The leading cause of death for under 50s.

Over two million problem users.

Responsible for more deaths a year than guns or cars.

2017 was the year that America’s opioid epidemic made the headlines. With story after devastating story of families and communities ravaged by lives lost to addiction. It was also the year that big pharma came under the spotlight for their role in fuelling this “public health emergency”, having flooded states with millions upon millions of pills. (More than forty states are suing the pharmaceutical companies, reminiscent of the mass litigation against tobacco (some background)).

Amid this notable coverage, the murky relationship between big pharma and the health professionals who prescribe their drugs has been under-reported. Mainstream media has barely touched on the broken ethics of doctors taking payments from pharma companies. Yet research shows that even a $20 lunch can influence prescribing habits, and the higher the payments doctors receive, the higher the rate at which they prescribe the promoted drugs. Research published this summer revealed drug companies made 375,000 opioid-related payments to doctors in just 29 months. One in five family doctors – health professionals implicitly trusted to do the best thing for patients – have received payments relating to these highly addictive narcotics.

The role of big pharma is half the story, the willingness of doctors to cosy up to them – facilitated by millions of dollars in payments and gifts – is the other half. But that isn’t making front-page news.

FURTHER REPORTING FROM UNHERD ON THE OPIOID CRISIS

1. Ian Birrell describes what he saw on a trip to Dayton, Ohio, in ‘The even more deadly hurricane surging across America’
2. Charlotte Pickles examines the role of doctors in enabling the spread of opioid addiction in ‘The cosy relationship between big pharma and doctors is killing people’
3. Peter Franklin writes about how legally prescribed opioids have developed the criminal market for such narcotics in ‘How to create a drug epidemic’

***

Introduction to this Under-reported series.

Summary guide to all under-reported articles in this series.

Actually, ‘new’ is putting it mildly. CRISPR is downright revolutionary and, whether for good or ill, it will change our world – and, quite possibly, ourselves too.

As you might imagine, editing genes is quite fiddly. We’re now pretty good at reading genetic sequences, but rewriting them is a whole other business. But what if Mother Nature were to crack the problem for us?

Well, it turns out she has. Bacteria contain distinctive sequences called ‘clustered regularly interspaced short palindromic repeats’ or CRISPR for short. These CRISPR sequences mark out ‘spacer’ sequences of DNA originally acquired from bacteria-killing viruses called phages. The array of CRISPR and spacer sequences is then used to manufacture proteins which recognise and attack corresponding genetic sequences from invading phages.

Basically, the bacteria are using the CRISPR based system to ‘photograph’ the enemy’s DNA and then make little molecular robots that cut-up anything that matches the image.

By co-opting these mechanisms, genetic engineers have acquired an immensely more powerful toolkit than they had before (‘before’ being circa 2013). The biochemist Jennifer Doudna is one of the pioneers of this field and together with Samuel Sternberg she has written the definitive book on the subject so far – A Crack in Creation: Gene Editing and the Unthinkable Power to Control Evolution.

That’s quite a title, but – according to Matthew Cobb in the New York Review of Books – it doesn’t over-claim:

“The possibilities of CRISPR are immense. If you know a DNA sequence from a given organism, you can chop it up, delete it, and change it at will, much like what a word-processing program can do with texts. You can even use CRISPR to introduce additional control elements—for example to engineer a gene so that it is activated by light stimulation. In experimental organisms this can provide an extraordinary degree of control in studies of gene function…”

The implications are profound:

“In 2016, the power of gene editing and the relative ease of its application led James Clapper, President Obama’s director of national intelligence, to describe CRISPR as a weapon of mass destruction. Well-meaning biohackers are already selling kits over the Internet that enable anyone with high school biology to edit the genes of bacteria.”

On the other hand, our ability to ‘edit out’ genetic diseases will be greatly enhanced – indeed clinical trials are already underway. Eliminating defects is one thing, but what about making ‘improvements’?

“Like many scientists and the vast majority of the general public, Doudna remains hostile to changing the germline in an attempt to make humans smarter, more beautiful, or stronger, but she recognizes that it is extremely difficult to draw a line between remedial action and enhancement.”

The genetic basis of intelligence and other traits are highly complex. We’re not even close to full explanation for how it works – and thus, even with CRISPR, our ability to meddle is, for the moment, limited.

However, other new abilities will be within our grasp much sooner. A particularly dangerous example is ‘gene drive’ – a natural or artificial modification that enhances the transmission of particular genes through sexual reproduction:

“When a gene drive is used, the frequency of the altered gene increases exponentially with each generation, rapidly flooding the whole population… The problem with a gene drive is that it is essentially a biological bomb…”

CRISPR makes it much easier to make these biological bombs – which we can then use to biologically nuke species that we don’t like (especially fast-breeding pest species).

Even without a direct IQ boost from CRISPR, we already have the intelligence we need to reshape the biosphere. Whether we have the necessary wisdom is another matter.

> CRISPR was one of the five big tech stories identified by Nigel Cameron in his article on how the media’s obsession with Trump is burying coverage of other important news stories.