BOOTSTRAP BIO
Genetics shouldn’t be a lottery.
And now it doesn’t need to be. Because technology has made it possible to mitigate the fundamental unfairness of the genetic lottery. Let’s talk through the moral case for why genetic fairness is important, and then the practical case.The Moral Case for Genetic Fairness
Morally, it’s simply not fair that some are born with inherited advantages and others are not. This is as true for inherited health as it is true for inherited wealth. Professor Paige Harden made this point at length in “The Genetic Lottery”, as an extension of Rawlsian thought.Now, some believe that the proper response to inherited genetic inequality is to redistribute money so those born without genetic privilege can have more equal outcomes. But in reality, the equalizing intervention is typically medical rather than monetary.For example, some kids inherit good eyesight while others are born with bad eyesight. We mitigate that with prescription glasses. We don’t say your genes doom you to bad eyesight forever, and that seeking good eyesight is “euoptics.” We also don’t just direct scarce healthcare dollars towards those with bad vision as if they were incurably blind. We simply fix the underlying source of the problem, cheaply, with technology. And thereby make it possible for those who inherit bad eyesight to live equal lives as independents — not as economic dependents.In fact, as a society, we went further. Anyone can now upgrade their sight with telescopes, with microscopes, with infrared goggles, and with augmented reality headsets. You can get Lasik, contact lenses, colored contacts, and soon Neuralink. There’s really no limit to how much you can customize or upgrade your sight. And again, getting improved sight isn’t pathologized as coercive “euoptics.”This holds for many areas. We don’t say that children with metabolic disease should live with metabolic illness forever, and that seeking good biochemistry was “euchemics.” We don’t say that kids with cleft palates should have trouble speaking and eating forever, or that fixing this with surgery was “eusurgics.” We just fixed the problem, cheaply, with technology.There’s a lesson here: when we can fix an issue, cheaply, with technology…then we have a moral obligation to make that intervention available. And now we can do that at the genetic level.The Practical Case for Genetic Fairness
The practical case for genetic fairness is simple: your civil rights give you bodily autonomy and your taxes paid for genetic technology. Put them together, and you have the bodily autonomy to use genetic technology.On the first point, there’s a hidden consensus on bodily autonomy. The way to see this is that many on the left believe in reproductive choice as a human right, while many on the right believe in vaccine choice as a human right. It is completely consistent to support both of these rights. The overlap is that millions of people just don’t want the state to tell them what they can do with their own bodies. Let’s call this a human’s right to choose.On the second point, your taxes paid for billions of dollars in biomedical research. You funded genome sequencing, carrier testing, gene editing, gene therapy, in vitro fertilization, preimplantation genetic diagnosis, polygenic risk scores, and more. So, it’s because of you that we now know what genetic variants predispose you to great health or to great height.If we put those ideas together, you have the right to choose what to do with the genetic knowledge you paid for.Actually, you have more than the right. Now you have the technology. Because in the last decade we’ve seen the first glimpses of what a world without inherited genetic inequality would look like.As context, for years it’s been the standard of care for prospective parents to screen for “simple” inherited genetic conditions caused by only one gene. These types of conditions can be detected before pregnancy and addressed with a procedure called in-vitro fertilization with pre-implantation genetic diagnosis, where microscopic embryos without disease variants are screened for and then implanted.But over the last five years, it's become possible to start screening for complex conditions like heart disease and Alzheimer’s, which are diseases caused by more than one gene. The same technology also allows parents to select not just against harmful things like disease, but for helpful things like height and intelligence.Of course, we know that it’s unfair to inherit disease genes. But why should only the tall have access to tall genes? And why should only the smart have access to smart genes? That’s the status quo, but it’s also fundamentally genetically unfair. Particularly when we now have public databases of tall genes and smart genes to pick from (technically: height-increasing and education-correlated variants). Particularly when your tax dollars paid for those databases. And particularly when no state can rightfully override your bodily autonomy, your human right to choose.The point being: there is a strong moral case for giving people the option to choose what they want to do with the genetic knowledge they paid for. There is an even stronger case for doing so now that the technology is practical.And so we intend to offer the genetic technology that the public paid for to the public itself. We intend to do so at the minimum possible price and maximum possible scale, such that the technology becomes as ubiquitous (and unremarkable) as eyeglasses. We will of course remain compliant with the laws of every state in which we operate. But from a moral standpoint, our goal is to give as many people as possible the opportunity to choose their genes for themselves (and their descendants) rather than simply accept inherited genetic inequality.Because genetics shouldn’t be a lottery. And because genetic fairness can now be achieved through technology.
