My father had his first heart attack at 37 years old. Let that sentence sink in for a second. No part of this shocking statement has been lost on me, certainly not when I recently turned 38. I have spent my entire adult life aware of the seriousness of heart disease and I have assumed since my teens that eventually heart disease will cause my death.
However, I am doing my best to prevent that from happening any time soon. I have never smoked a cigarette, whereas my dad used to smoke more than a pack a day. I monitor my weight, and even with a job that is largely inactive, I manage to exercise regularly.
I also watch what I eat. I avoid red meat, I scarcely visit a fast food restaurant, and I aim for fresh fruits and vegetables every day. Despite my efforts, I still have high cholesterol, so I have taken a statin every day since I was 30.
Statins are among the most common prescription drugs in the US and their use is increasing rapidly. The drug I take inhibits an enzyme that helps produce cholesterol. Between my diet, regular exercise, and my daily enzyme inhibitor, my cholesterol is fine but not great. I wish I could do more.
Scientists now know there is a gene, PCSK9, which can strongly affect cholesterol levels. Some people have a version that is over active, leading to reduced clearance of cholesterol from the body, which results in higher blood cholesterol levels. The extra cholesterol ends up in arteries which increases the risk of a heart attack.
There are some lucky people who seem to have a version of the gene that dramatically lowers their cholesterol. I don’t know what genes I have, but I know I would do almost anything to avoid a heart attack while my children are still in elementary school. When my dad had his first heart attack, he had three kids under 9 years old. I sometimes think about how my life would have been different if he had not lived through it.
So many factors combine to determine my chance at heart disease. I changed my behavior, my diet, my lifestyle, and even my enzyme activity to try to lower my chances. What if I could I change my genes too?
So far, this is not possible. Gene therapy for something like PCSK9 mutations does not exist yet. It has been modified successfully in human cells, but never in people. We don’t know if changing PCSK9 would reduce cholesterol in people who received the gene through editing (but it should be noted that it worked in mice).
Too often media presentations of human genome modification are unhelpfully burdened with language about playing God (like here, here, and here). Behind all of these concerns is a strange genetic exceptionalism that assumes DNA is somehow sacred or off limits to any intervention. There are many reasons to tread carefully when it comes to human genome modification but strict prohibition because modifying DNA is “playing God” is indefensible.
One reason to move forward with caution is that human bodies are vastly complex systems and that there are likely to be unintended consequences to any intervention we make. But that is just as true for my exercise routine (sore knees), my diet (increased cost), and my medication (statins have many well documented side effects). Unintended consequences are why we need medical trials. They are not a reason to avoid human genome modification.
Issues of inequality and injustice are another reason to embrace this technology with caution. Treatments that involve modifying human genomes are likely to be expensive which will only further the health inequalities in our country. But then again, these problems exist for current treatments. Some groups have less access to the relatively inexpensive statins including people of color, the poor, and the uninsured. Concerns about justice are a reason to expand access to healthcare, not a reason to prohibit genome modification.
To ban human genome modification because altering DNA is somehow playing God doesn’t make sense theologically either. Statins lower cholesterol by altering the activity of a protein inside my cells. Why is it acceptable to alter how my proteins are used but it is not acceptable to alter how my DNA is used? God is sovereign over my DNA, but God is also sovereign over my proteins. God gave me my DNA and he oversaw the production of every protein. Since I think that it is perfectly reasonable to inhibit the proteins in my cells, I think it is ethically consistent to permit inhibition of the DNA too.
Changing the DNA in my liver cells could possibly lower my blood cholesterol for life. The irreversibility of the procedure gives some critics pause, but in that irreversibility I see a cure. Genome modification offers a cure for the incurable. Instead of 50 or even 60 years of side effects, I could be offered a cure for high cholesterol.
Human genome modification is an exciting new technology that is just over the horizon, but it is coming our way fast. In order to be prepared to engage this technology wisely, people of faith need to avoid reflexive condemnation and instead carefully consider genome modification as the technology progresses.
People of faith need to be part of the conversation around if and when human genome editing is acceptable. Genome modification has the potential to offer cures where none now exist, to give hope to those who have no hope, and to bring freedom from sickness and disease. Christians are able to offer a response to human genome modification that no other group will provide. We can respond by saying, “Thank you Lord for these thy gifts which we are about to receive.”