Permissionless biohacking

We already have tools and rules to avoid catastrophe. We just need to decide what it means to be human.

Walter Isaacson is mid-tour for his new book on the CRISPR story. Isaacson has a knack for distilling conventional wisdom into a best-selling biographies; it seems he’s done it again with Prof. Jennifer Doudna. That conventional wisdom goes something like this: We’re gaining the power to design our babies, and eventually create superpeople, and our society and public institutions aren’t ready.

I have nothing to add to that story. Actually, I’m embarrassed to admit I find myself zoning out from having heard that plot so many times. I sense that many in biotech react the same way.

But it’s obviously true. Gene editing may well be the tool that delivers humanity mastery over biology. It may ultimately be the transistor of the life sciences, with uses in therapeutics, diagnostics, and research tools. It demands our attention.

We usually talk about big biotech ideas through an ethics lens. Gene editing, stem cell research, and population-wide sequencing all get this treatment. My problem is that bioethics can’t be our only guide here. With tools this powerful, it’s not just about what we should do. It’s also about what someone, somewhere, will do. If this technology can produce superhumans, then there will be a country that starts churning them out. Then the global balance of power will shift, economically, militarily, or both.

It’s also tempting to think about the politics and policy of new technology. But we don’t know what will ultimately be possible. That makes it a hard field to regulate.

Here’s the question: How do you think about an industry that’s going to be super important, but doesn’t exist yet?

You can think like an investor. You don’t need to make one bet on one technology. You don’t need to know what technologies or business models will succeed. You just need a prediction about where the world is heading, and a thesis about what makes for a good bet if your prediction proves correct. Then you place bets on as many technologies or business models as you can manage that fit your thesis.

In this case, the investor is society itself. Instead of hoping to earn money by investing in businesses, we are hoping to generate a good/just/successful future by investing in science and institutions. So let’s build a thesis to guide our investments.

Here’s a quick list to get us started.

Get there first

I make no apologies for being an ardent bionationalist. Whatever the biotech firms of the future look like, I want them headquartered here. That means we (the U.S., or at least our allies) have to stay in the lead on the development and commercialization of the technology.

So don’t let’s put our head in the sand. Fund the basic science aggressively. Subsidize on-shore manufacturing. Don’t blacklist, ban, or demonize the field. When it comes time to politicize it, wrap it in the flag, call it a national security issue, and keep pushing forward.

We also have to protect the climate that for the last half-century made the US the best place to start a business. That means well-funded universities, a clear path for college-educated foreigners to nationalize, and a competitive investment tax structure.

Strive for equal access

Isaacson pushes his audience to imagine the plight of future parents at the “genetic supermarket,” specifying the traits of their baby. If the free market is allowed to run wild, he asks, will we end up with a society of rich superhumans and poor, plain-vanilla Homo sapiens?

This is a valid concern. It’s also fairly easy to avoid. It requires two things. The first is a refusal to de-medicalize genomics.

Today, we consider genetic testing and abortion to be a medical issue between the mother and her doctor. (In the case of abortion, many hope to regulate the decisions the mother and doctor can make.) When we talk about designer babies, though, the conversation slips into commercial terms. Parents will “shop” for their babies’ height, weight, and skin color. They will “upgrade” their kids’ strength or intelligence. Today, the closest example of this kind of medical consumerism might be picking eyeglass frames.

But gene editing is a therapy, not a fashion accessory. The FDA can and should be our guardrail here. You can’t take drugs just because you feel like it. You shouldn’t be allowed to recreationally hack your baby’s genome, either.

The good news is that on this question, biotech is firmly in the driver’s seat. Normal people aren’t clamoring for the ability to genetically modify anything, so politicians are taking their lead from lobbyists. This can occasionally lead to weird outcomes. Theranos, for example, got Arizona to pass a state law permitting patients to get and review diagnostic tests without going through a physician. In its early years, 23andMe picked fights with the FDA, and it continues to push a direct-to-consumer vision of genomic testing. We don’t want this to become the dominant voice from within our industry. Biotech should want these tools to stay within the payer/provider/regulator framework we already know.

The second requirement is universal access to healthcare. As long as gene editing is a medical procedure, the best way to ensure everyone has access to it is to make sure everyone is covered.

Suppress externalities

Gene editing will obviously serve up a feast of unintended consequences. We usually hear about these as a per-patient risk. For example: what if we turn the dial on intelligence and it turns out to be linked to debilitating anxiety? What if we dial up physical strength but decades later realize we’ve shortened lifespan? These are the kinds of risks our existing clinical trials and FDA approval, and post-market surveillance systems are designed to catch.

But there’s another kind of risk that’s not well-managed by the FDA: the risk to human evolution.

Some unfortunate outcomes are easy to imagine. If parents constantly choose to make their kids taller than the median height, humanity will eventually be poorly adapted to living in the natural world. But the collective action of individuals, even if they’re making sound medical choices, might eventually put humanity at risk.

Consider the old example of sickle cell carriers, who are more resistant to malaria. If we scrub sickle cell and other inherited diseases from the genome, will we make humanity less robust? For certain traits, at least, humanity might drift into being a monoculture.

Evolution has always been a process of natural selection. Gene editing of the germ line is a form of deliberate selection. There’s nothing sacrosanct about natural selection, but it has a way of asserting itself eventually. Monocultures suffer blights and plagues. A more homogeneous humanity would be more susceptible to environmental change, or a clever pathogen. This, to borrow a term from economics, is a genetic externality.

It’s worth thinking, now, about how to minimize this. A modest proposal: let’s ration — by lottery, say — the availability of any single germline therapy. This would force the development of multiple methods of action, making it harder to homogenize any one part of the human genome.

Have a vision

For all the excitement about gene editing and other avenues of mastering biology, I’m struck by how narrow the vision of that future usually is. We cure all the diseases. We unleash our tribal and racist impulses on our children, stripping out any offending characteristics. We make super-soldiers.

Is that the limit of our imagination? It’s easy to say what we fear. But if we are truly on the verge of directing our own evolution, there has to be more. We really need to ask: what do we want to become?

We become what we choose to improve. If we want new technology, we should improve intelligence. If we want amortality, we should pursue longevity. But maybe we want a more just world. Should we pursue empathy? Maybe we want humans to colonize the stars. Do we improve cryogenic stability? Maybe we want to preserve human history. Should we develop brains that come with a “data out” port so we can record memories?

These are not idle questions. Our mastery over communication subdued our predators and put humans in every biome. Our mastery over agriculture swelled our numbers. Our mastery over transportation paved the world and gave every human access to every corner of the globe. Our mastery over computation gave us access to virtually all of recorded human knowledge.

Biological mastery will mean giving humanity the ability — the responsibility — to decide what it even means to be human. It’s not an easy question to answer. That means it’s time to get started.