Congratulations to all of our Georgetown University graduates. For many of them, this is a chance to “make up” for what was not possible during the pandemic.
I missed the on-campus activities, as we went away with friends for a long weekend trip to southern Vermont to enjoy the spring countryside. It was a fabulous getaway. We flew from DC to Burlington, Vermont, where I completed my internal medicine residency and chief residency a long time ago.
Perhaps it is the faulty memory of an aging brain, or the extraordinary changes in any community over four decades, but I barely recognized the place (though I would be on more familiar turf in the downtown portion of Burlington). The drive from the airport was easy, and predictably beautiful.
One of our companions studies evolutionary biology in cancer, and during our walks through the woods, our conversations turned to the dazzling complexity of the environment and the seemingly endless adaptations that maintain the ecosystem’s equilibrium. We could not help but wonder at the hubris of humans, who believe we can control these processes and influence health and diseases rather well.
Looking at this from a 40,000-foot (or 1,000,000 year) perspective, one can see this as a deadly serious, multidimensional game of evolutionary chess. We make our moves, which are seemingly successful efforts (in one or two dimensions), while the “ecosystem” makes a series of countermoves in multiple dimensions of varying cadence. We play a fascinating pas de deux with the ultimate grandmaster.
I was captivated by this idea in part because I attended an amazing presentation this past week by David Liu from the Broad Institute, entitled “Laboratory Evolution of Genome Editing Proteins for Precise Gene Correction and Targeted Gene Integration in Mammalian Cells.” He and his team, and their many collaborators and competitors around the world, can do just that. It is no longer science fiction or boastful overreach; it can be readily reduced to practice. They can fundamentally alter the human genome to prevent or treat diseases. The concepts and the data are simply jaw-dropping. This is the next “big thing” in biomedical research. It is going to be a fundamental building block of translational biomedical research for the foreseeable future.
So, what happens when fatal genetic diseases are cured by these approaches? How will this be done? Will it be done equitably? Can (and should) we suppress our inevitable desires to “improve” the germline, to accelerate evolution, which is slow but sure when it comes to creating and selecting favorable characteristics? A wonderful recent book by Yuval Noah Harari, “21 Lessons for the 21st Century,” has explored some of these issues, which are both thrilling and terrifying.
These issues are so overwhelming to consider that I really treasured the opportunity to walk in the woods with Harriet and cherished friends, marveling at all that could be accomplished by old-fashioned natural selection, looking forward to a busy week, refreshed by an interlude filled with wonder.
Make the world a better place this week.
Lou
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