Oncologist, scientist and writer Siddhartha Mukherjee spoke about gene editing and Artificial Intelligence as the new frontiers of medicine, the ethical implications of both and why he writes.
On writing as a form of thinking
Some people think to write, I write to think. It is a mechanism for me to lay down on a page and organise, by laying down on the page, some ideas about what we are and where we are going. Perhaps, the illuminating thing that virtually all physician writers have discovered is that medicine allows you to do this in a way that no profession does, and no other calling does — the intimacy that you can share with what it means to be a human being today. On genetic reading and writing and Artificial Intelligence Over the last four or five years we have acquired technologies to change and interrogate the human genome with the kind of facilities that we didn’t have before. There are two things coming out of this. One thing is that we were struggling in medicine, biology and sciences to explain the nature of human variation. We knew there were powerful genetic components to this, but we didn’t know what those components were and we are now beginning to know those components. But, we seem to have now crossed on to a new arena of limits. I call this the process of reading. It is simultaneously exhilarating but very dangerous. Writing takes a deeper step into the exhilarating abyss of human biology. Writing means we also have the capacity to begin to change the information. We can certainly delete genes, you can reactivate a gene in a human embryo, in a sperm-producing cell or an egg-producing cell, and almost certainly delete a gene that might predispose you to breast cancer. Deleting is not a problem, replacing it with a new one is at the threshold. We are about to cross the threshold. You can decide whether it is a line in the sand or not. For me it is. Artificial Intelligence is a complex field. I have some strong reservations about it. So, if I were to identify two arenas where we are drawing strong lines in the sand about what the human future looks like, it would be reading and writing genes and it would be Artificial Intelligence. It is the combination of these two things. It is when computers begin to read us, when we, rather than becoming the supervisors, become subjects of our robot overlords, that is when I suspect, for all of us, our level of discomfort rises.
On genetic engineering and its moral implications
If we are talking about genetic changes and genetic engineering, three arenas need to be distinguished. The first arena I will call all other species, the rest of them — that is a little bit like saying that the world is divided into cows and non-cows! Interventions have already started and, in those species, the attempt is to change the species in a So, by all other species, I mean mosquitoes, crocs, fish. All these species are open for potential genetic engineering in large parts. The main dangers in doing that are ecological. So, the main dangers are biohazard and the main concern there is human humility. We should be humble about our knowledge and a lack of knowledge of the ecosystem. We want to make changes in the ecological world for good reason, I suspect. We could go horribly wrong, but we need to have mechanisms to remind us how to keep those practices safe. The second category is called somatic gene therapy. Here, we are trying to make genetic engineering in cells that are not permanently moved to the next generation. The third arena is the most complicated and is called germline engineering. And, here you are changing not just any cell in the body but cells that make sperms, eggs or embryos themselves. Here the bright-line distinction is that whatever change you make will be transmitted across generations… there are strong moral hazards. Should we be playing with our own genomes? We certainly haven’t done it in the past. Should we have the humility in the face of the capacity to change our genetic information? Could we have profound effect on ourselves as a species in the way that we self-determine our future? Should we stop now?
This is an edited excerpt. For the longer version, visit www.indianexpress.com