撰文 | Bill Gates

 

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我和梅琳达成立基金会的那一年，克林顿总统在白宫召见了一些世界上最伟大的科学家，并宣布了一个堪称人类历史上伟大里程碑的项目。两个互相竞争的项目（其中一个由美国国立卫生研究院领导，另一个由私人公司推动）完成了人类基因组图谱的第一版草图。克林顿说：“毫无疑问，这是人类有史以来迈出的最重要、最惊人的一步。”

 

16年后，并未大肆宣扬的遗传学家们又迈出了至关重要、堪称里程碑的另一步。当时，人类基因组图谱让我们能够阅读我们遗传密码的全部30亿个碱基，而我们现在有能力去编辑人类基因组了。一部分要归功于努力工作以改善酸奶生产的研究人员所做出的偶然发现， 科学家们现在可以将手插入人类细胞之中，选择性地剪掉部分遗传密码，然后将新的序列永久地插入基因组之中。

 

现在，科学家们已经启动了使用这种全新的基因编辑工具的早期临床试验。这些工具为人类疾病的诊断和治疗带来了极大的乐观情绪。甚至在研究人员还没有成功完成人类临床试验之前，基因编辑就可以在植物和动物的改造中大显身手——这为我们基金会改善贫困国家的饥饿和卫生状况的工作带来了希望。

 

尽管我对于这些进展感到十分振奋，我们还是要谨慎推动这些技术。改写电脑程序代码是一回事，改写我们种族的遗传密码则是完全不同的另一件事。

 

和所有伟大的新技术一样，基因编辑对于抱有善意（即减少人类所受的痛苦）和恶意（即造成这种痛苦）的人们来说都具有十足的吸引力。即使只考虑前面一种人，伦理问题也是十分棘手的。

 

这就是我在读到《基因传：众生之源》时十分高兴的原因。本书的作者是哥伦比亚大学的癌症专科医生和研究员——悉达多·穆克吉，我最近有幸私下与他进行交谈。对于带领我们探索基因组学的过去、现在和将来来说，他是最好的人选。

 

 

我很喜欢穆克吉在2015年TED大会上的发言，还有他写的那本闪烁着睿智光辉的《众病之王：癌症传》，该书于2011年荣获普利策奖。对于全职作家来说，一个医生用业余时间写出来的书拿下了普利策奖这件事一定会让他们火冒三丈吧！

 

在《基因传》中，穆克吉再次显示出他深入浅出阐述困难的科学问题的天赋。他是为一般大众写这本书的，因为他清楚单靠科学家来对科学发现所引发的重要伦理问题进行辩论是不够的。正如他在我们的对话中反复强调的那样，为这些技术决定恰当的规则和边界需要广泛的公众讨论、辩论和共识。

 

穆克吉通过多种方式使《基因传》平易近人。就像所有优秀的科学作家一样，他使用创意十足的类比来解释困难的概念。他还是一个很棒的叙事者，他用这一天赋来编织自己家族的精神病史，我对这一部分感到极其震撼。通过故事，他为我们介绍了遗传学中的重要先驱——从孟德尔（他在竞争高等学校科学教职的考试中多次落榜，但后来开启了现代遗传学的大门）到弗朗西斯·柯林斯（他是虔诚的基督徒、狂热的摩托车爱好者，也通过杰出的努力领导了政府部分对人类基因组的测序）。

 

本书中我最喜欢的部分是最后一部分“后基因组时代：遗传学的命运与未来”。这一部分在引起对困难伦理问题的关注上面起到了至关重要的作用，而这些问题将变得日益严峻。

 

十年内，临床医生就可能运用基因编辑来帮助患有由单基因缺陷引发的疾病（如囊胞性纤维症）的人们，这是这种新技术一种毫无疑问合乎伦理的运用方式。但是如果将修复用于卵子和精子上，以挽救此后可能得此类疾病的人，是否也符合伦理呢？这种疗法可能会十分有效，但这也可能意味着由这些精子或卵子中所诞生出来的孩子会将他们身上经过基因修饰的基因组传递给他们自己的孩子，这改变了人类的种系、也跨过了伦理的边界（原文为“跨过了伦理的卢比孔河”。领军跨过卢比孔河，在古罗马历史上形同叛乱。凯撒带兵跨过卢比孔河，掀起了罗马内战的狂潮——译者注）。

 

改变人类的种系并非只是设想中的可能性。中国的许多研究团队正在人类胚胎上为此争分夺秒地工作。虽然这些研究人员使用的是无活性的胚胎，一个瑞典发育生物学家近期宣布，他正在编辑健康、有活性的人类胚胎。他说他不会让编辑过的胚胎发育超过14天，但是并没有讲出其他科学家可能在计划什么。穆克吉说：“截至本书出版之时……第一个‘后基因组’人类可能已经在出生的路上了。”

 

在阅读《基因传》时，我想到了我自己的一长串伦理问题。比如说，如果产前检测告诉你，除非做出一点小小的编辑，不然你的孩子的IQ很有可能低于80，你会怎样做？如果一家私立试管婴儿诊所为其客户的胚胎提供了一点点帮助，便能使孩子的IQ从高变得更高，会发生什么事？这可能会加剧已经成为大问题的不平等现象——尤其是在只有富人能够接触到这种技术的情况下。那么能显著降低自闭症类群发生几率的一系列编辑又如何呢？这是否意味着以危险的方式降低人类的多样性？因为这也许会彻底抹杀掉一位未来的阿兰·图灵（图灵是才华横溢的计算机先驱，他参与了二战中破解德军恩尼格码密码系统的工作）出现的可能性。

 

技术是无道德属性的，它既非善也非恶。技术的善恶完全取决于我们——不止是科学家、 政府官员和财富足以创建基金会的人——对这些新技术的思考，以及这些技术应当如何被使用，又不应如何被使用。阅读《基因传》会让你了解到你在这种辩论中能积极参与到那些方面中。

 

Lost and Found with “the Most Wondrous Map Ever Produced”

 

The year Melinda and I started our foundation, President Bill Clinton convened in the White House some of the world’s great scientists to announce a huge milestone for humanity. Two rival efforts, one led by the National Institutes of Health and the other by a private company, had completed the first draft of the human genome map. “Without a doubt,” Clinton said, “this is the most important, most wondrous map ever produced by humankind.”

 

Fast forward 16 years. With little public fanfare, geneticists have reached another super important milestone. While the human genome map gave us the ability to read all three billion letters of our genetic code, we now have the power to edit the human genome as well. Thanks in part to a chance discovery by researchers working to improve yogurt, scientists can now enter human cells, selectively snip out sections of code, and then incorporate new sequences permanently in the genome.

 

Scientists have now launched early-stage clinical trials with these new genome-editing tools. These tools are generating a ton of optimism for diagnosing, treating, and curing human disease. Even before researchers successfully complete clinical trials in humans, genome editing will be put to good use in modifying plants and animals—all of which holds big promise for our foundation’s work to alleviate hunger and improve health in poor countries.

 

Although I am excited about these advances, we have to approach them with caution. It’s one thing to reprogram the code that runs our computers. Reprogramming the code that runs our species is a very different thing altogether.

 

As with any powerful new technology, genome editing will be attractive to people with both good intentions (reducing human suffering) and bad (causing it). Even just with respect to the former, the ethical questions are enormous.

 

That is why I am so glad I read The Gene: An Intimate History, by Columbia University cancer doctor and researcher Siddhartha Mukherjee and recently had a chance to chat with him in person. He is the perfect person to guide us through the past, present, and future of genome science.

 

I loved Mukherjee’s 2015 TED Talk and his brilliant book about cancer, The Emperor of All Maladies, which won the Pulitzer Prize in 2011. It must really tick off full-time writers that a doctor can win a Pulitzer in his spare time!

 

In The Gene, Mukherjee once again shows his gift for making hard science easily accessible. He wrote this book for general audiences, because he knows that it’s not good enough for scientists alone to debate the huge ethical questions that their discoveries provoke. As he emphasized repeatedly in our conversation, determining the proper rules and boundaries for these technologies requires broad public discussion, debate, and consensus.

 

Mukherjee makes The Gene accessible in a variety of ways. Like all good science writers, he offers creative metaphors to explain difficult concepts. He is also a beautiful storyteller. He uses that talent to weave in his own family’s history of mental illness, which I found incredibly touching.  And through stories, he introduces us to the key pioneers in genetics—from Gregor Mendel, who repeatedly failed the exam to teach high school science but later ushered in the modern science of genetics, to Francis Collins, the devout Christian motorcycle enthusiast who brilliantly led the public effort to sequence the human genome.  

 

My favorite part of the book was the final section, “Post-Genome: The Genetics of Fate and Future.” It does a great job bringing into sharp focus the difficult ethical questions that will become increasingly intense.

 

Within 10 years, it will be possible for clinicians to use genome editing to help people with diseases caused by a single faulty gene, such as cystic fibrosis—an unquestionably ethical use of this new technology. But what about making the repair in egg or sperm cells to save people from developing these diseases later in life? This form of therapy could be highly effective, but it would mean that children born from these sperm or eggs would pass along their genetically modified genomes to their own children—altering the human germ line and crossing an ethical Rubicon.

 

Altering the human germ line is not just a hypothetical possibility. Teams of researchers in China are racing to do so in human embryos. While these researchers are using non-viable embryos, a Swedish developmental biologist recently announced that he is editing healthy, viable human embryos. He says he will not let the edited embryos develop past 14 days, but there’s no telling what other scientists may be planning. “By the time this book is published … the first ‘post-genomic’ human might be on his or her way to being born,” Mukherjee reports.

 

As I read The Gene, I came up with long lists of ethical questions of my own. For example, what if a prenatal test told you with a high degree of certainty that your child will have an IQ of 80 unless you do this little edit? What if a private IVF clinic offered its patients a little enhancement to their fertilized embryos to boost children’s likely IQ from high to very high? This could exacerbate inequities that are already a big problem—especially if this technology is available only for wealthy people. What about a series of edits that could dramatically reduce the incidence of disorders on the autism spectrum? Wouldn’t that mean reducing human diversity in dangerous ways—perhaps even eliminating the possibility of a future Alan Turing, the brilliant computer pioneer who helped break Germany’s Enigma code during World War II?

 

Technology is amoral. It is neither good nor bad. It is up to all of us—not just scientists, government officials, and people fortunate enough to lead foundations—to think hard about these new technologies and how they should and should not be used. Reading The Gene will get you the point where you can actively engage in that debate.

 

链接：

https://www.ted.com/talks/siddhartha_mukherjee_soon_we_ll_cure_diseases_with_a_cell_not_a_pill?language=en#t-672063