An Obstetrical Edition


Miscarriages –early pregnancy losses- have long been the subjects of research. They are unfortunately all too common, and until very recently, we were only aware of those that occurred after a noticeable menstrual delay –the tip of the iceberg, in other words.

Some progress has been made in understanding why they occur, of course –random genetic mistakes either from development, or from abnormalities in the sperm or egg DNA that happened to be involved, for example. But this type of knowledge is often after the fact -insufficient to predict or prevent the problem, although with in vitro fertilization (IVF) there are often techniques available to detect genetic flaws and guide the choice of fertilized egg to be implanted. This does little to address the issue in the much larger population attempting pregnancy in the more traditional, unaided fashion, however.

I was therefore intrigued by an article in the BBC news: http://www.bbc.com/news/health-35301238 that outlined a proposal to genetically modify some human embryos (not for implantation, be aware) to ‘…understand the genes needed for a human embryo to develop successfully into a healthy baby.’

I realize that, at first glance at any rate, this proposal seems to cross a boundary that has been hitherto sacrosanct: experimenting with human embryos. It seems to trespass on at least two traditional shibboleths. The first one –the more problematic and dogmatically based one- is that from the moment of conception, the embryo –or morula, once the fertilized egg has divided into 16 cells- is a person, or at least entitled to all the respect and privileges of a human being. This is more of a belief, a religious or moral tenet, than a demonstrable attribute of the embryo at this stage, though, and a more neutral consideration of its personhood would have to rely on either arguments from potential or its ability to survive outside of the uterus, should that be required.

The other, and maybe less religiously coloured objection, is the issue of unintended (or even intended) consequences: that to interfere with human DNA is to interfere with humanity itself and perhaps even the reason we are as we find ourselves –evolutionary adaptations that are the solutions to myriad problems of which we may be only dimly aware, if at all; and that we don’t really understand what we’re doing –or how to do it safely –i.e. without inadvertently affecting other things, even if we did. Like any ecosystem, everything is interdependent in one way or another: solve one problem and perhaps create another that you might not have even suspected was being modulated by the initial problem.

This, of course, is the thrust of the UK proposal. One can reasonably study animal models –mice, for example- only if they have comparable genes for early embryologic development. And as Dr Niakan, from the Francis Crick Institute, said: “Many of the genes which become active in the week after fertilisation are unique to humans, so they cannot be studied in animal experiments.” Initially, the study could have more benefits in IVF work – ‘Of 100 fertilised eggs, fewer than 50 reach the blastocyst stage, 25 implant into the womb and only 13 develop beyond three months…’ “We believe that this research could really lead to improvements in infertility treatment and ultimately provide us with a deeper understanding of the earliest stages of human life.”

Convinced? It’s a difficult one, isn’t it? Clearly, we need to understand how things work (as the study proposes) long before we attempt to modify them in any way. And if gene editing on a human embryo can be done, it is inevitable that it will be done by someone, somewhere, but perhaps with less stringent rules and guidelines to constrain it. So, should we just bite our collective tongues, and bow to progress? And is there really a choice?

I’m not sure where I stand on the issue of genome editing; I don’t think there is a one-size -fits-all solution, but I do think there is un bel compromis. The issue must be kept open for discussion, made public, in other words, so that at the very least it is not perceived as being done in secrecy and without identifiable or appropriate input. The pros and cons must be aired and in terms that all can understand. And the opinions of all of the various interest groups -both religious and secular- should be publicly and repetitively solicited. The left hand must know what the right hand is doing.

No, there is unlikely to be consensus; people will divide along predictable lines as I have suggested, but at least there will be a chance for an airing of the arguments, and an assessment of their merits or deficiencies that is available to all who care –a public catharsis. A mitigation…

But in the end, I think we must always be mindful of the dangers that Shakespeare intimated in his Much Ado About Nothing: ‘O, what men dare do! What men may do! What men daily do, not knowing what they do!’

 

 

 

 

 

 

 

 

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