This is not an acceptable use of gene editing IMHO. Cholesterol can be managed by diet. High levels of Cholesterol are down to choices made, not some inherited disease that patients couldn't avoid from when they were born.
kelseyfrog•1w ago
Same thing with T2D. If your blood sugar is disregulated due to insulin sensitivity disorder, you should simply die.
wpm•1w ago
And depression as well, you gotta just buck up and smile and try real hard to not jump off of a bridge.
kelseyfrog•1w ago
Right, all mental health problems are a choice (or a call for attention).
nuc1e0n•1w ago
I wouldn't go that far. Other, less invasive treatments should still be available IMHO, but there should remain an element of personal accountability. Gene editing is a very powerful tool, and messing with complex systems in powerful ways that we don't fully understand could be a recipe for many troubles down the line. I think the use of gene editing should be very surgically applied to obviously detrimental mutations, not for some scatter gun like approach.
What if the body raising cholesterol levels serves some purpose we aren't yet aware of? I've heard there's some evidence that medication to reduce blood pressure has a potential link to the onset of Parkinson's disease. Maybe messing with blood pressure in that way without addressing underlying causes has been a mistake, and messing with cholesterol levels without addressing underlying causes could also be.
gizmo686•1w ago
That is why we do long and expensive trials before approving any medication for use.
Having said that, we have we been medically lowering people's cholesterol levels for decades, and the evidence seems pretty clear at this point that it is a net health benefit to those for whom treatment is indicated.
It is not at all obvious that targeted gene editing would be more disruptive to the body compared to flooding the body with a drug that happens to interfere with the one part of the process that we found a drug to interfere with.
Particularly if we are editing the gene to match a form that is already present in much of the population.
nuc1e0n•1w ago
Some issues could only become evident over a period of hundreds of years with gene editing. That's longer than any medical trial I'm aware of. And mistakes made would be difficult, if not impossible, to undo.
If medications can already do what's required for cholesterol issues, why wouldn't we continue to use them rather than making some change to affect a complex balance that could cause problems over very long timescales?
If we were to be editing a specific gene to match what the wider population has, then I'd be more ok with that.
kelseyfrog•1w ago
We should give or deny medical treatment based on our personal values, such as responsibility.
nuc1e0n•1w ago
Medical ethics boards already do such things don't they?
kelseyfrog•1w ago
You're confused. Maybe do some research on ethics boards?
nuc1e0n•1w ago
If you think so, what sources would you recommend? According to Wikipedia on medical ethics, "These values include the respect for autonomy". Not expecting any level of self control doesn't show respect for autonomy IMHO.
kelseyfrog•1w ago
The AMA Principles of Medical Ethics[1] is a good starting point.
Principle nine reads as;
> IX. A physician shall support access to medical care for all people.
I can't in good conscious find withholding care due to the value of personal responsibility with supporting access to medical care for all people.
Interesting. I'll look into that. The Hippocratic oath says that a physician should do no harm (ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν). It's a personal value judgement as to whether some intervention is providing medical care or causing harm. I consider reckless genetic modification to be causing harm.
gizmo686•1w ago
> The Hippocratic oath says that a physician should do no harm
No it doesn't. Such a standard would make the practice of medicine impossible, as all treatments have some risk of harm.
What is relevant to this discussion is the below excerpt of the modern form of the oath:
> I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
maxerickson•1w ago
The existence of a gene edit directly contradicts your assertion.
That you don't label the specific phenotype a disease doesn't really matter.
wpm•1w ago
Why is it better for it to be managed with diet vs this? Presumably if managing it via diet alone worked universally they wouldn't be doing research into drugs like this.
Maybe such a mutation would be a suitable target for a gene editing treatment. I'm not aware of all the issues involved there. I think the linked article doesn't have enough detail to form a fair opinion with.
gizmo686•1w ago
High cholesterol is well documented to be heritable. Perhaps more relevantly, even if they would work, lifestyle changes have a significant patient compliance problem, which significantly reduces their effectiveness.
There is a more reasonable brother argument to could make, which is that we have well tested and effective drugs available today for managing cholesterol. Any new treatment would need to clear the bar of being better than those (in at least some circumstances) to be put into wide use. This bar may cleared by the fact that existing treatments often have adverse side effects.
Further, the one time treatment aspect is actually a demerit in some ways, as one cannot stop the treatment if there is an adverse effect. This means that the safety profile would need to be much better than us typically required. And proven over a longer timeline.
Of course, this is all concerns about approval and widespread deployment. We are still in the early human trial phase, where much more risk is accepted (subject, of course, to ethical guidelines).
nuc1e0n•1w ago
Genetic treatments have the scope to not only have unintended consequences, but unintended consequences that can last over generations of people. I am in favour of them for some things, but we need to tread very carefully with the technology.
gizmo686•1w ago
Germline editing is banned everywhere (with some exceptions for laboratory testing that will not result in an actual human).
Nothing about this treatment is targeting the germline.
Edit: Also, high cholesterol tends to become a concern for old people, who tend not to reproduce.
resoluteteeth•1w ago
Suppose that we were able to develop a drug that would allow people to regrow lost limbs through gene editing.
Do you think that such a drug should not be given to anyone who lost a limb due in an accident that was partly due to their own poor judgement because it was "down to choices made"?
Also, is there something special about gene editing that means it should not be used for these situations? Or if you go outside when it's icy and fall and break a bone, should the hospital refuse to treat you since that was your own fault?
nuc1e0n•1w ago
I can't see how genetic modification would be the correct way to treat such injuries.
Maybe substances that can trigger epigenetic effects would be more relevant to such things. I understand a Japanese team is working on a means of triggering tooth regrowth by means of an injection. I've got no problem with that. Or something like Skele-Gro from Harry Potter either.
Eliza113•1w ago
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nuc1e0n•1w ago
kelseyfrog•1w ago
wpm•1w ago
kelseyfrog•1w ago
nuc1e0n•1w ago
What if the body raising cholesterol levels serves some purpose we aren't yet aware of? I've heard there's some evidence that medication to reduce blood pressure has a potential link to the onset of Parkinson's disease. Maybe messing with blood pressure in that way without addressing underlying causes has been a mistake, and messing with cholesterol levels without addressing underlying causes could also be.
gizmo686•1w ago
Having said that, we have we been medically lowering people's cholesterol levels for decades, and the evidence seems pretty clear at this point that it is a net health benefit to those for whom treatment is indicated.
It is not at all obvious that targeted gene editing would be more disruptive to the body compared to flooding the body with a drug that happens to interfere with the one part of the process that we found a drug to interfere with.
Particularly if we are editing the gene to match a form that is already present in much of the population.
nuc1e0n•1w ago
If medications can already do what's required for cholesterol issues, why wouldn't we continue to use them rather than making some change to affect a complex balance that could cause problems over very long timescales?
If we were to be editing a specific gene to match what the wider population has, then I'd be more ok with that.
kelseyfrog•1w ago
nuc1e0n•1w ago
kelseyfrog•1w ago
nuc1e0n•1w ago
kelseyfrog•1w ago
Principle nine reads as;
> IX. A physician shall support access to medical care for all people.
I can't in good conscious find withholding care due to the value of personal responsibility with supporting access to medical care for all people.
1. https://code-medical-ethics.ama-assn.org/principles
nuc1e0n•1w ago
gizmo686•1w ago
No it doesn't. Such a standard would make the practice of medicine impossible, as all treatments have some risk of harm.
What is relevant to this discussion is the below excerpt of the modern form of the oath:
> I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
maxerickson•1w ago
That you don't label the specific phenotype a disease doesn't really matter.
wpm•1w ago
greydius•1w ago
https://en.wikipedia.org/wiki/Familial_hypercholesterolemia
nuc1e0n•1w ago
gizmo686•1w ago
There is a more reasonable brother argument to could make, which is that we have well tested and effective drugs available today for managing cholesterol. Any new treatment would need to clear the bar of being better than those (in at least some circumstances) to be put into wide use. This bar may cleared by the fact that existing treatments often have adverse side effects.
Further, the one time treatment aspect is actually a demerit in some ways, as one cannot stop the treatment if there is an adverse effect. This means that the safety profile would need to be much better than us typically required. And proven over a longer timeline.
Of course, this is all concerns about approval and widespread deployment. We are still in the early human trial phase, where much more risk is accepted (subject, of course, to ethical guidelines).
nuc1e0n•1w ago
gizmo686•1w ago
Nothing about this treatment is targeting the germline.
Edit: Also, high cholesterol tends to become a concern for old people, who tend not to reproduce.
resoluteteeth•1w ago
Do you think that such a drug should not be given to anyone who lost a limb due in an accident that was partly due to their own poor judgement because it was "down to choices made"?
Also, is there something special about gene editing that means it should not be used for these situations? Or if you go outside when it's icy and fall and break a bone, should the hospital refuse to treat you since that was your own fault?
nuc1e0n•1w ago
Maybe substances that can trigger epigenetic effects would be more relevant to such things. I understand a Japanese team is working on a means of triggering tooth regrowth by means of an injection. I've got no problem with that. Or something like Skele-Gro from Harry Potter either.