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[narrator] What you're looking at
is the fertilization of a human egg
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with a sperm cell.
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There's nothing new about that. It happens
all the time in fertility clinics.
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But there's something different happening.
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That needle is also delivering a tiny tool
that will change the embryo's DNA.
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A new technology called...
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-CRISPR.
-CRISPR.
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-CRISPR.
-A revolutionary technology that can...
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...edit DNA with incredible precision.
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To get why this is such a big deal,
consider this:
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life has existed on this planet
for nearly four billion years.
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99.99% of that time passed
before Homo sapiens showed up.
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And then for 99.9% of human history,
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we, too, were oblivious
to the genetic code tucked inside the cells
of all living things.
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In fact, it's just in the last 65 years,
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a single lifetime,
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that we've figured out how DNA works,
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built machines that could read it,
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and then tools that could rewrite it.
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Now a question we've been asking
for decades is becoming very real.
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If humans had the technology
to control the source code of life,
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what happens
when we turn it on ourselves?
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[man 1] Take what we now know
about the DNA molecule in our cells.
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It's entirely possible
we may learn to use it.
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...in order to tinker with our blueprints,
genetic makeup.
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Once you start tinkering,
where do you stop?
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[man 2]
And that's where things get complicated.
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...crucial to finding cures
for diseases like cancer.
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Critics say it's opening up
a Pandora's box.
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[man 3] Is this the way we want to nurture
the next generation of children?
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[man 4] This makes man his own god.
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Today we celebrate the revelation
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of the first draft
of the human book of life.
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As a society, we've spent
about $3 billion dollars
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to sequence the first human genome,
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a really landmark achievement,
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equivalent to maybe, you know,
constructing the pyramids in Egypt.
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The genome
is our entire genetic blueprint,
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three billion pairs of As, Ts, Cs, and Gs,
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that each of us carry
in almost every cell.
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Mapping it was the biggest undertaking
in the history of biology.
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[Sanjana] In the 15 years since then,
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the price of sequencing a genome
has fallen dramatically.
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That's many, many zeros off the price tag.
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Take a closer look at that chart.
That's not a typical scale.
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The numbers are decreasing
by a factor of ten.
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With all that data,
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researchers can identify genes
that cause diseases.
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But to actually change those genes,
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you'd have to track them down
within the genome.
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Humans didn't have an easy way to do that,
but it turns out...
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bacteria did.
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See, they've been battling viruses
for billions of years,
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and some of them developed
an immune system
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that records segments of viral DNA
within their own genome.
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So when that virus attacks again,
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its DNA is easy to recognize and to cut,
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with enzymes that act like scissors.
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That prevents the virus from replicating.
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That immune system is called CRISPR.
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Its discovery was cool enough,
but in 2012,
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Jennifer Doudna and her collaborators
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showed that they could reprogram
the CRISPR system
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to track down and edit
a gene of their choice,
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taking CRISPR from an interesting fact
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to a powerful tool.
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For harnessing
an ancient bacterial immune system
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as a powerful gene editing technology,
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the breakthrough prize is awarded
to Emmanuelle Charpentier
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and Jennifer Doudna.
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It was a result
of curiosity-driven research
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that was aimed
in a very different direction
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from where it ended up.
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I never thought I'd become
a genome engineer.
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The ease of use of the CRISPR system
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has enabled it
to really spread like wildfire
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through the scientific community.
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There are so many papers every day
being published with CRISPR
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and using it in plants,
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in bacteria, in yeast...
Really, in every living organism,
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'cause all living organisms
run on DNA.
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The technology is so affordable
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that you can now tweak the DNA of bacteria
at home
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with a DIY CRISPR kit.
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I've been doing science professionally
for about 25 years
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and I have never seen a technology
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take off the way gene editing has.
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[Sanjana] I think back to Silicon Valley
40, 50 years ago,
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when it's just becoming clear
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that we had this ability
to program computers.
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It was really hard, I think,
to see all the developments
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like the internet,
or computers inside everyone's pocket.
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What will happen 20, 30, 40 years
from now?
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Piglets that might one day provide livers,
hearts, and other organs for humans.
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[man] Now they're making mosquitoes
that are resistant to malaria.
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[woman] The woolly mammoth
could be making a comeback.
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[narrator] That last one might remind you
of a certain sci-fi classic.
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Don't you see the danger
in what you're doing here?
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Genetic power's the most awesome force
the planet's ever seen,
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but you wield it like a kid
that's found his dad's gun.
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All of these experiments
raise difficult ethical questions,
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perhaps none more than the use of CRISPR
in human embryos.
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Nobody has tried to start a pregnancy
with those embryos,
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but if they ever do,
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we will be crossing a line
that people have debated for decades.
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This debate has long had
some important distinctions.
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First of all is the distinction between
somatic gene editing
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and germline gene editing.
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[narrator] Somatic cells
are most of the cells in the body:
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blood, brain, skin cells,
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where the DNA doesn't get passed down
to offspring.
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Germline edits involve sperm, eggs,
or embryos,
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basically changing the DNA
of future generations.
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It's a profound difference,
because in germline editing,
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we're talking about making changes
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that ultimately affect
the human population
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and human evolution.
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Another major divide that emerged
early on in the debate
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was between therapy and enhancement.
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[narrator] Therapies treat diseases,
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and enhancements give advantages
to people who are already healthy.
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The top left box is where the real action
is happening,
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treatments for people
living with diseases.
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The challenge here is delivery.
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For different diseases, different cells
in your body are affected.
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Some diseases affect the liver,
some affect the heart,
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some affect the lungs, and some organs
have much easier deliveries.
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The most promising experiments are
for conditions like sickle cell disease,
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HIV, and certain cancers where the disease
lives in the blood or the bone marrow.
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Those cells can be removed from the body,
edited outside,
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where you don't have to worry about
delivering into an entire person,
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and after the editing is confirmed,
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replaced in the patient.
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Somatic gene editing has always been
much less controversial,
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primarily because
any change you would make
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would end with that person.
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Generally that's considered
to be medicine.
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Somatic gene enhancement
is like plastic surgery.
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Any change you make ends with them.
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There are no genetic plastic surgeons yet.
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Researchers are focused on diseases,
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and as those trials begin,
the big debate will be here,
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whether we should move beyond
treating the sick
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to editing diseases out
of future generations.
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[man] That hasn't happened.
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As far as anyone can tell,
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nobody is trying
to make CRISPR babies yet.
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That's a temptation
that I think has to be grappled with.
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I think the technology
is not quite there yet,
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but I think it's close.
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Creating a genetically modified baby
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is already illegal
in at least 25 countries.
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In much of Europe,
it's been banned for decades.
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If you look at a pattern across countries,
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one of the primary variables
that would explain differences
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is proximity to the Nazi experience.
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What you find is much more skepticism
of the idea
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that somehow we're going to improve
the human species.
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Two power centers of CRISPR research,
the US and China,
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have restrictions on germline editing,
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but they don't have laws against it.
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In 2015,
the UN called for a worldwide moratorium,
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saying that germline modifications
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could jeopardize the dignity
of all human beings,
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because the problem
with crossing the germline
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is that this other line might not hold.
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[Evans] The line between
therapy and enhancement
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has, over time, gotten a lot more fuzzy.
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For one thing, not everyone agrees on
which genetic conditions need fixing.
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[Evans] Is deafness a disease?
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Many in the deaf community
would say it is not.
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Is dwarfism a disease? Many would say not.
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The idea that we're all sick,
that we're suffering,
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that I "suffer" from dwarfism...
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No, I live with dwarfism.
I've lived with dwarfism for 39 years.
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I'm proud to be a second generation
raising a third generation of people
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living with dwarfism.
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I don't suffer,
I suffer from how society treats me.
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But the line is fuzzy
even for diseases we agree on.
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Depending on which variant you have,
the APOE gene increases, decreases,
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or doesn't affect the risk
of Alzheimer's disease later in life.
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Say you switched your child's DNA
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from a high-risk to a low-risk variant.
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Would that be a therapy or an enhancement?
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There are rare genes linked to lower risk
of heart disease, diabetes,
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immunity to HIV, stronger bones,
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bigger muscles, less body odor,
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the ability to get by with less sleep.
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Where would you draw the line?
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In the '90s movie Gattaca,
society is divided into genetic classes,
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because fertility clinics
sell enhancements to their customers.
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We didn't want...
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I mean, diseases, yes, but...
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Right, we were just wondering if...
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if it's good to just leave a few things
to chance.
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You want to give your child
the best possible start.
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Believe me, we have enough imperfection
built in already.
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When I watched that movie,
it was completely science fiction.
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It's amazing to think that now we're on
the cusp of that being a real possibility.
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And that raises one of the most profound
ethical threats in genetics,
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or as you may know it,
"designer babies."
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-Designer babies.
-Designer babies.
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[man] ...where parents can pick eye color,
intelligence, and height.
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Imagine if I could choose kids
that could go on in the NBA.
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That's where people get
a little carried away.
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Some traits are relatively simple,
like eye color, freckles, and this is true,
how sticky your earwax is.
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But intelligence, height,
athletic ability,
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these are all complex traits.
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They're partly nature and partly nurture,
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and the part that's nature
involves hundreds,
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even thousands of locations on the genome,
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interacting in ways we don't understand.
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And that makes them bad targets
for something like CRISPR.
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If governments give a green light
to germline editing,
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it would start with preventing
the transmission
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of diseases caused by a single gene.
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But the thing is, most of the people
who carry those genes
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already have a way to do that
without editing any DNA,
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which is why the shorter path
to designer babies isn't gene editing,
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it's gene selection.
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People who know that they're carriers
for a genetic disease have long had this option
called preimplantation genetic diagnosis.
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Which is a mouthful,
so people call it PGD.
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When I describe this, most people
I talk to think it's science fiction,
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but it's actually been around
for over 27 years.
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In PGD, a fertility clinic removes cells
from embryos created through IVF
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and tests their DNA for genetic diseases.
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They can then select the embryos
without the disease
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to implant in the woman.
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But that technology has also been used
to screen for genes
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that raise the risk of disease,
but don't guarantee it,
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and to check for other traits,
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like an embryo's sex,
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or its eye color.
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As the technology advances,
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it'll be possible to get
an entire genomic report card
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for your embryos,
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like the kind you get
when you send your saliva
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to a personal genomics company.
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And for complex traits, like intelligence,
height, or diabetes,
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we may not be able to edit them directly,
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but we might be able to predict them...
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to an extent.
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[Greely] I don't think we're ever
going to be able to say honestly
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this embryo is going to get 1450
on the two-part SAT.
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But I do think we'll be able to say
a 60% chance of being in the top half,
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13% chance of being in the top 10%.
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These predictions
are called polygenic scores
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and they're based on
statistical correlations
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from across the genome.
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Most of them aren't very accurate,
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so they've stayed in the realm
of academic research.
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But they get better with more data,
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and now a company
called Genomic Prediction
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says they'll soon be the first
to offer polygenic tests
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to fertility clinics.
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Their CEO has said he was inspired
by the movie Gattaca.
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There's nothing in the current US law
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that would keep a clinic from using
genetic trait prediction immediately.
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Whether that'll be true in the future,
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when people start using this
to select babies
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for reasons that other people
think are wrong,
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that's going to be a really interesting
political fight to watch.
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But we're still talking about
a small number of people,
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because IVF is hard.
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[Greely] The problem with IVF right now,
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what accounts for 90% of its cost,
and 99% of its discomfort and risk,
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is egg harvest.
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But he predicts
that we'll eventually be able
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to grow human eggs in a lab
from skin cells
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and use them to create dozens of embryos.
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[Greely] This sounds like science fiction.
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It is if you're a person.
It's not if you're a mouse.
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It's already been done in mice,
both eggs and sperm,
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and healthy little mouse pups
have been born.
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If that works in humans,
and that's a big if,
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then IVF becomes a whole lot easier,
and gene selection more powerful.
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Add gene editing to that process
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and you can see
how the fertility industry
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could steer the future
of human evolution.
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But we don't need to speculate
about the distant future
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to see how the genomic revolution
could change us.
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[Cokley] In 1994, Dr. John Wasmuth
found a gene for achondroplasia.
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A lot of dwarf parents were scared,
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because we thought it was the...
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and, you know,
in many ways it really still could be, the first step towards eradicating
our kind of dwarfism.
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Genetic technologies can narrow the range
of human variation.
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We've already seen how individual choices
about prenatal testing
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can shift whole populations.
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There are now only 918 girls
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for every one thousand boys
in the country.
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In Iceland, Down syndrome is on the verge
of being eradicated
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and it's due in large part
to the widespread use of genetic testing.
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Is there really no place for us
in the world?
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It's a hard conversation.
I mean, I'm a pro-choice woman
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and I have to accept the fact that for me,
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being a pro-choice woman
and a woman with a disability means...
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that I have to accept the fact
that non-disabled women...
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see a fetus like me as not viable.
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And since unequal access to healthcare
is a fact of our world,
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we risk giving the wealthy
an extra genetic advantage.
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This will not be made available
to everyone on the planet.
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It would only be the wealthy people
who would have access to this.
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Already, rich kids are 10-15% healthier
than poor kids.
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It's not enormous,
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but I wouldn't want to add another 10-15%
on top of it.
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And we've seen how easily we can fall prey
to simple answers for complex problems
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when they're dressed
in the language of science.
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[Evans] The Immigration Act
in America of the 1920s
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was based upon
an entire faulty scientific premise,
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that the genes of the Nordic countries
were superior to the other races.
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It doesn't even need to be true,
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gene editing doesn't actually
even have to work,
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to have social effects.
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But gene editing gives us a chance
to massively reduce human suffering.
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That's why the stakes are so high.
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My biggest fear, honestly,
is that we'll see the use of gene editing
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getting ahead of itself.
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What I mean by that
is an application that causes harm,
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that creates a backlash
against a technology
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that I think has really the potential
to be incredibly positive
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and have a positive effect
on society.
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[Greely] Unless we're in nuclear war,
unless the world ends,
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we're going to be using genetics
more and more in human reproduction,
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and that will have consequences,
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but I do the work I do in the hopes
that if we think about these things,
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we worry about them,
we talk about them enough in advance,