Gene Editing and Human Disease

By Reem Hassoun

Published 6:33 PM EST, Mon February 22, 2021

Gene Editing: The Basics

While gene editing may sound like a sci-fi concept that is too futuristic to even think about implementing in the modern day, new improvements in technology have provided scientists with the means to not only make this happen now but to use it in order to improve the health of human beings all over the globe. Recently, gene editing as a whole can be narrowed down to one key technology—CRISPR, or clustered regularly interspaced short palindromic repeats. This remarkable tool gives scientists the power to alter the genome of a human, allowing them to replace, remove, and even change the location of the gene. CRISPR is based on bacteria and archaea, which are naturally found defense mechanisms against viruses that attack the body’s immune system, and it involves two main parts. The first part contains a series of DNA repeats, which work to store the DNA sequences that arrive from the viruses that attack the system. This allows the bacteria to “recognize” or find the DNA of the virus if it attempts to invade again. Additionally, this prevents the virus from doing damage by sending this DNA to the second part. This part involves the actual gene editing, where it cuts or alters the DNA of the virus that was sent through the repeat in the first part.

The Inner Workings of CRISPR Technology

Figure 1: Bernie Hobbs, CRISPR: The new tool in the gene editing revolution explained.

Understanding the Implications

With CRISPR, scientists are able to take these basic principles and apply them to utilize gene editing in the lab. However, with every new advancement comes both negative and positive implications. When it comes to the more negative side of gene editing, ethical concerns are often brought up and taken into account. For instance, gene-engineered human creation is very controversial amongst the gene editing community. With the more widespread implementation of technologies, including CRISPR, that make this possible, people are becoming wary of its potentially detrimental impact on human nature for future generations. Despite these concerns, the outlook for gene editing is predicted to have monumentally positive impacts on humankind in terms of long and short term development. One main factor that draws many scientists to CRISPR is its potential to cure and aid a myriad of human diseases. These include blood disorders, AIDS, Cystic Fibrosis, Huntington’s Disease, blindness, and even cancer. In fact, the Hangzhou Cancer Hospital is currently working on a clinical trial which removes the immune T cells from the patient and extracts the PD-1 encoding gene through cell modification done with CRISPR. The modified cells are then able to be placed back into the patient with a larger aptitude to attack the cancer cells. With this technology spreading rapidly, more scientists are able to conduct trials like this, which have the potential to save millions of lives and improve the standards of living for all individuals—especially those whose lives revolve around their sickness or the sickness of a loved one. At the start of the decade, this level of innovation wasn’t even thought to be possible. Now, CRISPR and gene editing advancements changed the entirety of the medical and scientific communities, providing scientists with a tool that has the ability to change the world for the better.

Reem Hassoun, Youth Medical Journal 2021

References

Clara Rodríguez Fernández – 23/07/2019 7 mins – CRISPR, Tops. “7 Diseases CRISPR Technology Could Cure.” Labiotech.eu, 14 Jan. 2020, http://www.labiotech.eu/crispr/crispr-technology-cure-disease/. 

“What Are Genome Editing and CRISPR-Cas9?: MedlinePlus Genetics.” MedlinePlus, U.S. National Library of Medicine, 18 Sept. 2020, medlineplus.gov/genetics/understanding/genomicresearch/genomeediting/. 

You, Liting, et al. “Advancements and Obstacles of CRISPR-Cas9 Technology in Translational Research.” Molecular Therapy. Methods & Clinical Development, American Society of Gene & Cell Therapy, 15 Mar. 2019, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447755/.

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An Ethical Analysis of Healthcare Costs in America

Introduction

Debates regarding healthcare costs and coverage in the United States have been persistent for several decades, as identifying a system that is morally sustainable whilst being economically sufficient is extremely difficult. While there are several programs in place to ensure that individuals are medically covered, healthcare costs in the United States have been increasing at a rapid rate from year to year. Currently, America’s healthcare system is mixed, meaning it is made up of both public and private elements. About 65% of citizens under the age of 65 are privately insured, or getting funded from non-governmental sources. While 25% are publicly insured, meaning they rely on government funding. This includes programs such as Medicare as well as Medicaid. The other 10% of citizens are left uninsured (Figure 1). Even though this seems like a small number, this is still equivalent to about 30 million citizens. 

Figure 1: Insurance in America

Ethics: A Deeper Look

With this system arises various ethical implications that are detrimental to individuals all over the nation. This is especially true for those in poverty as they are often unable to afford adequate healthcare services without further harming their financial state. This also leads to large amounts of discrepancies in healthcare distribution, as those with financial stability have a large amount of power in regards to the healthcare that they receive, as well as those whom they may be funding, highlighting the overarching moral issue. When looking at these issues in a holistic view, it becomes apparent that, regarding healthcare in the United States, capital is favored over individual health.

An Economic Perspective

According to George M Martin, a professor at the University of Washington Seattle, medical costs are rising at alarming rates, to a point where research shows that from 2001 to 2007, the percentage of healthcare-related bankruptcies has risen nearly 50%. Not only are an increasing number of people facing bankruptcies from medical costs, but about ¾ of these people are insured, well-educated, and amongst the middle class. The inefficiency of the current healthcare system is highlighted by this, as if even those who are supposed to be “well-off” and economically self-sufficient are having trouble paying healthcare costs, it must be extremely detrimental to those that can’t even afford to financially sustain themselves with the necessities of life. 

Figure 2, National Healthcare Expenditure- % of GDP

As the years go by, the American government is spending an increasing amount of capital, as reflected by the GDP percentage, on healthcare (Figure 2). Additionally, Tracey LaPierre, a professor in medical sociology, claims that America spends the most on healthcare compared to several other prominent nations. While this may look like a good thing on the surface, it is actually detrimental to the economy because more costs are being put into healthcare while citizens still are not reaping the benefits, as previously mentioned. Dan Polsky, an expert in health economics, puts this all together, claiming that America’s system, with its high administrative costs and complexity, is unable to uphold the demands of the people regarding healthcare, therefore proving to be somewhat ineffective in regards to satisfying those relying on the system.

The Social Situation

Currently, the situation in America regarding the health of individuals is extremely insufficient not to mention unethical, as it severely impairs not only the economic state but the health of those in poverty. As stated by the World Health Organization, poverty creates hazardous conditions for the individuals in that situation, not to mention it puts them at an extreme risk of undernutrition. With over 800 million individuals currently living in the slums and being habitually exposed to several health hazards, by 2020,  this number will likely increase to 1.4 billion as an effect of the truancy of effective policy involvement. 

As a result of the widespread disregard of basic needs regarding health, a strong case can be made regarding the allocation of resources that give priority to those in need. Overall, the unmet need for those facing harsh economic situations that restrict them from gaining fundamental resources highlights the need for more government assistance regarding healthcare. This assistance would provide the prolific amount of individuals that are currently suffering from these unfortunate circumstances with better conditions that would drastically alter their lives for the better.

Potential for the Future

With the abundant amount of individuals currently in poverty and struggling to financially support themselves, it is ethically unacceptable to continue pursuing the healthcare system presently embodied in the United States. This system is especially detrimental to those in poverty regarding health and financial means. A solution to alleviating ethical healthcare struggles is by providing the citizens of America with universal healthcare, which is a system in which the majority of individuals have their healthcare covered, typically through taxation. With this system, the same standard of care would be provided to all patients by physicians, and those in serious need of healthcare would have proper access. Overall, it becomes apparent that there are many more benefits of this system, and it, therefore, is a plausible solution when considering the extent to which the government should cover healthcare costs in the United States.

Reem Hassoun, Youth Medical Journal 2021

References

Chau, Kao-Ping. “Overview of the U.S. Healthcare System.” American Medical Student 

Association, February 10, 2006, https://publichealth.arizona.edu/sites/publichealth.arizona.edu/files/Chua_Kao-Ping_HealthCareSystemOverview_2006.pdf

Cicconi, Lora and Strug, Kerri. “Universal Healthcare in the US.” Ethics of Development in 

Global Environment, May 25, 2000, https://web.stanford.edu/class/e297c/poverty_prejudice/soc_sec/universal.htm

“FastStats – Health Insurance Coverage.” Centers for Disease Control and Prevention. Centers for 

Disease Control and Prevention, January 20, 2017. https://www.cdc.gov/nchs/fastats/health-insurance.htm. 

Hanson, Kara, Lucy Gilson, Catherine Goodman, Anne Mills, Richard Smith, Richard Feachem, 

Neelam Sekhri Feachem, Tracey Perez Koehlmoos, and Heather Kinlaw. 2008. “Is Private Health Care the Answer to the Health Problems of the World’s Poor?” PLOS Medicine. Public Library of Science. November 25. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050233.

Himmelstein, DU, Thome, D, Warren, E, et al., “Medical Bankruptcy in the United States, 2007: 

Results of a National Study,” The American Journal of Medicine, 122(8): 741-746 (2009). 

Martin, George M. “Views on the Ethical Struggle for Universal, High Quality, Affordable 

Health Care and Its Relevance for Gerontology.” Experimental Gerontology, U.S. National Library of Medicine, Jan. 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5237434/.

Nicholson, Thomas, et al. “Double Standards in Global Health: Medicine, Human Rights Law 

and Multidrug-Resistant TB Treatment Policy.” Health and Human Rights, Harvard University Press, 18 June 2016, https://www.ncbi.nlm.nih.gov/pubmed/27781001.

Rossiter, Louis. “RISING COSTS FOR HEALTHCARE: Implications for Public Policy.” PDF 

File. February 2009. https://www.wm.edu/as//publicpolicy/documents/nfibrisinghealth.pdf

 Schrecker, Ted. “Denaturalizing Scarcity: a Strategy of Enquiry for Public- Health Ethics.” 

Bulletin of the World Health Organization, World Health Organization, Aug. 2008, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649456/#__ffn_sectitle.

Artificial Organs: A Social and Ethical Analysis

The Problem

Artificial organs are a recent form of life saving technology that rely on methods such as 3-D printing and stem cell implementation, which are becoming more common in the medical community as automation advances. Lately, scientists have been putting in a lot of research and resources into the development of these artificial organs, particularly as a result of  the significant imbalance between those in need of organs and those who are actually receiving them. In 2015, about 121,000 people needed an organ transplant, but only about 31,000 patients received one (Figure 1).

Patients that Received Organs (blue) vs. Patients in Need (grey)

     Figure 1, Organ Procurement and Transplantation Network, 2015

This gap is a huge problem; people with failing organs do not have much time to spare.  According to the Nation Health Resources and Services Organization, about 20 people die on average per day because of a lack of viable organs for transplant. As a result, artificial organs have become especially important, as they provide other means for people to obtain the organs that they require.  

A Societal Perspective

The wait for essential organs is absurd and inhumane. In fact, it can generally take up to five years to get off the waitlist for a transplant, which can cost a human life. Consequently, some find it necessary to resort to unconventional ways to get what they need. As expressed by Nancy Scheper-Hughes, a professor of anthropology at the University of California, Berkeley,  the extensive wait for these organs often motivates people to take the state of their lives into their own hands. In this instance, they become willing to travel long and far to obtain organs that they receive through channels of legal or illegal means. These distances are often foreign countries, with the most popular destination being India.

With the implementation of biomedically engineered artificial organs, these desperate patients will no longer need to put themselves and even their families in jeopardy to live. This way, the patients are able to receive the organs that will save their lives in a legal way without the trouble of traveling in their unfortunate conditions. With new and improved organs, not only will people have a better quality of life, but they’ll be able to contribute to society in ways that may not have been possible for them before.

The Ethical Dilemma

While these organs may seem like a perfect solution, there are some serious ethical consequences that arise as a result of increased implementation. A main issue that will accompany the spread of these high-tech organs is their large cost. As shown in Figure 2, the cost of procedures that implement artificial body parts such as hips and knees are already what many would consider high, with a simple ear tube procedure costing up to $4,500. 

The Cost and Annual Revenue of the Artificial Organ Market

Figure 2

Considering these organs would only be available to those who could pay, it could be considered unvirtuous to allow them to become very widespread, as others that cannot afford these situations will be at a major disadvantage that could potentially decide their quality of life. Also, since one cannot control their health if they are on the verge of death, it becomes immoral to make these organs available to those that can afford the high expenses. 

Potential Solution

After evaluating this complex issue from multiple perspectives, it becomes clear that a solution is needed. Overall, in order to help solve the issue of organ scarcity whilst reducing the ethical implications, highly-demanded artificial organs should be implemented, however the complexity of their software should be reduced. The limitations of this solution, however, are that it takes extensive research and time in order to maintain the effectiveness of these organs while simultaneously reducing their complexity, and that the artificial organs being produced would only be available for those in need of major organs. Despite these drawbacks, the outlook for biomedically engineered artificial organs is exceptionally bright, and this market has the potential to save a myriad of lives that would otherwise be lost.

References

Hutchison, Katrina, and Robert Sparrow. 2016. “What Pacemakers Can Teach Us about the 

Ethics of Maintaining Artificial Organs.” Hastings Center Report 46 (6): 14–24. doi:10.1002/hast.644.

Malchesky, Paul S. 2011. “Organ Replacement, Medical Device Costs, and Medical 

Tourism: Globalization of the Clinical Application of Artificial Organ Technologies?” Artificial Organs 35 (12): 1139–41. doi:10.1111/j.1525-1594.2011.01396.x.

  “Organ Donation Statistics.” Organ Donor, September 30,  2019.     https://www.organdonor.gov/statistics-stories/statistics.html

Sanjairaj, Vijayavenkataraman. (2016). “A Perspective on Bioprinting Ethics.” Artificial 

Organs. 40. 1033-38. 10.1111/aor.12873. 

Scheper-Hughes, Nancy. “The Global Traffic in Human Organs.” Current Anthropology 41, no. 2 (April 2000): 191–211. doi:10.2307/3596697.

Vermeulen, Niki & Haddow, Gillian & Seymour, Tirion & Faulkner-Jones, Alan & Shu, Wenmiao (Will). (2017). “3D bioprint me: A socioethical view of bioprinting human organs and tissues.  Journal of Medical Ethics. 43. medethics-2015. 10.1136/medethics-2015-103347.

Reem Hassoun, Youth Medical Journal 2020