“Designer Babies” are a Distraction from the Real Debate: Prenatal Genetic Screening

“Designer babies,” the curated and industrialized meme of what genetic engineering might be continues to captivate the public’s perception of the future of human genetics. But despite all the hype, the technology is nowhere close.

Or is it?

The advent of CRISPR/Cas9 gene engineering is revolutionizing biologists’ ability to “easily” edit the genomes of many species previously difficult or inaccessible to work with, including humans. The excitement over CRISPR/Cas9 is justified on many levels, but not all. “We’re not seeing Cas9 in the clinic right now, but it is only a matter of time,” Jacob Corn of the Innovative Genomics Institute at UC Berkeley said at a Radcliffe Institute of Harvard University conference on October 2. But how long is “a matter of time?”

“One thing I want to stress for people in the audience, is that it is only three years old. So even the most experienced person in the world has only been working with it for three years,” he said.

Dr. Arthur Caplan, Director of the Division of Medical Ethics at the NYU Langone Medical Center said, “I think there will be some opportunities to do some human germ line interventions, and I expect them to be around in about 20 years.” Although ethical concerns about “designer babies” may be more legitimate than before, Caplan has another concern that fewer people are paying attention to which he believes is much more imminent: prenatal genetic screening.

Compared to CRISPR/Cas9 gene-editing, prenatal genetic screening is not a new concept. “The field of genetic counseling began after WWII. It started with prenatal disease and Down syndrome because you could diagnose it,” Caplan said. “One interesting fact was that genetic counseling was firmly and strongly and unabashedly neutral.” Caplan explained that genetic counselors actually swore an oath to not sway the opinion of the patient. They didn’t tell them what to do or what you ought to do with these results, they would just give you the information.

“Part of the reason they took this neutral stance was because they were coming right out of WWII,” the end of an era of Nazism, and “they didn’t want any association with Nazi race hygiene,” Caplan said. But this noble assertion is only part of the story, since at the time genetic counselors all studied Freud, meaning the practice called for lots of talking from the patient and mostly listening from the counselor.

Originally this testing was designed for pregnant woman over the age of 35, but this is changing. “We are starting to do more tests for neurological conditions in fetuses,” Caplan said. There are many examinations for cognitive abilities, such as early stage tests for Alzheimer’s, but he thinks that some of this “is being offered prematurely.” Chromosomal aberrations where large segments of DNA are mistakenly rearranged are easier to test than the more finessed mutations that scientists are continually investigating for diseases such as Alzheimer’s and many others.

There are all sorts of conditions and behaviors that scientists are working on explaining through genetics, such as addiction, homosexuality, and antisocial behavior. But the consensus on the underlying genetics of these behaviors is tenuous. Caplan expressed concern that parents who learn of these traits might “helicopter” their children and maybe “keep their antisocial risk child under close surveillance,” or “try to deprogram them if they thought homosexuality might emerge.”

An old ethical concern of prental genetic screening is that it may lead to an increased number of abortions if certain genetic mutations are detected. “Abortion after a detection of Down syndrome in the US is probably somewhere between 70 and 85 percent,” Caplan said. “The rate in the UK is about 90% and is 88% in Denmark.”

Yet as controversial as these abortions are, the diagnosis of Down syndrome is more straightforward than a genetic underpinnings of a complex trait, such as antisocial behavior. Scientists have correlated a variant of the monoamine oxidase A with increased frequency of antisocial behavior in males, but correlation is certainly no causation. The role of the environment, and the interplay between genes and the environment are additional factors to take into consideration when studying and predicting such multiplexed human behaviors. But is there really a concern about an increase in abortions from genetic tests for traits like antisocial behavior?

“You could see them ending pregnancies,” Caplan said. We are doing a survey now about when parents might end a pregnancy for any of those reasons.”

Caplan said that in the future DNA testing will be routine. I will predict that if you don’t offer this in the next 3 to 4 years, you will be sued.” And even though it is highly controversial science, “there are a number of abortions being done because of that criminal chromosome.”

Easier and cheaper genetic testing is going to reinvigorate the abortion debate. Caplan thinks that “there will be no extra consent forms, that it will just be part of the routine battery of tests.”

The debate comes down to “what freedom you have or are going to have to terminate that pregnancy, and I don’t think people are watching it closely.”

Whereas discussion over “designer babies” remains largely philosophical in nature, prenatal screening is likely to add fuel to the abortion debate in an impending and practical manner. Caplan summed it up succinctly: “We are on the edge of one hell of a battle.”

Sources: Seminar and panel talks from “The Past, Present, and Future of DNA” on October 2, 2015 at the Radcliffe Institute of Harvard University.

Note: This article was updated in content and clarity on October 11, 2015.

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