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Pregnant promise Fetal medicine is amazing but will lead us into difficult ethical territory HAVING children is still a risky detectable than can be treated. business, even in the west. Around To put it in perspective, 1 in 25 babies is born with a genetic a recent study found that the disorder, and up to a quarter average person carries around of infant deaths are caused by 400 potentially damaging DNA genetic diseases. The burden of variants and that 1 in 10 people suffering and trauma is immense. is at high risk of developing a But fetal medicine is advancing. genetic disease as a consequence Within 10 years we can expect (American Journal of Human fetal genome sequencing to be Genetics, vol 91, p 1022). routine, which will improve “Prospective parents diagnosis enormously. Options could face a bewildering for treating diseases while a child range of diagnoses and is still in the womb are also set for rapid expansion (see page 50). treatment options” Given the option, most parents would probably prefer to know That suggests prospective in advance if their child will parents who choose fetal be among the 1 in 25. But this sequencing will be faced with a knowledge will not necessarily bewildering range of diagnoses, end the suffering. If fetal prognoses and treatment options, sequencing becomes routine, often for non-life-threatening diagnosis is likely to run ahead conditions or ones that will only of treatment, with many manifest later in their child’s life. more genetic defects being We may find ourselves hankering
for a simpler time when only the most serious genetic disorders were diagnosable early on. An even more difficult collective decision is looming: do we want to intervene in human evolution? The technology for genetically repairing the germ line – the fetal cells that go on to form sperm and eggs – is in development. That raises the prospect of being able to cure genetic diseases not just in one’s own children, but in their children, and so on. At present that is considered ethically unacceptable. But germline engineering could rid us of conditions such as cystic fibrosis and muscular dystrophy. If the technology is there, surely the unethical option would be not using it? These are decisions for the future, but we need to start thinking about them now. ■
Another wasted year INTERNATIONAL climate change talks turned 18 earlier this month, but there was little sign that their wasted youth is over. The 18th annual climate change summit in Doha, Qatar, might have ended with an apparent victory for developing nations, but in reality the world is barely any nearer to facing up to its responsibilities. First the good news. Rich countries have conceded that they should help poor countries cope with the harm they will suffer as the world warms. With dangerous climate change now almost inevitable, developing countries need this lifeline (see page 10). The agreement could have a useful knock-on effect, pressuring developed countries to take action on their own emissions. If they do not make cuts, they could
ultimately face a much larger bill for damages. But for all the fanfare, it was an agreement in principle only. The treaty signed at Doha did not establish a mechanism for compensation, or commit any money. Instead, it made a promise to set something up at next year’s conference. The text thus follows a well-worn and tiresome path of procrastination. In Bali in 2007, nations agreed to establish a binding treaty by the end of 2009. That promise was broken when the 2009 Copenhagen summit collapsed. Cancun 2010 agreed on virtually nothing except to meet again in 2011. Durban 2011 agreed to agree on a new treaty by 2015. Every year, delegates use the same tactic to give the appearance of action,
but achieve nothing in practice. In some respects, Doha was a step backwards. The biggest breakthrough in Copenhagen came when developed countries promised to give money to poor countries to help them adapt. Yet Doha saw this commitment placed on the back burner. After the conference Edward Davey, the UK’s secretary of state for energy and climate change, was harangued by a young delegate for agreeing such a feeble treaty. Davey responded that he would have liked to have done more but had to “live in the real world”. His meaning is clear, but the real real world is not one of endless diplomatic quibbling. It is one of rising seas and deadly storms. The negotiations have long since lost touch with it. ■ 15 December 2012 | NewScientist | 5