Wednesday, June 28, 2023

Embryo Selection: Healthy Babies vs Bad Arguments

Great article by Diana Fleischman, Ives Parr, Jonathan Anomaly, and Laurent Tellier.
Polygenic screening and its discontents 
... But monogenic and chromosomal screening can only address a part of disease risk because most health conditions that afflict people are polygenic, meaning they are not simply caused by one gene or by a chromosomal abnormality. Instead, they are caused by a huge number of small additive effects dispersed throughout the genome. For example, cancer, schizophrenia, and diabetes can be best predicted by models using tens of thousands of genes. 
A polygenic risk score (PRS) looks at a person’s DNA to see how many variants they have associated with a particular disease. Like BRCA1, polygenic risk scores are typically not determinative: “Polygenic screening is not a diagnosis: It is a prediction of relative future risk compared to other people.” In other words, someone with BRCA1 has a higher risk than someone without, and someone with a high breast cancer PRS has a higher risk than someone with a lower breast cancer PRS. But in principle, BRCA1 is just one gene out of thousands contributing to a PRS, with each bit contributing a small part of a total risk estimate. ... 


... Recently, a group of European scientists argued that polygenic screening should not be available to couples because it will lead to stigmatization, exacerbate inequalities, or lead to confusion by parents about how to weigh up information about risks before they decide which embryo to implant. These are indeed challenges, but they are not unique to embryo selection using polygenic scores, and they are not plausible arguments for restricting the autonomy of parents who wish to screen their embryos for polygenic traits. Furthermore, from an ethical perspective, it is unconscionable to deny polygenic screening to families with a history of any disease whose risk can be reduced by this lifesaving technology. 
Many new technologies are initially only available to people with more money, but these first adopters then end up subsidizing research that drives costs down and quality up. Many other medical choices involve complexity or might result in some people being stigmatized, but this is a reason to encourage genetic counseling and to encourage social tolerance. It is not a reason to marginalize, stigmatize, or criminalize IVF mothers and fathers who wish to use the best available science to increase the chances that their children will be healthy and happy.
This is a comment on the article:
1) They don't want to admit that some people are better than others, inherently. Boo hoo. 
2) You put a scorecard of embryos in front of everyone, and everyone has a pretty good ballpark estimate of which are better and which are worse. Nobody is going to pretend equality is true when they are choosing their kids genes. 
3) So bad feels. 
4) Must therefore retard all human progress and cause immense suffering because don't want to deal with bad feels. 
That's the anti-polygenic argument in a nutshell. I don't expect it to be very effective. At best it will cause it to take a bit longer before poor people have access.

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