Expanding Access to Gene Editing in Public Health Services

1. Public Forum Debate ----------------------------- Public Health Services and Gene Editing . General Topic Area Introduction Resolved: Public health services should expand access to gene editing technologies

2. Public Forum Debate ----------------------------- Public Health Services and Gene Editing Key Topic Questions • Is gene editing desirable? • Should access to gene editing be provided by public health services?

3. Public Forum Debate ----------------------------- Public Health Services and Gene Editing Lecture Overview Background and technology Pros Cons Framework Concluding Thoughts

4. Public Forum Debate ----------------------------- Public Health Services and Gene Editing Gene Editing -- Gene Gene Medicine.net, Medical Definition of Gene, https://www.medicinenet.com/script/main/art.asp?articlekey=3560 Gene: The basic biological unit of heredity. A segment of deoxyribonucleic acid (DNA) needed to contribute to a function. An official definition: According to the official Guidelines for Human Gene Nomenclature, a gene is defined as "a DNA segment that contributes to phenotype/function. In the absence of demonstrated function a gene may be characterized by sequence, transcription or homology." DNA: Genes are composed of DNA, a molecule in the memorable shape of a double helix, a spiral ladder. Each rung of the spiral ladder consists of two paired chemicals called bases. There are four types of bases. They are adenine (A), thymine (T), cytosine (C), and guanine (G). As indicated, each base is symbolized by the first letter of its name: A, T, C, and G. Certain bases always pair together (AT and GC). Different sequences of base pairs form coded messages. The gene: A gene is a sequence (a string) of bases. It is made up of combinations of A, T, C, and G. These unique combinations determine the gene's function, much as letters join together to form words. Each person has thousands of genes -- billions of base pairs of DNA or bits of information repeated in the nuclei of human cells --which determine individual characteristics (genetic traits). The chromosome: Genes are arranged in precise arrays all along the length of 23 pairs of much larger structures: the chromosomes.

5. Public Forum Debate ----------------------------- Public Health Services and Gene Editing Gene Editing Gene Patronus Medical, no date, http://blog.patronusmedical.com/the-benefits-of-gene-editing The Benefits of Gene Editing In many cases, genetic diseases occur when a mutation appears inside a cell. Although researchers have been able to identify which cells the mutations occurred in, little could have been done to repair the defective genes. Gene editing allows doctors to use specialized molecular tools to remove, repair or replace damaged genes with a healthy copy. Although the technology is still a bit far off from being used regularly by medical professionals worldwide, animal trials have been successful. In fact, a team of Chinese scientists will be the first to test gene-edited cells in human patients this month. CRIPSR, or “clustered regularly interspaced short palindromic repeats,” is the most advanced and effective gene-editing technique being utilized by scientists. CRISPR is inexpensive, easy to use and precise. Gene modifications using CRISPR have extended from corn and rice to mice and pigs. Associated Press, December 1, 2015, http://www.foxnews.com/health/2015/12/01/potential-benefits-and-ethical-implications-gene-editing.html The potential benefits and ethical implications of gene editing While scientists have long been able to find defective genes, fixing them has been so cumbersome that it's slowed development of genetic therapies. With gene editing, scientists home in on a piece of DNA and use molecular tools that act as scissors to snip that spot - deleting a defective gene, repairing it or replacing it. There are some older methods but a new tool called CRISPR-Cas9 has been adopted by laboratories worldwide because it's faster, cheaper, simple enough to use with minimal training, and allows altering of multiple genes simultaneously.

6. Public Forum Debate ----------------------------- Public Health Services and Gene Editing Gene Editing – Human Germline Human eggs, sperm, embryos – human genome Keren Weintraub, National Georgraphic, December, 2015, https://news.nationalgeographic.com/2015/12/151203-gene-editing-terrific-terrifying-science/ 5 Reasons Gene Editing Is Both Terrific and Terrifying This week, a high-profile group of researchers, ethicists and advocates convened in Washington, D.C., to discuss the ethics of editing human genes. In particular, they're concerned about changes to human eggs, sperm or embryos—known as the human germline. Editing the germline means the gene changes get passed down Keren Weintraub, National Georgraphic, December, 2015, https://news.nationalgeographic.com/2015/12/151203-gene-editing-terrific-terrifying-science/ 5 Reasons Gene Editing Is Both Terrific and Terrifying This week, a high-profile group of researchers, ethicists and advocates convened in Washington, D.C., to discuss the ethics of editing human genes. In particular, they're concerned about changes to human eggs, sperm or embryos—known as the human germline.If you edit the genes of an adult, the changes don’t get passed down to that person's children. But editing genes in the germline would affect the child’s own egg and sperm, so the genetic changes are inherited.

7. Public Forum Debate ----------------------------- Public Health Services and Gene Editing Public Health Services *Provided and/or overseen by the government *Concern with “population health” *Protection of the environment? Pollution threatens health Species extinction threatens health *Can it be mandatory? In this context, can gene editing be mandatory?

8. Public Forum Debate ----------------------------- Public Health Services and Gene Editing Approaches to the Topic Gene editing good, need to let more people access Gene editing bad, shouldn’t expand access Gen editing inevitable, need to make sure as many people get it as possible Greater access means great development, greater access widens inequality

9. Public Forum Debate ----------------------------- Public Health Services and Gene Editing Benefits of Gene Editing . Disease “cut” part of problematic genes – Gene-based diseases kill X # of people (cancer, sickle cell are some examples), gene editing solves Gene editing can create bacteria, bacteria can kill viruses Engineer resistance to other diseases 2. Stronger countries – stronger workers, stronger soldiers 3. Engineer humans for space travel 4. Reduce pregnancy terminations due to genetic diseases

10. Public Forum Debate ----------------------------- Public Health Services and Gene Editing Answering Some Objections . Mutations – mutations inevitable, mutations aren’t severe, low risks Not natural – nature can be cruel, hereditary diseases Shouldn’t decide for future generations – diseases kill future generations “Designer babies” -- won’t happen any time soon, human enhancement good Health problems – Without gene editing there are health problems

11. Public Forum Debate ----------------------------- Public Health Services and Gene Editing Benefits to Public Health Services Equality – everyone gains access Government control good – we don’t want these technologies left (exclusively) in the hands of the private sector

12. Public Forum Debate ----------------------------- Public Health Services and Gene Editing Problems with Gene Editing Mutations – Not natural Shouldn’t decide for future generations “Designer babies” Discrimination against non “designer babies” Increased abortions for non-designer babies Health problems – Without gene editing there are health problems Super soldiers Engineered biological weapons

13. Public Forum Debate ----------------------------- Public Health Services and Gene Editing Problems With Public Health Services 1 Costs – Pubic health services expensive – tax increases, overall costs of health care increase (reducing health care accessability for others)2 Libertarianism – public health services rely on “stolen” tax dollars 3. Civil liberties/freedom deprivation – Governments could require gene editing, threating freedom. Would we want totalitarian governments to control gene editing? 4. Accelerated development – supporting with public health services increases development, gene editing bad 5. Public health approaches bad – We shouldn’t try to solve public health problems with gene editing

14. Public Forum Debate ----------------------------- Public Health Services and Gene Editing Environment? Is a poor environment a public health problem? Is protecting the environment (by reducing species extinction through gene editing) desirable/”topical”?

15. Public Forum Debate ----------------------------- Public Health Services and Gene Editing Framework Questions We always reserve framework questions for last because it is important that frameworks support the values advanced in the contentions.  We will have a greater discussion of framework in later essays, but suggestions for consideration include — The role of the government is to protect the health of the population (Pro) The government should not be in the business of provide health care, reallocation of tax dollars if a violation of freedom (Con)