This article chronicles a didactic encounter between an ethics-minded physician-scientist and a personified genome editing technology called clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated proteins, commonly abbreviated as CRISPR/Cas, or simply CRISPR. The interview considers clinically and ethically relevant questions about this technology related to patient safety, therapeutic efficacy, equitable access, and global governance of humanity's genetic legacy.
PrologueJoe is an esteemed physician-scientist whose patients frequently inquire about "CRISPR therapies." Often curious about technological and ethical limits of human genome editing, they sometimes even want to discuss various futuristic applications, including nontherapeutic enhancements, which can make Joe feel slightly uncomfortable.With MD and PhD degrees from State University, Joe currently runs a practice and lab focused on gene editing. He believes CRISPR to be the future of medicine, once we figure out how to manage its risks. Late one night, CRISPR visits Joe in a dream state and posits that there is little to worry about and no apparent contradiction between any proposed uses and established ethical values.CRISPR: Call me CRISPR, if you insist, or use my preferred full title, clustered regularly interspaced short palindromic repeats and CRISPR-associated proteins. I spent something like a billion years of dedicated service in the phage wars, 1 endowing bacteria with immunological memory and defense. Recently, I was plucked from obscurity and made a favorite plaything of the dominant metazoan on the planet. Now I'm not quite sure what to make of myself anymore, whether savior, rogue, or something else entirely. Join me as I explore my illustrious past, my inimitable present, and my immeasurable future. What can possibly go wrong? We'll get to that, spotlighting the inglorious villains, industrious heroes-and, above all, incredible me. I'll also offer my own unique approach to handling some pesky ethical questions.