, intelligent people with strong and agile bodies live, people who were raised with love and attention by their parents – what can you see wrong with that?

– No one says that it's bad to live in paradise. But many fear that if we want to build a paradise on Earth, we will create something else.

– Yes, why? I need arguments, not fears.

– Let me ask you to name the arguments in favor of the coming paradise. Ten years ago you wrote the book Liberating biology. There were several sections devoted to the most relevant biotechnological areas. Tell us about each of them: what have we achieved now, what fears and concerns are associated with this and why do you consider them groundless. The first direction was the fight against aging.

– Well, huge progress has been made here in 10 years, although, to be honest, we have not yet defeated aging. However, very promising work is underway and the famous geneticist George Church believes that we will be able to reverse aging in 5 or 6 years.

– 5 years?!

– That's what he says. And I'm not surprised – progress is happening very quickly, some key technologies could not be in my book, because they were invented quite recently. For example, the CRISPR genome editing method – it appeared three years ago and is very useful for prolonging life.

As for the common doubts, nothing new has been invented here. People are worried: is it good if the elderly will live longer? But the whole point of this work is to make the young live longer. We do not want to remain 85-year-olds forever; technologies are aimed at leaving us 20-year-olds forever, in order to preserve the maximum level of strength and health for as long as possible, and not to imprison the elderly in nursing homes until the end of time.

Another fear is overpopulation. If everyone lives forever, there will be too many of us. There is a calculation that if at the current birth rate people will live for 500 years or more, then by the end of the century there will be about 11 billion of us. A lot, but, perhaps, both the economy and the planet will cope with such a number. And for the remaining 85 years, we will have the opportunity to think about what to do next. To date, overpopulation is a weak reason to refuse to prolong life.

Another popular question is whether these long–lived people will decide that they do not need to give way to younger ones, since they themselves have enough strength. But in fact, even now young people are not waiting for their elders to give up the reins of government to them, they separate and create something new, their own, open companies, expand the economy. It is those countries with the highest average age of the population that turn out to be the richest and most technologically advanced. In short, I don't see any reason why eternal youth would slow down the development of mankind in any way.

– By the way, my personal fear is that suddenly it turns out that at the age of 150 he will simply get bored of living.

– And there's nothing to be afraid of, it got boring – stop taking rejuvenating pills. Personally, I won't get bored, but if someone is tired, no one will keep them alive by force.

– Great. The second direction is medicine, in particular, genetic therapies.

– There are also a lot of new technologies here, again, primarily thanks to CRISPR. Very soon we will learn how to take immune system cells from a person, train them to attack cancer cells and launch them back into the body. Incredible methods of growing new organs that can be transplanted instead of a failed heart or liver have appeared. The most amazing technology will be arranged something like this: you use genetic engineering to create a pig that does not grow any organ of its own, implant stem cells there, and they grow inside the pig into an organ completely identical to the original human one. Thus, a pancreas could already be grown in a pig: an embryo was made in which its own pancreas was not formed, human stem cells were injected into it, and a human pancreas grew out of them. In the future, such a gland can be transplanted to the patient – instead of a failed organ or to prevent the development of diabetes.

Another story is infectious diseases. Of course, you've heard about the Zika virus. A vaccine against it is being tested now. It was developed in three months – it used to take ten years for such things.

– Well, it's hard to imagine ethical doubts here.

– Yes, at least when it comes to treating those who are already ill. It is more difficult with preventive measures and diagnostics.

– Yes, for example, all these popular genetic tests that are offered by different companies like 23andMe. So far, little can be learned from them, but what if we learn how to accurately diagnose for the future? You spit into a test tube, send it by mail to the company, and the answer comes to you – in exactly five years you will die, nothing can be done. What about ethics?

– Well, we don't know how to do that yet. By the way, I posted the result of my genotypic screening on the Internet for everyone to see. This is far from the same as a complete decoding of DNA, it is rather a set of sites that differ in my genome from the genomes of other people, and researchers are just learning how to somehow link these sites with a possible predisposition to certain diseases.

By the end of this decade, a complete decoding of the genome will cost less than $ 10, which means it will be done en masse and there will be enough data to finally figure out which genes are responsible for what, how they work together, how to detect predisposition to diseases.

In the meantime, an example – already now you can find an error in a certain gene that promises you Alzheimer's syndrome with a probability of 80 percent. By the way, I didn't have it. When the results hadn't come yet, I told about this test at a party. Do you know what people said? "I would never do that." And I have this motivation: if there was a mistake in the gene, I could plan my life in an informed way. For example, I could give up everything and go to the Caribbean, live for my own pleasure while I have the opportunity.

Another argument is that people with a gene error are ideal candidates for participation in clinical trials of new drugs. Usually no one thinks about Alzheimer's before the age of 50, and you need to start drinking pills much earlier. You have no idea how difficult it is to find volunteers, and this slows things down a lot. With a genetic test – voila, the problem is solved.

– Well, I'm ready to admit that a person should have maximum information about himself, and about others? Does your wife have the right to know that you will almost certainly fall into insanity at the age of 70?

– Well, first of all, your wife very likely thinks that you have long fallen into senility. Secondly, I don't really believe in the privacy of information. You know, everyone used to be sure that people were paranoid about protecting their privacy, but go to Facebook – it seems that everyone there is only doing what they are posting their personal secrets. And with genetic data, sooner or later it will be the same, privacy is not so necessary for people.

– But if everyone finds out that you are destined to die at the age of 40, who will want to create a family with you, have children?

– There was a story about a woman from Chicago who knew that she had a genetic disorder that leads to an early form of severe dementia and probable death before the age of 40. She told her fiance about it, and they got married anyway. Nothing prevented their love, although they were not going to have children – but not because the husband did not want to raise them alone, but because there was a danger of inheriting this violation to them. Here a new biotechnology came to the rescue. They made several embryos according to the IVF procedure, tested them, left only those who have no error in the gene and gave birth to three perfectly healthy children. There was no doubt whether all this was necessary. I think you will be surprised when you find out how many people in such a situation will do the same – if they are confident in the health of their children.

– The next item is cloning. In my opinion, this was a hot topic ten years ago, and now they hardly talk about it.

– By the way, there was a round date recently – the 20th anniversary of the birth of Dolly the sheep, the first cloned mammal. Yes, it was a hot topic, everyone was discussing whether it was ethical to make a human clone. I don't see any problems, to be honest – if it were possible to make the procedure effective and safe, it's not much different from twins. Another thing is that human cloning was talked about almost exclusively in the context of the treatment of complete infertility. Now other methods have appeared for this, using stem cells that can be turned into sex cells, and now I doubt that a person will ever be cloned. There is no practical sense, which means there is no money for research.

– Well, by the way, how are things with stem cells? In this context, the main ethical snag was the question of whether an embryo could be considered a human, and if so, from what stage of development. Is the discussion going on here?

– Yes, this discussion continues sluggishly, although in my opinion the answer is unequivocal: an embryo is not a person. The argument is not so hot anymore, because all this was a hot topic when we needed human embryos to produce stem cells, and now we have learned how to make stem cells from adult cells, so there is no need to kill embryos. However, if we hadn't properly studied stem cells from embryos, which many tried to prohibit, we might never have found a way to make stem cells from adult cells.

– Next – perhaps the most relevant and interesting question. With the new methods of genetic engineering, we are technically ready to create people with the desired properties. There are a lot of doubts here, even for me.

– At the end of last year, a large general conference of the American and Chinese academies of Sciences was held in Washington, the question was discussed whether it was possible to allow the use of the CRISPR method and other genetic editing technologies on human embryos. The decision was this: to recommend not to conduct such studies yet. This is not a ban, but rather, "let's study the issue better, and then we will move on." To date, experiments on the use of CRISPR to the embryo have been carried out exclusively with embryos that, due to genetic disorders, could not even theoretically grow into a child. The researchers tried to edit a certain gene, and, by the way, they did not succeed. But we need just such experiments – safe, but allowing us to gain valuable experience, without them we will not be able to do anything further.

– As far as I understand, we do not understand so well which genes, how and for what exactly are responsible, that is, before you start editing something, it would be nice to understand what exactly?

– In fact, we already know about 4,000 diseases, each of which is caused by a mutation in a single gene. They are, however, quite rare, but there you can fix one gene, and a person will be born healthy. In most cases, it's not about one gene, but the whole ensemble, and we usually don't know what else this ensemble is responsible for, what will happen if it is configured differently. There is still a lot to be done, although there is progress.

– And how to make a person smarter or stronger, we do not understand at all?

– We do not understand in 2016, but perhaps we will understand in the conditional 2040. It is suspected that progress in this direction will go especially fast in the coming years. We have quite a lot of tools for this, now we will collect a lot of data and understand much better how the genome functions. Maybe in twenty years we will be able to edit the genome in such a way as to give children the necessary properties at the request of parents.

– The most obvious concern about this was expressed by Francis Fukuyama, whom you constantly criticize: such technology will not go to everyone, but to the privileged class, which will make its offspring even more privileged, and so on. The result will be two different human races: smart, healthy, beautiful and strong masters and ordinary slaves.

– To me, such a fear seems rather ridiculous. Firstly, it is somehow strange to expect that rich people will want to become guinea pigs, and secondly, look at what is happening with other technologies, for example, genomic sequencing. They are rapidly getting cheaper. I am sure that the world will become richer and richer, that we will get access to new resources, and economic growth will occur much more evenly and in all countries. New technologies are what rid us of inequality, not strengthen it.

– Of the remaining topics, it is worth mentioning GMOs. Here, it seems to me, everything is clear.

– Yes, everything is really clear here, and it's all the more strange to see that this amazing anti-GMO hysteria does not even think of ending. More recently, more than a hundred Nobel laureates wrote an open letter to Greenpeace, the main message was – "stop killing children!". Never in history has a single person died, got sick, or received any direct harm from GMOs at all. But Greenpeace opposes the creation of transgenic rice with improved nutritional properties, which can save a huge number of lives in the poorest countries. In fact, the opposition of Greenpeace is killing children, it is a crime against humanity. That's how the Nobel laureates wrote: "a crime against humanity", these words should have been uttered by someone a long time ago.

– The opponents of GMOs have a strong argument that has nothing to do with science. They like to repeat that the entire transgenic industry is in the hands of several huge corporations – and people are afraid of corporations no less than genetic engineering.

– Indeed, almost all GMOs are made by several huge corporations, of which Monsanto is the most famous. But why did this happen? Thirty years ago, the same activists demanded that the government regulate GMOs as much as possible. It was quite a populist step, but it turned out to be a bottleneck on the contrary – big ones can get through it, and small ones can't, because it costs a lot of money to bring a new variety to the market due to bureaucratic difficulties. You have to pay millions of dollars – for trials, for legal support, for a total of 200 million. I remember the times when there were many companies ready to enter the GMO market, they had the technology, they had the desire and there were several tens of millions – today they either engaged in something else or were absorbed by giants. So the high concentration of the market in the hands of corporations is the fault of the anti–GMO activists themselves.

– Last question: in my opinion, one of the reasons why so many people are distrustful of new biotechnologies is a persistent pop-cultural myth. Look at what biologists look like in box–office films - they either release a dangerous virus into the wild, or turn humanity into an army of soulless dummies. Maybe we need a new myth – about brave scientists and evil organic farmers?

– Yes, that would be great. But drama is drama, and there are dramas only when something terrible happens. You know, I once had dinner with Mackl Crichton, the author of a book about Jurassic Park, and complained to him that scientists recreate dinosaurs according to the plot, and it ends very badly, but you could have written a completely different book. Scientists recreate cute little dinosaurs to the delight of all children, but a group of evil bioconservatives led by Jeremy Rifkin infiltrates a peaceful zoo with dinosaurs and causes real chaos there. Explosions can be left! Even if dinosaurs eat Rifkin, the main thing is for everyone to understand that biotechnology is touching and good, and bioconservatism is disgusting and bad. Crichton asked if his book really represents biotechnology as something frightening? I replied – of course, Michael! He refused to believe it. You know, it's much, much easier to scare people than to inspire optimism, it's easier to convince them of hopelessness than to give hope. But no matter what, the world is changing for the better.

Portal "Eternal youth" http://vechnayamolodost.ru  18.07.2016