February 26, 2018

23 and Me, You, Everything

Peter Kennedy
Managing Principal

In case you didn’t notice, the age of genomics is upon us.

It recently occurred to me that the subject has surfaced and been explored across an extremely wide range of FSG scenario projects we’ve been working on over the last year – genetic bases in human factors, genomic testing and therapies, performance enhancement informed by ethnic (gene-based) diets, and even genetic mutations in Northeast US fish stocks, as an adaptive response to toxic chemicals.

Years ago when FSG principals were working heavily in the pharmaceutical sector the human genome had yet to be mapped and the marvels it would eventually reveal were merely speculative.  We are now just beginning to grasp, if quite incompletely, how big a deal the genomics revolution is and will continue to be.

It’s mind-blowing enough to submit a saliva sample to one of the commercial DNA companies and receive a detailed report back charting your genetic haplogroup, along with a list of hundreds of DNA cousins and, optionally, how much you are at risk for having inherited some genetic disorder.  All of this for as little as $79.  Millions of Americans have already had their DNA tested.  Inevitably, for many, there are surprises – racial and ethnic ancestries that are not part of passed-down narratives of family roots and origins.  In a nation still struggling with its racial past, one can’t help but believe that these revelations are, ultimately, all for the good.

Meanwhile, on the commercial side, many billions of dollars are now being invested in genomic science aimed at developing life-changing and life-saving therapies. CRISPR (actually CRISPR-Cas9) and other so-called gene editing technologies are the subject of considerable hope and expectation.  In fact, CRISPR is already being deployed in the fight against cystic fibrosis and Huntington’s disease. Researchers are exploring CRISPR applications for prevention and/or treatment of hemophilia and sickle cell. And there’s more. The National Institutes of Health says CRISPR “holds promise for the treatment and prevention of more complex diseases, such as cancer, heart disease, mental illness, and human immunodeficiency virus (HIV) infection.” 

To be clear: These are early days still.  Siddhartha Mukherjee, the Pulitzer Prize-winning oncologist and author of The Gene: An Intimate History, writes that while science now fully understands the genetic code (how, for example, the data in a single gene is used to build a protein), “we comprehend virtually nothing of the genomic code—i.e., how multiple genes spread across the human genome coordinate expression in space and time to build, maintain, and repair a human organism.”

The emerging field of epigenetics is grappling with that complexity. Epigenetics is concerned with heritable changes in gene expression that are independent of underlying DNA sequence. In genomic parlance, this is called a change in phenotype that does not involve a change in genotype. For the layperson, including this writer, epigenetics is about understanding how age, lifestyle and the environment affect gene expression. This learning will have far-reach effects on everything from medicine to athletic training to mental health and to early childhood education. 

There are, of course, some very dark sides to the genomics revolution.  In a truly nightmare scenario, bad actors, including nation states, could conceivably embrace genomic technologies to engineer biological weapon, including killer viruses, targeted at specific genotypes. CRISPR or future gene-editing technologies could trigger unintended and irreversible genetic consequences in subsequent generations. Some ethicists fear that what is today somewhat antiseptically called ‘gene management’ (including preimplantation genetic diagnosis or PGD) is a moral minefield that leads inexorably into the dark abyss of eugenics.

What’s troubling – at least from the outside – is that like many other technological disruptions of the present era, the genomics revolution is so highly technical and complex that ethicists and regulators may not be able to comprehend – let alone affect – developments coming out of labs until they are practically out in the marketplace. The scientific community itself appears to be worried, especially about gene editing and the use of human embryos in research.  Last year the prestigious journal Nature published a statement calling for “substantial basic research…to check the safety, accuracy, and feasibility of genome editing as a potential clinical tool.”


Genomic Scenario Uncertainty

Needless to say, there is no chance of forcing the gene genie back into the bottle. Cheaper and more powerful genomic technologies are coming. The gold rush is on. 

The scenario planning challenge is how to think in a profoundly expansive way about where all this could lead in coming decades--for good, bad and everything in between.






Comments  | 

Patrick Marren
Between this, social media, and AI, it is easy at least to dimly envision that in a century's time the 2010s will be seen to have had more in common with the 1500s than with 2118. This makes imagination even more critical, and multiple, widely various scenario views of possible futures more necessary. (Gene genie - a Bowie reference perhaps?)
If we're returning to something resembling the 1500s, can you also promise a Michelangelo? Or a da Vinci? A Brunelleschi? I'm thinking big here...
Charles Thomas
Patrick, your point is simply expressed, but really a profound issue. It is hard to find a time in history (perhaps at the conclusion of World War II ?) when so many high leverage advances in science and technology emerged with such simultaneity. To your list, I would add molecular design and engineering, the (now almost prosaic) 3-D manufacturing, and some of the nascent science just emerging from astrophysics, such as gravity waves. Like nuclear power, many of these advance are not just impossible to forecast, but contain quite profound ethical considerations - uncertainty and ambiguity, indeed!