How China is Leading Genetic Tech

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7:00 AM HKT, Wed August 23, 2017 6 mins read

When it comes to appraising Chinese technological innovation in the West, there are a few areas where cultural differences become starkly apparent. Perhaps none is as divisive as biotech — specifically, genetic screening and embryo selection, two fields that ignite turbulent political debate in the United States, but have seen substantial development and increasing commercial deployment in China over the last few years.

A recently published article in Nature magazine by David Cyranoski entitled “China’s embrace of embryo selection raises thorny questions” brings some of these underlying cultural incongruities into high contrast, shedding light on how China views genetic tech differently from the West — and why this might give China a competitive edge in the field. Here are some important takeaways from that article.

DISCLAIMER: I’m not an expert on this stuff by any means. I am, however, someone who reads widely on this subject, as an American living in China, married to a Chinese woman, and planning to have a child within the next few years. I hope my attempts to wrestle with the subject can help clear up some cultural disconnects regardless of the reader’s disposition. If I’ve gotten something twisted, hit me up in the comments.

Definitions

First, we’ll need to set the vocabulary. Here’s a quick glossary for what follows:

Preimplantation genetic diagnosis (PGD): This is when a couple pursuing in vitro fertilization (ie, a test tube baby) is alerted to the existence of genetic mutations (eg, ones that cause heart disease) in an embryo
Embryo selection: A related concept, and key point of debate: this is when the parents doing the PGD decide whether or not to implant the diagnosed embryo in a human uterus; that is, they decide whether to destroy the embryo or carry it to term
Genetic screening: This is when one of the parents in this hypothetical tests their own DNA for the presence of genes associated with heritable disorders

Still with me? Here are the main cultural disconnects when it comes to applying this tech in China vs the West:

1. Yousheng (优生) vs Eugenics

Let’s stick with definitions for a minute. The English word “eugenics” was coined in 1883 by Francis Galton, Darwin’s cousin. Galton smashed the Ancient Greek for “good” and “breeding” together to create this new word to describe what Merriam Webster today defines as “a science that tries to improve the human race by controlling which people become parents.” The opposite of eugenics is dysgenics, which looks like this:

In the West, the word “eugenics” is inseparable from the concept’s deployment by Hitler to justify Nazism’s horrific racial politics. It’s seemingly impossible to discuss eugenics or related ideas in the US today without intense pushback from people concerned over the potentially harmful social and ethical side-effects such discussions might bring about. The extent of genetic influence on intelligence, for example, is a topic that sparked violence on an American college campus as recently as May:

This cultural taboo does not exist in China. The Chinese word for eugenics, yousheng (优生), has the same etymological meaning (优, you, “superior”; 生, sheng, “birth/life”), but comes without a history of political exploitation or social stigma, and is used with objective detachment. As Cyranoski points out in the Nature article, the word yousheng

is used explicitly as a positive in almost all conversations about PGD. Yousheng is about giving birth to children of better quality. Not smoking during pregnancy is also part of yousheng.

2. Quality of life vs “Pro-life”

“Quality” is another word worth exploring here — in the context of embryo selection in China, it refers not only to the quality of a potential child, but to the quality of its life. Cyranoski says early on:

The conditions [for PGD and embryo selection in China] are ripe: genetic diseases carry heavy stigma, people with disabilities get very little support and religious and ethical push-back against PGD is almost non-existent.

China is far less friendly towards people with disability than most Western countries, and lags behind in workplace anti-discrimination laws. On top of that, most Chinese parents are legally limited to have, at most, two children — a recent update of the one-child policy China introduced in 1979.

As a result, prenatal selection has a long history in China. Some parts of the country have even outlawed sonograms to prevent parents from screening for sex (specifically, to counteract a strong preference for males).

China’s two-child policy has already been seized upon as an advertising angle

The Chinese PGD advocates that Cyranoski quotes only support the use of the technology to prevent genetic disorders — not to select for qualities the parent might desire. Qiao Jie, a fertility specialist and hospital president in Beijing, tells him, “Now, more and more diseases can be stopped — if not immediately, in the generation after next.” A researcher from Jiaotong University in Shanghai says that he’s refused a parent’s request to select against a “mutation that renders many Asians unable to process alcohol, something that could affect the ability to take part in the often alcohol-fuelled Chinese business lunches.”

An embryo, in vitro

Another question hanging over all this is how we choose to define “life.” Of course, there are reams of legalese devoted to answering this question in the United States, with conservative legislatures like that in my home state of Texas actively adding to the pile. In China, abortion has been a legal “government service available on request,” except in certain clearly life-threatening cases, since the 1950s. There is no social stigma attached to terminating an embryo that has been diagnosed with a genetic disorder, and there is no “pro-life” camp of comparable influence in China to argue against the research and commercial development of PNG or embryo selection on moral grounds.

3. Different health care systems

While we’re playing around with loaded topics, here’s another key bit of Cyranoski’s Nature article:

Insurance coverage is “pitiful”, says Svetlana Rechitsky, director of the genetic-testing firm Reproductive Genetic Innovations in Northbrook, Illinois. Sitting at her desk, sorting through letters from insurers — mostly refusals to offer coverage for PGD — she says, “It’s getting worse and worse.” Already the procedure is much cheaper in China — about one-third of what it costs in the United States.

I probably don’t need to spell out the issues surrounding the affordability of health care in the United States right now, but it’s worth repeating Cyranoski’s observation that “without government support, [PGD] remains for many a prohibitively expensive procedure.” In China, PGD has received sustained research and development in top hospitals and academic institutions, and services related to genetic screening have already been made available on a mass commercial level by private, non-governmental institutions like Berry Genomics and the Beijing Genomics Institute (BGI), which pump out corporate videos that look like they jumped off a Jurassic Park storyboard:

The companies peddling these genetic screening tests go so far as to claim that “reducing the price of genetic medicine and DNA testing could dramatically reduce the subsequent cost burden of treatment for patients and their families, making healthcare more affordable for individuals and the government alike.”

4. The BGI Effect

Here’s Cyranoski’s most direct and important summary of the differences in stigma around PGD in China vs the US:

People in China seem more likely to feel an obligation to bear the healthiest child possible than to protect an embryo. The Chinese appetite for using genetic technology to ensure healthy births can be seen in the rapid rise of pregnancy testing for Down’s syndrome and other chromosomal abnormalities. Since Shenzhen-based BGI introduced a test for Down’s syndrome in 2013, it has sold more than 2 million kits; half of those sales were in the past year.

Prenatal Down’s syndrome screening is also common in the US, but, as Cyranoski points out, “many in the West won’t terminate a pregnancy just because of Down’s syndrome.” While in the US it’s more often administered as part of a larger process of prenatal care, Chinese companies like BGI are moving the screening process into the private domain. In addition to Down’s syndrome screening, BGI’s consumer services include a wide variety of tests, including screens for individuals looking for red flags in their DNA and couples preparing for pregnancy.

BGI’s NIFTY Test

“To understand genomics is to master the future” — BGI President Wang Jian

All this to say — there really isn’t a comparable movement in the United States to make genetic screening and PGD acceptable, available, and affordable at scale. That BGI corporate video states innocuously enough that “to understand genomics is to master the future.” It stops short of identifying the real stakes: the ability to manipulate those genomics.

5. Screening vs Editing

It must be said that the US has made great strides in other areas of genomics research. Scientists at MIT and UC Berkeley have recently — and independently, or so each side claims in patent court — developed the ability to directly edit segments of the human genome using a method called CRISPR-Cas9 (see a good general overview of CRISPRs here, and how they’re being used by researchers in China hoping to cure cancer here). A team led by Oregon Health and Science University researcher Shoukhrat Mitalipov made headlines at the beginning of this month after publishing a paper — also in Nature — detailing the first use of CRISPR technology to directly edit a human embryo (they successfully edited a gene that controls a heritable heart condition).

This is a huge breakthrough to be sure, but the headline of a Wired article from a few days ago highlights an underlying issue: CRISPR Fans Dream of a Populist Future for Gene Editing. While only a dream in the US, for any number of legal, political, and philosophical reasons, such “populist” applications of genomics research are being actively, even aggressively, developed in China today.

So… what?

There are many reasonable points of debate around this subject, and many sides on which to fall. “We should eliminate hereditary diseases entirely,” “Selecting against these diseases will make life for people who have them now even more difficult than it already is,” “It’s morally wrong to kill a fertilized egg, period,” and “Oh shit China is creating genetically modified superbabies” are among the most salient.

Regardless of where you land on the subject, the facts above must be kept in mind, and the cultural disconnect between Chinese and Western attitudes towards genetic tech must be bridged by mutual understanding, if any debate on the subject is to ultimately be useful. Personally speaking, I’m still not sure what my wife and prospective-father-I will choose to do with PGD when the time comes, but it’ll be an informed choice.

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Cover image via China Daily

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