viernes, 24 de noviembre de 2017

BioEdge: NEJM debates repairing human germlines

BioEdge: NEJM debates repairing human germlines

Bioedge

NEJM debates repairing human germlines
     
With the rapid advance in gene-editing technology, the time has come to consider how to ethical trials, according to an editorial in the New England Journal of Medicine. Bryan Cwik, a philosopher at Portland State University, in Oregon, zeroes in on some unprecedented difficulties in designing trials of modifying the human germline.

Cwik argues that “intergenerational monitoring” will be needed, not just of the first generation of modified children, but of their children and grandchildren. There could be subtle effects which emerge only after two or three generations. He points out that:

Monitoring for effects of gene editing will require consent and participation from multiple generations of descendants of the original participants. Studies will therefore require researchers to have access to key medical data for entire families over several decades.
But is this compatible with the autonomy of the research subjects? How can unborn grandchildren give consent to a lifetime of monitoring, with blood tests, physical examinations and collection of genetic material. Some descendants may not be aware that their forebears were genetically modified and notifying them may be socially and psychologically distressing. Cwik concludes:

... protection of the dignity, welfare, and privacy of research participants is of the utmost importance, and no amount of therapeutic potential can justify proceeding with human experiments until that protection is secured.
In another editorial in the same issue of the NEJM, Harvard stem cell scientist George Churchjeers at such arguments.

... some critics fret about the slippery slope of human enhancement and the impossibility of obtaining consent from future generations. Doing nothing merely for fear of unknown risks is itself risky — greatly restricting the advance of medicine... We already embrace many enhancements inherited over multiple generations — generally without consulting future grandchildren — for example, education, homes, and extinction of pathogens through the use of vaccinations. The issue for many critics lies not in enhancement relative to our ancestors, but rather relative to one another.
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Several of our stories this week deal with end-of-life issues. For a bit of a change, how about an historical diversion?

“And when Rachel saw that she bare Jacob no children, Rachel envied her sister; and said unto Jacob, Give me children, or else I die.” You might recognise this quote from the Bible. It is often used to illustrate the pain of infertility, which hurts no less 4,000 years later.

Jacob was a wandering pastoralist. But Turkish archaeologists announced this month that they had uncovered evidence of urban infertility in Kültepe, an Assyrian site in the centre of modern Turkey. It is a clay tablet with cuneiform script with a prenuptial agreement – also 4,000 years old. It may be the first pre-nup in recorded history.

If, after two years, the bride has still not borne a child, the tablet says, the wife will allow her husband to use a female slave as a surrogate mother to produce an heir. The slave would be freed after giving birth to a son.

Many ethical issues in the Reproductive Revolution have precedents, but it’s amazing to see that today’s surrogate mothers were anticipated by Assyrian slave girls four millennia ago.



Michael Cook
Editor
BioEdge
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