Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

The embryo as a patient

2,091 views

Published on

Should we use CRISPR-CAS9 for germline editing in human embryos ?

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

The embryo as a patient

  1. 1. The embryo as a patient Dr Aniruddha Malpani, MD www.drmalpani.com
  2. 2. Logical next step in medicine • Adult • Child • Foetus • Embryo
  3. 3. Precision medicine • Prevention is better than cure • Treat at the genetic level – at the root cause of the disease
  4. 4. We’ve come a long way, baby !
  5. 5. From PGS – preimplantation genetic selection to PGT - preimplantation genetic therapeutics
  6. 6. Playing God ? • Familiar debate ! • Is IVF ethical ? When does life begin? what are the rights of an embryo? • Can human embryos be used for harvesting embryonic stem cell lines ? • Should cloning be allowed ?
  7. 7. Two views • Manipulating Nature is dangerous v/s • Triumph of man's ingenuity which can be used to overcome Nature's constraints.
  8. 8. Who decides ? • Top-down – scientists, philosophers, activists, government, doctors. • Bottom up - Leave the decision to each individual couple, who provide the reproductive apparatus to create the baby.
  9. 9. Challenges • Both technical and ethical • Assilomar Conference. Recombinant DNA. 1975. Moratorium , need time to evaluate the risk reward ratio • Transhumanism - Logical next step for human progress . Humans engineer their own evolution, rather than depend on nature
  10. 10. Challenges • Cells are still a black box . Worry about unintended consequences • Gene Drive • Gene Flow across species can lead to interbreeding • Dare we open Pandora’s box ?
  11. 11. Science Fiction
  12. 12. Different standards
  13. 13. Slippery slope !
  14. 14. Criticism • Unnatural and artificial - Is nothing sacred ? • Money - Is everything for sale ?
  15. 15. Knee Jerk Reflex - Ban genetic engineering ! • It’s too dangerous, so let's prohibit it ! Easy to do, but will backfire. Throw the baby out with the bath water. • Other countries will steal a march on us and we will be left behind • Drive it underground ? • Need sensible guidelines and regulation
  16. 16. • Actions have consequences. • Inactions have consequences too • Fear of the unknown cannot paralyse us into inactivity
  17. 17. Dr Frankenstein
  18. 18. Should human embryo research be banned ? • We are not mad scientists trying to play God • We are doctors trying to do the best for our patients
  19. 19. Doctors are trusted professionals • If we trust doctors to make life and death decisions in the ICU, then why can’t they be trusted to make decisions about genetic engineering responsibly in partnership with their patients ? • Could set up a multidisciplinary committee to review each request ?
  20. 20. 3 principles of medical ethics • Autonomy • Beneficence • Non-maleficence
  21. 21. Evolution 2.0 ? • Human reproduction is not efficient. Hit and miss affair. Why not improve it ? • Natural Selection is a biological fact of life • If humans can do a better job, then why shouldn’t we ?
  22. 22. Human Reproduction v 2.0 • Mother Nature is not always kind - millions of people die of preventable diseases, which we can treat today
  23. 23. The problem with regulations • Rules vary so much from country to country means there are no right answers. • Rigid and inflexible. Get outdated • Isn’t it better to allow doctors the freedom to select what is best for their patients ? • This conference shows we are responsible and sensible
  24. 24. Solution ? • Let patients decide for themselves – it’s their life and their baby • A democracy empowers people to make their own choices • It’s unethical to interfere in their personal family-building plans • Need to individualise and personalise the care we provide

×