Disease context and gene editing

Gyngell ¹ and Stamell, ² respectively, recently argued for and against therapeutic gene editing. In some instances, gene editing might be prudent after very careful consideration. However, behind some of the arguments lurks a misunderstanding about complex chronic diseases. A ‘disease’ is a human value judgement concerning the outcome of the particular operating characteristics of that physiological system (originally specified by its genetics) in an environment. That is, a complex disease is both subjective and is context dependent. Chronic disease is simply an ‘undesirable’ gene(s) by environment interaction. It is not a ‘fault’ to necessarily be cured as such. In one context, these operating characteristics may be denoted as a ‘weakness’ (e.g. poor O₂ carrying ability/predisposition to coagulation in sickle cell anaemia) versus being denoted as a ‘strength’ in another context (e.g. increased resistance to trypanosome infiltration). Many other ‘karmic’ examples like this could be suggested. Adjusting the context of someone’s complex chronic disease (e.g. lifestyle changes, etc.) is surely both a more benign and a reversible strategy than running to a permanent technological fix with CRISP-Caspase9 (even under strict regulatory control). Human diversity is an advantage to our planet – to be fostered by sensible environmental adjustments – not something to be accidentally canalised by inappropriate selective breeding.