He Jiankui, an American-trained embryologist, spent three years in a Chinese prison. Now, recently re-emerged and seemingly rehabilitated, he has re-embarked on his work. His only comment is that he acted too quickly, something far short of an apology.
What does the public say?
Does their opinion matter; should it matter? On social questions for which science doesn’t have all the answers, the intercession of stakeholders is crucial. On the other hand, do stakeholders have the requisite information to make an informed decision? Given that trust in the established medical establishment is at an all-time low, how would they get it, and from whom?
And what if individual parental choice conflicts with what is best for society at large – or for the child - how are the decisions made then? And, of course, there’s wishful thinking. Anything that might help improve a child’s performance in an area deemed important by a parent is glommed onto- even if the science is paltry at best.
An American group has undertaken scientific research to poll the populace on selection for a particular trait, in this case: intelligence (as opposed to selection against disease). The recently reported results are published in the prestigious journal Science.
Survey participants were offered three hypothetical services for their children:
- Participation in widely available courses designed to elevate SAT preparatory scores
- Preimplantation genetic testing (PGT-P), –in conjunction with IVF technology, which selects the most alluring embryo (at least according to parental choice). In this case, the embryo possessing the most known genes signaling “intelligence.”,
- Gene editing, manipulating the genes to create a hereditary change in the genetic structure
First, some caveats. The authors, primarily economists, make several assumptions:
- The services are free, eliminating any concern of increasing disparities between the haves and the have-nots.;,
- The services are safe, a quantum leap from current technology, since both PGT-P and gene editing require IVF, which carries independent risks to mother and offspring (including elevated cancer and metabolic risks).
- Community beliefs change over time. [1]
Of the 6,823 people surveyed in the Science study, participants were asked if the three enhanced intelligence services offered were morally acceptable, morally wrong, or not a moral issue – or whether they were unsure, and if they would avail the procedures for their kids.
The services had a practical purpose: the anticipated results promised to get their kids into a top-rated college. Participants were told that the use of each of the three services, SAT prep testing, selection of the child with the highest likely IQ via IVF embryo selection, and genetic editing, would each increase the odds that the child would be accepted by a top 100 college, by a small, but quantifiable amount.
“We told them that about 3% of high school seniors attend a top-100 ranked college, and that each service would raise their likelihood of having such a child by two percentage by points (from 3 to 5%).”
We all know how important getting kids into a top-rated school is to many parents. Just recall the desperate housewives who created the great College Admission Scandal, committing bribery to achieve that end. So, it’s unsurprising that 76% of survey participants had no moral objection to SAT prep testing, although only 69% said they would use it for their kids.
As for using IVF to select the embryo via PGT-P to select the embryo with the highest cluster of high IQ genes, a majority - (58%) had no moral qualms, and 43% said they would be likely to use it. At least one US company offers this service, using a “polygenic score” of genetic superiority for which they claim healthier babies and the capacity to offer it for intelligence.
When it came to gene editing using CRISPR or a similar modification tool, as used by He Jiankui, a procedure creating a heritable change (for which Jiankui was imprisoned), 41% had no moral qualms, and 34% said they would be likely to use it.
Another study, conducted in the UK by the same authors, found that participants under 35, those most likely to avail themselves of these types of services, were more likely to support genetic interventions for selected traits ( e.g., height, sex, hair color, etc.) than older cohort members.
Those participants with a bachelor’s degree were more likely to agree that gene editing and PGT-P (via IVF) for selecting “smart” embryos were morally acceptable, compared to their less-educated peers, and were more likely to use them for their kids.
Peer pressure made a difference. When parents were told that 90% of those similarly situated would opt for PGT-P or gene editing, they were more likely to go along. When others were told that only 10% would use the procedure, most similarly rejected the approach. People are heavily influenced by what they presumed their peer group would do.
The authors conclude:
“Public views of technology should influence policy-making in a democratic society. Experts who are critical of a technology should not assume that the public shares their knowledge or view point….We should learn the extent to which people who would not otherwise use IVF would do so to use PGT-P.”
A short section was included about the need to perform more research and increase consumer literacy. They went on to add a short sentence conveying the complexities of pleiotropy, the implications of which aren’t fully explained.
The unanticipated effects of Pleiotropy: be careful what you wish for
Pleiotropy occurs when a single gene, or locus on a gene, affects two or more unrelated, expressed, or visible (phenotypic) traits. Since hundreds of genes govern intelligence (ignoring environmental influences), it is possible that improving one gene will impact others in unanticipated and adverse ways, inadvertently deleting the good traits and keeping the bad ones. Eradicating Gaucher’s disease, a hereditary condition that affects Ashkenazic Jews causing extreme fatigue, bruising, and a shortened life span might sound wonderful. But the gene responsible for the disease also may be protective against tuberculosis. Similarly, the gene causing sickle cell disease, which most frequently targets Blacks, also protects against malaria.
Now, let’s look at schizophrenia, which has a high hereditary component and is apparently related to genius. Surely, in selecting an embryo via polygenic scores using PGT-P, we would eliminate those who might later manifest that debilitating disease. Except, if we eliminated all people with schizophrenia, John Nash, the Nobel prize-winning mathematician, wouldn’t have been born; nor his son, a similarly diagnosed mathematician managing well outside an institution.
Albert Einstein had two sons. The younger, Hans Albert, became a recognized expert in hydraulic engineering. The older, supposedly more brilliant son, Eduard, set on becoming a psychiatrist, suffered several breakdowns, and was later institutionalized with schizophrenia.
Some observers say the expression of hereditary schizophrenia exists on a continuum. In selecting an embryo using PGT-P to maximize intelligence, embryos with any genetic indication of schizophrenia would be eliminated – perhaps leading a parent to deselect a potential Albert Einstein, whose “normalcy” may have been a result of other compensatory genes or his birth order, and environmental factors, all of which play a significant role in the expression of intelligence.
The survey, which makes a strong case for parental approval of genetic engineering or selecting the most auspicious embryo for intelligence for implantation during IVF, ignores other factors which may be relevant, including the role of changing expert opinion, conveying critical information to the parental stakeholders, and how that information might impact parental decision making.
While genetic editing via CRISPR is morally verboten in the US, no law prevents parents from using PGT-P (or the selection of embryos for particular traits) during IVF. We can assume the wealthy have already quietly partaken of that choice. Perhaps it’s time to see what the “experts” say and consider the importance of mandatory education for parents before they embark on these genetic adventures.
[1] Shortly before IVF was made available, a 1969 Harris poll found that most Americans opposed the procedure, and the American Medical Association imposed a moratorium on IVF research. In 1978, one month after Louise Brown, the first IVF baby, was born in the UK, the same poll found that 60% supported IVF and would use it themselves.
