The embryo as a patient

Dr Aniruddha Malpani, MDwww.drmalpani.com

Logical next step in medicine

• Adult• Child• Foetus• Embryo

Precision medicine

• Prevention is better than cure• Treat at the genetic level – at the

root cause of the disease

We’ve come a long way, baby !

From PGS – preimplantation genetic selection to

PGT - preimplantation genetic therapeutics

Playing God ?

• Familiar debate !• Is IVF ethical ? When does life begin? what

are the rights of an embryo? • Can human embryos be used for harvesting

embryonic stem cell lines ?• Should cloning be

allowed ?

Two views

• Manipulating Nature is dangerous

v/s• Triumph of man's ingenuity

which can be used to overcome Nature's constraints.

Who decides ?

• Top-down – scientists, philosophers, activists, government, doctors. • Bottom up - Leave the decision

to each individual couple, who provide the reproductive apparatus to create the baby.

Challenges

• Both technical and ethical• Assilomar Conference. Recombinant

DNA. 1975. Moratorium , need time to evaluate the risk reward ratio• Transhumanism - Logical next step for

human progress . Humans engineer their own evolution, rather than depend on nature

Challenges

• Cells are still a black box . Worry about unintended consequences• Gene Drive • Gene Flow across species

can lead to interbreeding• Dare we open Pandora’s

box ?

Science Fiction

Different standards

Slippery slope !

Criticism

• Unnatural and artificial - Is nothing sacred ?• Money - Is everything for sale ?

Knee Jerk Reflex - Ban genetic engineering !

• It’s too dangerous, so let's prohibit it ! Easy to do, but will backfire. Throw the baby out with the bath water. • Other countries will steal a march on us

and we will be left behind• Drive it underground ?• Need sensible guidelines and regulation

• Actions have consequences. • Inactions have consequences

too• Fear of the unknown cannot

paralyse us into inactivity

Dr Frankenstein

Should human embryo research be banned ?

• We are not mad scientists trying to play God • We are doctors trying to do the best for

our patients

Doctors are trusted professionals

• If we trust doctors to make life and death decisions in the ICU, then why can’t they be trusted to make decisions about genetic engineering responsibly in partnership with their patients ?• Could set up a multidisciplinary

committee to review each request ?

3 principles of medical ethics

• Autonomy• Beneficence• Non-maleficence

Evolution 2.0 ?• Human reproduction is not efficient. Hit

and miss affair. Why not improve it ?• Natural Selection is a biological fact of

life• If humans can do a better job, then

why shouldn’t we ?

Human Reproduction v 2.0

• Mother Nature is not always kind - millions of people die of preventable diseases, which we can treat today

The problem with regulations

• Rules vary so much from country to country means there are no right answers. • Rigid and inflexible. Get outdated• Isn’t it better to allow doctors the

freedom to select what is best for their patients ? • This conference shows we are

responsible and sensible

Solution ?

• Let patients decide for themselves – it’s their life and their baby• A democracy empowers people to make

their own choices • It’s unethical to interfere in their

personal family-building plans• Need to individualise and personalise

the care we provide