Genetic Interventions: What You Need to Know

Abstract 

Technological advancements in genetic engineering have the prospects of changing the landscape of medicine in the near future. Gene therapy and enhancement will solve some of the most debilitating health problems such as Down syndrome and allow individuals to choose phenotypic expressions as witnessed in the blue-eyed babies. There have been calls to ban these procedures because of the moral implications they have on society. Banning has also been contemplated because some interventions are considered risky and could potentially have counterproductive effects on one's health. However, allowing genetic experiments to continue appears to be the future of medicine. The paper will argue against banning the interventions remaining keen to highlight the positive impacts of the scientific discovery. 

Introduction 

With major advancements in the field of genetics, genetic therapy and human enhancement have become possible. Therapy involves fixing what has gone wrong through the treatment of an illness or an injury. On the other hand, enhancement aims at improving the state of humans beyond what is considered normal healthy living. The new technologies have enabled the enhancement of human capacities, dispositions, and abilities. Whether is it is therapy or human enhancement; the intervention involves the fundamental alteration of the basic instructions of the body. Therapy continues to target even the germ cells meaning that it might eventually have an impact on the future generations. On the somatic cells, it has promised to treat and eliminate a wide array of illnesses including cystic fibrosis, cancer, Down's syndrome, hemophilia, and even AIDS. The enhancement will enable individuals to acquire the traits they want including the blue-eyed babies and increased muscle strength among others. The manipulation of human genes is more of an ethical than a legal issue. Despite the promises, genetic interventions should not be banned. Although much of the research is in its inception, the genetic intervention will assist in remedying medical conditions, solving infertility, sex selection, and preventing drug adversities. 

Genetic Therapy Can Solve Cases of Infertility 

The article “Two Mommies and One Daddy” explores the sensitive regarding genetic therapy and its role in solving fertility issues. The fertility treatment is known as ooplasmic transfer where an egg cell is derived from an infertile woman and injected with a gel-like cytoplasm from another woman. Research has shown that the process can reverse infertility due to the transfer of healthy mitochondria. “Since these bits of cellular machinery contain DNA, children conceived this way inherit genes from their mother, father, and the donor, hence the three-parent tag” (Two Mommies and One Daddy). However, this problem was eventually banned by the United States’ Food and Drug Administration (FDA). However, research conducted on human embryos and animals has shown that the mitochondrial transfer is a safe process and is ready for human trials. Scientists believe that it will solve infertility and ensure that children acquire desirable traits from their parents. According to research, the mitochondria possess a host of genes that give human traits such as intelligence, personality, and appearance among others. Therefore, banking on mitochondrial engineering will solve a host of reproductive issues. On the other hand, banning it will hamper research that could change the landscape of reproductive health in the world. 

Prevention of Disease 

The goal of medicine is to prevent diseases. Genetic therapy enables testing which eventually uncovers disease that would normally have been missed by the conventional strategies. It also enables individuals to acquire additional information regarding their health that could significantly shape the course of their lives. One of these strategies is known as the preimplantation genetic diagnosis (PGD). The technique can be used alongside in-vitro fertilization to enable the "test for genetic disease and genetic predisposition, and can even determine sex-all before a woman is actually pregnant" (Kincaid, 2015). Scientists have asserted that the PDG is a major scientific advance that needs to be embraced. It is particularly vital for children who risk inheriting a serious genetic disease. Therefore, parents with diseases such as Huntington's do not have to fear that they would eventually pass it to their children. Many believe that this strategy will push disease prevention to levels that have never been witnessed before. Research has also established that gene mutation remains one of the most significant causations of disease in the American population. Therefore, banning the intervention means that many Americans will continue to experience genetic problems that affect their movement, thinking, mental health, and reproductive abilities among others. 

Genetic testing for embryos has now existed for approximately a decade. According to the New York Times, the process is expensive, "but they make it possible for couples to ensure that their children will not inherit a faulty gene and to avoid the difficult choice of whether to abort a pregnancy if testing of a fetus detects a genetic problem" (Kolata, 2012). In the US, a body known as The Society for Assisted Reproductive technology" has confirmed that the preimplantation diagnosis is ethically justified. Most importantly, these diseases continue to lack the necessary effective and safe interventions for the treatment. The only problem identified is that the process can be extremely expensive. Also, many insurance companies will not cover it because of the associated hefty costs (Kolata, 2012). Although ethicists have been divided on this issue, a section has supported it saying that the interventions should be taken out of necessity and whether the persons can afford. Although debates will continue, the bottom line remains that gene therapy and testing will assist in uncovering diseases and mitigating them at the prenatal level to ensure that children live healthy and desirable lives. 

The Gene Enhancement Will Allow Sex Selection 

As previously shown, manipulation of genes can result in manipulation of traits based on the preferences of an individual. One of the preferences enabled by gene interventions is known as sex selection. The World Health Organization (WHO) defines sex selection as “The practice of using medical techniques to choose the sex of offspring” (Gender and Genetics: Genomic Resource Center). Sex selection can encompass a host of strategies including In-Vitro Fertilization, separating sperm, and the selective termination of a pregnancy. It can also enable the parents to choose one sex over the other. Sex-selection can be done for medical reasons. For instance, it can prevent children from inheriting conditions associated with X-linked disorders. It can also play a significant role in family balancing. A parent can choose different sex if they already feel that they are contended with children of a particular gender. It is also in line with gender preference reasons. Many people would tend to favor male offspring based on the sociocultural aspects that favor men than women. However, it should be noted that this can come with ethical concerns such as discrimination against a particular gender. However, when done for purely medical reasons, it can be a life-changing intervention. 

Treatment of Chronic Infections 

As previously stated, gene therapy seeks to complement the traditional interventions especially by providing treatment to chronic infections. An example of a chronic infection that gene therapy will treat, according to studies, is the Duchenne muscular dystrophy. According to a report published in the New York Times, progress has been made in the treatment of this disease. The author states, “After decades of disappointingly slow progress, researchers have taken a substantial step toward a possible treatment of Duchenne muscular dystrophy” (Wade, 2015). The treatment of the illness will significantly become possible with the recent gene-editing technique that was recently formulated. The disease affects the muscles of especially boys and can cause paralysis by the age of 10 years. It is then followed by breathing difficulties and heart failure that result in early death. The disease comes as a result of defects in a gene encoding for a protein called dystrophin which plays a significant role in muscle function. The disease is hereditary and most importantly untreatable. Gene therapy works on the basis of inserting the correct gene in place of a damaged one. Research conducted on the mice has shown that the technique can treat the genetic disorder that remains a threat to many children across the world who in the risk of dying from the disease. 

Gene therapy has also been identified as a potential treatment for Down's syndrome. According to scientific reports, there is a possibility that manipulation in the gene could enable the treatment of Down syndrome including those who have been born with it. Down's syndrome is a serious medical problem that affects not only physical growth but also intelligence. It can also result in significant medical problems that range from heart disorders to dementia. The technique used in the treatment of this disease is known as chromosomal therapy. Although it is still in its inception stages, it promises to solve the problem and improve the health conditions among the children born with the disorder. It is important to note that Down's syndrome is a chromosomal disorder and as such, chromosomal therapy will seek to rectify the entire chromosome. Chromosome 21 is responsible for this disease, and therefore in eliminating it, scientists are looking for ways to silence the chromosome (Wade, 2015). The success of this process will enable scientists to solve additional problems apart from Down’s syndrome. 

Gene Interventions and the Military 

Mehlman and Li (2014) discuss the important role that the genetic interventions have on the military. The authors say, "Advances in genomic science are attracting the interest of the US military for their potential to improve medical care for members of the military and to aid in military recruitment, training, specialization, and mission accomplishment" (Mehlman & Li, 2014). It, therefore, shows that the military in the US continues to explore a wide array of interventions aimed at meeting the military objectives. The first intervention is known as the biobanks and Geno-phonebanks. Here, the military will collect the DNA material from current and former members of the military in a bid to enhance the identification of the remains. The military has also explored genetic testing as a way of bolstering their objectives in defending the country. The authors believe that genetic testing can identify personnel with genetic disorders who do not have any symptoms until the future. Some of the disorders tested include Alzheimer's and Huntington's disease. The military has also utilized genetic testing in assisting the confirmation of various clinical diagnoses. Military physicians are continuously exploring these strategies to help their staff operate at the most optimum level. 

The use of genomic technology will also be used in the treatment of genomic and non-genomic illnesses. For instance, it will involve the use of approaches such as the recombinant DNA in the manufacture of drugs. The gene therapy has also been used in the military to treat illnesses and the injuries sustained in the field. The techniques have also been used in altering the genetic characteristics of the microbiome; an organism found in the digestive system of humans and plays a critical role in the process of digestion. Lastly, the military has also applied a genetic enhancement in their endeavors. Research says that "the military will be intensely interested in exploiting the association between genomics and human capabilities and performance” (Mehlman & Li, 2014). The reasoning behind this is to improve the health of the soldiers and most importantly, bolster their performance. For instance, the warfighters could be reconfigured genetically to require less sleep. According to studies, sleep deprivation is responsible for the disruption of up to 700 genes. Therefore, scientists are working tirelessly to ensure that the genes are not affected by sleeplessness to give the soldiers the much-needed impetus to work optimally. 

Genetic Intervention Will Reduce Abortion 

Even though opponents continue to view genetic engineering through controversial lenses, it remains significant to appreciate that it will improve the health of many people. It is also likely to mitigate controversial issues such as abortion which continue to divide opinion among ethicists. Abortion is one of the most polarizing debates not only in the US but in the rest of the world. Although it is not prohibited in most states in the US, conservatives, and ethicists feel that human life begins at conception and as such, abortion amounts to murder. The New York Times reports that many American parents whose children have Down's syndrome continue to engage in abortion. The author says, "In the United States, an estimated 67% of the fetuses with prenatally diagnosed Down syndrome are aborted” (Kaposy, 2018). In Canada, the rates are significantly higher. Some states have illegalized the practice of aborting children diagnosed with Down's syndrome. Some of the states include Ohio, North Dakota, Louisiana, and Indiana. A doctor performing an abortion in such circumstances is regarded as criminally liable. Through genetic therapy, the problem of Down's syndrome can be solved even when the child is yet to be borne. Therefore, this will limit the rates of abortion which will otherwise continue to be experienced in countries such as the US and Canada. 

Gene Therapy Can Be Improved Through Ethical Consideration 

Advocates that have called for the banning of the genetic interventions have largely cited ethical concerns. They feel that the therapy and enhancement lead to moral decay and conflict the very essence of humanity. Others have felt that the associated costs will likely lead to inequality in the society as the interventions will be available only for the individuals who can afford them. Although all these sentiments are true, it is difficult to wish away the critical role that the genetic intervention will play in the healthcare industry. It is in this regard that ethical guidelines should be taken to ensure that the process is legal and takes into consideration the important position that humans occupy in the world. Medical ethics has been applied in a wide array of contexts ranging from the care facilities to the human research practices. Proponents of the genetic interventions have opined that the same research principles can be employed in the genetic biology in ensuring morality prevails in the use of the approaches. 

First, anybody engaging in the study or treatment with a genomic intervention should be exposed to consent and confidentiality. Scientists assert that "Consent documents provide a means of communicating the risks of a study to participants" (Hudson, 2011). The consent documents help in communicating the risks and benefits that come with the study. As previously noted, a large part of the genetic studies is still in its inception. Therefore, it is only through research studies that the final outcome that will lay the foundation for future therapy will be found. Therefore, the legality or illegality of the genetic interventions will begin at the point of research. Hall and Cahill (2017) asserted that consent also means that the participants are given a chance to opt out of these studies. Secondly, confidentiality is also a significant issue that must be considered throughout the research studies. Throughout the process, the researchers will be collecting critical and sensitive information from the participants. Therefore, confidentiality should be adhered to in line with all the applicable laws and statutes. Some of the information that should be kept from the public access includes the biodata and the particular disease the participant has. When these two important considerations are adhered to, gene therapy and enhancement will be accepted by the regulatory authorities because they are borne out of an ethical process. 

Necessary steps will also need to be taken in order to integrate genetics into medicine. This will also require ethical consideration to ensure that it ends up successfully. The author asserts that some of the requirements include “An educated health care workforce, protections against inappropriate disclosure and discriminatory use of genetic information” (Hudson, 2011). All the genetic tests must be put under regulation to ensure that they meet the standards required for human beings. Some of these standards include beneficence and nonmaleficence. Beneficence means that the research interventions should endeavor to benefit the patient. On the other hand, non-maleficence refers to ethical principles that prevent researchers from engaging in activities that could potentially harm the participants. The two principals will, therefore, ensure that human research is conducted in a manner that respects human dignity (Green et al., 2015). However, in cases where alternatives could be used, the regulation asserts that this is welcomed. However, when genetic research fails to consider the critical research ethical guidelines, they will ultimately face banning, and the chances that they will be used in the future will continue to dwindle. 

Pharmacogenetics 

Another promising area in the field of genetics will deal with matching the genetic profile of an individual to the specific effects of a given drug. Studies have shown that genetic composition can predict toxic effects. An example of a toxic response is the hypersensitivity reaction among members of the HLA-B*5701 allele who have received a drug for HIV treatment known as abacavir (Hudson, 2011). Many medications taken for various diseases tend to possess toxic effects on particular users. With Pharmacogenetics, studies will allow scientists to predict the occurrence of an adverse impact hence enabling them to take mitigating strategies or drug withdrawal. 

Conclusion 

Although much of the research is in its inception, the genetic intervention will assist in remedying medical conditions, solving infertility, sex selection, and preventing drug adversities. On the contrary, banning the interventions means that the future of medicine will remain bleak. It should be noted that the conventional treatment has fallen below the required standards due to a plethora of medical conditions that cannot be reversed such as Down's syndrome, cancers, and HIV among others. The genetic experiments have so far shown positive signs in solving these conditions and other congenital ones such as infertility. However, the immense focus should also be placed on the research. Most of these interventions are in their infancy. The authorities will determine the credibility of the genetic interventions based on how the research is conducted. As a result, ethical consideration will remain a critical issue. Confidentiality, informed consent, nonmaleficence, and beneficence should be respected. However, this does not necessarily mean that concerns do not exist in gene therapy and enhancement. Some of the prospective issues include costs and sociocultural implications. With proper consideration of ethics, all these can be eliminated. 

References 

Mehlman, M. J., & Li, T. Y. (2014). Ethical, legal, social, and policy issues in the use of genomic technology by the US Military. Journal of Law and the Biosciences, 1(3), 244-280. 

Hudson, K. L. (2011). Genomics, health care, and society. New England Journal of Medicine, 365(11), 1033-1041. https://www.nejm.org/doi/full/10.1056/NEJMra1010517 

Kaposy, C. (2018). The Ethical Case for Having a Baby with Down syndrome. The New York Times https://www.nytimes.com/2018/04/16/opinion/down-syndrome-abortion.html 

Wade, N. (2015). Gene Editing Offers Hope for Treating Duchenne Muscular Dystrophy, Studies Find. The New York Times https://www.nytimes.com/2016/01/01/science/gene-therapy-muscular-dystrophy.html?_r=0 

Gender and Genetics: Genomic Resource Center https://www.who.int/genomics/gender/en/index4.html 

Kolata, G. (2012). Ethics Questions Arise as Genetic Testing of Embryos Increases. The New York Times https://www.nytimes.com/2014/02/04/health/ethics-questions-arise-as-genetic-testing-of-embryos-increases.html?_r=0 

Kincaid, E. (2015). Genetic testing is taking medicine to an all-new extreme. Business Insider https://www.businessinsider.com/preimplantation-genetic-diagnosis-and-preventing-disease-2015-7?IR=T 

Two Mommies and One Daddy http://www.slate.com/articles/health_and_science/new_scientist/2013/03/three_parent_embryos_mitochondrial_transfer_ivf_is_worth_pursuing.html 

Green, E. D., Watson, J. D., & Collins, F. S. (2015). Human Genome Project: Twenty-five years of big biology. Nature News, 526(7571), 29. 

Hall, T. & Cahill, K. (2017). Informed Consent and the Extraordinary Story of Baltimore's Henrietta Lacks https://www.wypr.org/post/informed-consent-and-extraordinary-story-baltimores-henrietta-lacks