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Commentary
Genome editing, Goldilocks and polygenic risk scores
  1. Christopher Gyngell1,2,
  2. Hilary Bowman-Smart1,
  3. Julian Savulescu1,3
  1. 1 Biomedical Ethics Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  2. 2 Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
  3. 3 Faculty of Philosophy, The Oxford Uehiro Centre for Practical Ethics, Oxford, UK
  1. Correspondence to Professor Julian Savulescu, Faculty of Philosophy, The Oxford Uehiro Centre for Practical Ethics, Oxford OX1 1PT, UK; julian.savulescu{at}philosophy.ox.ac.uk

https://doi.org/10.1136/medethics-2019-105713

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    Heritable genome editing (HGE) is officially here. ‘Lulu’ and ‘Nana’, born in China, are the first children whose genomes have been intentionally modified. A third gene edited baby may have already been born. Scientists in Russia are planning similar applications.1

    We recently argued that HGE should be judged by the same ethical standards that we apply to other technologies.2 There is a moral imperative to improve the health of future generations, to reduce inequalities and improve standards of living. If we can use HGE to achieve these aims, we should.

    We want to thank Sarah Chan, Peter Mills, Rachel Horton and Anneke Lucassen for their thoughtful criticisms of our paper. We would also like to thank the editors of the Journal of Medical Ethics for helping facilitate this detailed discussion. The moral questions posed by HGE, are complex, multifaceted and difficult. They required focused attention, which formats like this encourage.

    Our responses to each of the commentaries are detailed below

    Horton and Lucassen

    We agree with the following points made in Horton and Lucassen’s paper ‘The moral argument for heritable genome editing requires an inappropriately deterministic view of genetics’.3

    • Until we better understand what determines the penetrance of genomic variants, HGE is premature.

    • Many variants used in gauging polygenic risk are markers of disease risk, rather than agents of pathogenesis themselves.

    • The impact of any given variant will depend on its context within a genomic background, and the influence of environmental factors, some of which will be stochastic.

    These are some of the reasons why we say HGE targeting polygenic diseases is likely decades away.2 The technical challenges seem daunting. But science can move quickly, and often does so in bounds. Our capacity to capture and analyse genetic data is rapidly expanding. Over the next 5 years, genomic …

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    Footnotes

    • Funding CG, HBS and JS, through their involvement with the Murdoch, received funding from the Victorian State Government through the Operational Infrastructure Support (OIS) Programme.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Correction notice This article has been corrected since it was first published online. The author Hilary Bowman-Smart was missing from the first version of the manuscript

    • Patient consent for publication Not required.

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