Science, Technology and Ethics: Hacking Darwin with Jamie Metzl, PhD

Living a Life in Full is a conversation you always wanted to have with that person who gave an amazing TED Talk or the author of one of your favorite books, or that inspirational Olympian you always wanted to know more about. It's graduate level conversations with those making a difference in the world and in the lives of others. This show brings you new ideas and approaches so that you can live a life in full. I'm your host, Dr. Chris Stout and I hope you enjoy this episode. This episode of Living a Life in Full is brought to you by ATI Physical Therapy. If you need physical therapy, choose ati. ATI offers exceptional care, trusted expertise and remarkable outcomes customized to your needs. ATI has over 800 clinics coast to coast in 25 states. We want to start feeling better fast. ATI can help address chronic pain or recovery from an injury or surgery expertly, quickly and conveniently. ATI's first program uses a performance based methodology to safely return injured workers to their workplace. FIRST is designed to increase strength, endurance and cardiovascular functioning. ATI's sports medicine provides athletic training services to help athletes get back in the game. ATI has hundreds of professional collegiate, high school, middle school and club relationships nationwide. ATI also offers a variety of specialty services including home health, hand therapy and women's health. To Learn more about ATI's advances in evidence based practice, clinical outcomes and their innovative new smartphone app, please visit atipt. Welcome to another episode of Living a Life in Full. I'm your host, Dr. Chris Stout. I'm very excited today to have a dear friend, Jamie Metzl back on the show. The first time he was on, I referred to him as a real life Buckaroo Banzai. If you haven't listened to that episode, I encourage you to do so as we cover some of the same some of the amazing things that he's done in his history. But I do want to set a context for this episode by noting just some of his credentials. Jamie is not only a Senior Fellow of the Atlantic Council, a technology futurist, geopolitical, expert, novelist, blogger, syndicated columnist, and media commentator, but he's also completed 13 Ironman triathlons, 29 marathons, and 12 ultramarathons. And I suspect probably more since the last time that I checked. He has served as Executive Vice President of the Asia Society, Deputy Staff Director of the U.S. state Foreign Relations Committee, Senior Coordinator for International Public information at the U.S. state Department, Director for Multilateral affairs on the National Security Council, and as a Human Rights Officer for the United nations in Cambodia, a founder and co Chair of The National Security Organization, Partnership for America. Jamie is also a member of the Council on Foreign Relations and a former White House Fellow and Aspen Institute Crown Fellow. He holds a PhD in Asian history from Oxford, a JD from Harvard Law, and is magna cum laude Phi Beta Kappa graduate of Brown. Jamie is the author of a history of the Cambodian Genocide, the historical novel Depths of the Sea, and the genetics thrillers Genesis Code, An Eternal Sonata. Today he's here to discuss his newest book, Hacking Genetic Engineering and the Future of Humanity. Welcome back to the show, Jamie.

Thanks so much, Chris. Happy to be back.

First of all, congratulations on this amazing work. I mean, honestly, I learned so much from your book. I was so captivated by it. And after reading it, I felt like I should get continuing medical education credits.

I'm speaking to lots of doctors. I'm speaking to groups. When I wrote the book, I thought it was for a general public audience, but then the doctors and scientists who were reading it were saying, this is incredible. You need to share this with all the doctors and all the scientists. So now I'm speaking to medical conferences of thousands of doctors. I'm speaking at U.S. national labs to leading scientists. I think this really. And doctors are getting, in fact, CME credits for coming to these talks, as they should. You are a prophet of CME credits.

Well, and the problem would be, well, would it be CMEs and genetics or genomics or IVF? You know, because you really, you somehow without having this be like 800 pages, you have gone as wide and deep in a very concise, taught way. And that's what I want to talk to to you a lot about today on the show. So I guess maybe my first question is just to start, how do you go from an Oxford PhD in Asian Studies and a Harvard law degree to write a blockbuster tome on genetics in the future?

So, yeah, it's a story that's really personal to me. So as you mentioned in your intro, I served on the National Security council in the 90s under the Clinton administration. And my then boss, and now great friend friend was Richard Clark. And some of your listeners may remember that after 9 11, Dick was the person who had predicted 911 and had written the famous memo that was on President Bush's desk saying, no one, we need to be focusing on terrorism, Al Qaeda is the threat and we need to go after bin Laden. Well, before that, Dick would always say, if everyone in Washington is focusing on one thing, you can be sure there's something much more important that's being missed. And so more than 20 years ago, I was looking around at the world and I saw all these little disparate data points and looking at them and putting this story together, I came to this very strong realization that the genetics and biotech revolutions, which were at a much earlier stage then, were going to change everything. And so I started educating myself. I read everything I could get my hands on. I tracked down these scientists I thought I could learn from and would just say, hey, you're going to meet with me. You can do this the easy way or the hard way. The easy way is saying yes. Now, the hard way is I'm going to bug the shyphen t out of you until you meet with me. So just make it easy on yourself. And when I was, when I was ready, I went. I started writing articles in policy journals about this. And then a member of congress, a chairman of a house committee, called me and said, I read one of these articles. This is so important, nobody's talking about it. I want to do a hearing.

Was that Brad Sherman?

That was Brad Sherman, yes. I wanted to do a hearing based on your article. Will you come and be the lead witness? Will you help me organize it and will you suggest who else might join? So I did that. And then I was doing a lot of speaking and a lot of writing on this topic from the national security perspective. But when I was speaking to people, it was clear that I wasn't getting through. And I'd already written a history of the Cambodian genocide and a novel telling the story of the Cambodia genocide in a more accessible way. And so then I realized I needed to write the story of the genetics revolution in ways that could be more easy, could be easier for the general public to understand and absorb. And that was what led me to write my two sci fi novels, Genesis Code and Eternal Sonata. But then when I was on my book tours and I explained the underlying science to people the way a self taught citizen scientist and novelist would do it, which is often very different from the way scientists and doctors do, who are often not great communicators, unlike you. I could see people's eyes going wide, but then I could just see what was happening in their heads. They're saying that's the story because they'd heard the words. They heard genetics, they heard the word DNA, maybe gene editing, maybe ivf. But how these pieces fit together to tell this story of where our species is going and how that's fundamentally different from where we've come. And that was when I realized I needed to write the story of the genetics revolution. But for everybody in a really accessible way, with a little bit of humor that people could absorb and they could bring them into the conversation. Because what we're talking about is the future of our species. And everybody needs to be part of the conversation about where we're heading. We have some big decisions ahead.

That's great. And I think it also speaks to some of the other venues that you've had some op EDS and coverage with with the New York Times. You had an op ed making babies in the year 2045. And I was just sort of fascinated. I was sharing with my daughter, who's 21, you know, the concept of how antiquated it's going to be. Like, you and I have talked about technology before. How antiquated, like, you know, oh, my gosh, you used to drive yourself in a. Wasn't that dangerous? And then to your point of like, oh, my gosh, people wouldn't have IVF to be able to have a baby. Wasn't that risky? You know, didn't mothers die? And it's like, yeah, they did. So. And then you go like, then you're in tech crunch and then you're in Financial Times, so. And you have also, I've got to compliment you. I mean, you're. You have caught the. The attention of experts, like from cnn, Sanjay Gupta to Ray Kurzweil to George Church, I mean, who is sort of like the godfather of genetics and even the CIA. So let's take a step back, because not necessarily all of our listeners are going to be familiar with some of the basics. So I kind of want to get a little vocabulary set. So can you talk a little bit about what. Let's start off with just literally, biologically, the beginnings like IVF and CRISPR Cas 9. Sure. Those kinds of things.

Sure. So I'll try to make it really easy for people. And I think most people understand IVF in vitro fertilization. Human beings are a sexually reproducing species. We reproduce by sex. A little more than 40 years ago, the world's first in vitro fertilization baby was born, Louise Brown in the uk and basically, in ivf, you extract with a minor surgical procedure, eggs from the mother, and you fertilize those eggs with sperm from the father. But you fertilize it in the laboratory, and then you implant one or sometimes two of these fertilized eggs back into the mother. So the conception in IVF happens outside of the body. And the reason why that's so important to this story is because by taking conception outside of the human body. It gives us a much greater opportunity to apply science and technology to that process. And that's why IVF is kind of the entry technology that will allow us over time to fundamentally transform the way humans make babies, which, we can talk about this later perhaps, but which in my view will lead to the increasing end or just humans using, conceiving babies through sex much less often. Because if you conceive through sex, you won't be able to benefit from all of these other applications.

So, and then the, these other kinds of applications that's, that's leading us then into crispr, is that right?

Well, CRISPR is one. So when I, when I'm out speaking, which is, I'm on book tour now, so it's all the time, and I say, oh, I wrote a, I've written a book on the future of human genetic engineering. Nine people out of ten who've heard of it will say, oh, you mean crispr. And what I tell them is just imagine genetic engineering is a pie and gene editing is a slice of that pie. And crispr, which is the most effective form of gene editing, is a slice of that slice. It's a sliver of that slice. So the story of genetic engineering is much, much, much bigger and broader than crispr. But crispr, you asked, is a form of gene editing. And the metaphor that many people use, and it's a little overly simplistic, but it's kind of like word processing for genomics that everybody knows about DNA. And what crispr does is it uses a guide RNA and a molecular scissors to make a double stranded cut that is targeted. And so you can go to a specific place in the genome and make a cut. And then the genome will either self correct and so it'll patch back up, or if you have a foreign piece of DNA that is inserted along with, at the same time as the cut and it fits into that slot, the DNA will just essentially grab that. And so people are talking a lot about crispr. And CRISPR is, it's incredible relative to what has come before, it's cheaper, faster, better and more accurate. But it is by no means the last word on precision gene editing. Now there's a tool called base editing that doesn't do the double stranded cut because that's a pretty violent way of making changes. It just, it changes the letters. And there will be more and more. I mean, precision gene editing is going to get better and better and will be more and more accurate really forever.

Well, and it seems like, like CRISPR can be used not just to change genes, but then also, is it, is it correct that they can start to alter, like, epigenetic aspects of how the genes get expressed?

So, yeah, that's exactly right. So when I'm talking, I talk a lot about genetics, and genetics, it's the kind of core source code for who and what we are. So our genetics mostly, but not entirely, sets the parameters of what is possible. But then everybody, lots of times there'll be one really smart person in the audience where I'm speaking, and they'll be kind of laying in wait with their gotcha. And the gotcha's, what about epigenetics? And it's right, because the whole point of genetics is that every cell in your body has, almost every cell has the blueprint for your whole body. But if your skin cell is always trying to make a liver, like, your whole body's going to go nuts. So you have to have a process of differentiation. You can't just be a pluripotent cell. You can't. Every cell can't do everything simultaneously. And so the epigenetics, that is like, I mean, there are different metaphors that are used. It's like the notes on the score or the conductor saying who turns on and who turns off. And it's incredibly important. But epigenetics can also be sequenced. And so just if we crack the code of genetics, that's not enough. I mean, our genetics exist within what's called the multiomic complexity of our systems biology. And I try to never use language like that because it confuses people, but just it exists within the complexity of our biology, which has many different systems, but it's not, none of it is magic. And so we can sequence epigenetic information just like we can sequence genetic information. And the core point of all of this is that if humans, as I believe, are not infinitely complex, but just very massively complex, we are ultimately a huge data set. And with any data set, the more data we have, which we are going to get because we're going to have billions of people having their whole genome sequenced, and we'll have access to people's electronic health and life records, we're going to be able to increasingly, perhaps never perfectly, but increasingly, understand the complexity of our biology, and that will make more aggressive and substantial interventions possible.

You, you talk in your book. You know, you give a great foundation with the science and the technology aspects. And as you and I were talking just before we started our recorded conversation about, it's sort of like you can't go from there without talking about the ethics and the aspects of differences of opinion about that. And you give some sort of great examples in your book of some of the audience responses and things. And you also discuss a test for looking at, like, how far prospective parents would go into preventing genetic abnormalities. And then you give. It goes from very much the theoretical ethics to the practical of what's already in history. And like in Iceland, which I was unaware of this until your book, that you state that nearly all women who received positive indication of down syndrome chose to terminate their pregnancies. And this seemed to be similar also in Australia, China, Denmark and the UK and termination rates were from 90 to 98%. And then you ask, would we want it to be legal for prospective parents to affirmatively choose to implant a baby with down syndrome or even death sentences like Huntington's or Tay Sachs, which I thought was an elegant way of kind of turning the, you know, the argument kind of the other way. Like to say, well, wait a minute, you want us to do this, you know, and then thinking about not just the ethical aspects, but the legalities of that. So can you unpack that for us? Like what done in the ethical side?

Sure. So like I said, I'm on my book tour now. I'm speaking about this stuff multiple times a day. And what I always tell people is this isn't a conversation about science. The science has made this a conversation that we need to have. But this at its core is a conversation about values and ethics. Because my father and grandparents came to the United States as refugees from Nazism. And if had you asked the Nazis, I mean, that was the most technologically advanced society in the world. And if you had asked the Nazis, what are you doing? They would have said, we are applying the principles of Darwinism, that that was the core of what the Nazis thought they were doing. Wow. And so we really need to be sensitive. And so when I the sections of the book that you wrote about down syndrome, and I really, I suffered with those, and I have a lot of some friends who have kids with down syndrome. I spoke with them. I met with people from the National Down Syndrome association. And it's really sensitive stuff because it's one thing, I think it's very clear, at least to me, that if somebody has a child, somebody exists and they have any disorder or disease, they have an equal right to anybody else to thrive. There's just. There's no question about that. But what's sensitive is that's not the question we're going to be asking, we're going to be saying you have 10 or 15 pre implanted embryos in a lab and you have to pick which one of them is going to be implanted. And it's really hard. And it's like, would you pick the one that has some kind of genetic or chromosomal abnormality? And it's just, it's so sensitive because there are normative questions about that. And people rightly say, hey, if you're saying this disorder should, or I think in the case of down syndrome will be eliminated, by and large what does that say about people who have, who are living and wonderful people who are living with that disorder now? And there are no easy answers to these questions. They're incredibly sensitive. But these are the questions that we need to ask. And we can say, well, we don't want, like we were not comfortable with making this decision, but people are making the decision already with the information that they have. And it's not just, you know, people in Northern Europe and China, people in the United States. I mean, the number of people who are aborting, the percentage of people who are aborting once they have the diagnosis of down syndrome is much greater than what the number would be if everybody, based on percentages, who is a professed right believer in right to life, anti abortion were to make that decision when faced with, with this scenario. So we know that this is really sensitive, but we have to have this conversation and, but we need to do it in a way that enhances our humanity, that doesn't undermine our love and respect for people who are carrying these disorders. But we also can't romanticize. I mean, there's a whole disability rights community for very, very good reason. But there's a lot of suffering that comes with a lot of these diseases and disorders and people are dying gruesome early deaths. And so as sensitive as it is, we can't just say that there's no normative difference between having a kid who dies before they're five and lives to be 100.

Yeah, well put. I think that's the struggle and I think that's some of the things I want to circle in this conversation towards the tail end about some of the work that's being done to kind of get that open dialogue going. So you just mentioned earlier too sort of like that this is a big data challenge and I guess it makes me think about like the how that relates to the genome Wide association studies, gwas, if that's how it's pronounced. And that basically is that the case in which it's like using computer algorithms to look at Thousands of like SNPs or single nucleotide polymorphisms and then it looks for genetic variations in that. Is that.

Yeah. So, yes. So GWAS is the way that we are doing genetic analysis now because it's still a little too expensive to do whole genome sequencing for everybody. And the computing power that is necessary to do analysis of just the massive size of whole genome sequencing is actually pretty astronomical. But the way I see GWAS and what genome wide association study is, and I tried to really simplify it in the book so people could understand, is that scientists over the years have identified some high priority, kind of high impact places in the genome where there is variation. So most of our genome is like, is more than most. Almost all of our genome is pretty much exactly like every other, most other humans. But there are the points of difference. And so what the GWAS does is just focuses on those points of difference and that narrows down the world of genetic analysis. But where we are moving is to whole genome sequencing, also called next generation sequencing. And with that we'll sequence the entire genome. And I think that the reason why that is important is we are going to, and we are increasingly going to understand that our genetics is probably much more complicated than we think. Just because we identify one gene that says something significantly about one disease or one trait that doesn't tell the story of the full story of the disease or trait. So it will be for our complex traits, there'll be hundreds, thousands of genes that are relevant. And only by doing whole genome sequencing and comparing the genotypic information, what the genes say and the phenotypic information, how those genes are expressed over the course of life for billions and then billions of people, will we be able to more fully understand our complex, our more complex diseases, disorders and traits.

Gotcha. So that's sort of the aspect of the promise and peril, I guess, of pharmacogenomics.

Yeah, well, that's, I mean the healthcare applications, those are in many ways the kind of the entry points. And that's why everyone is going to be sequenced. Because in our world today of generalized medicine, where you're treated based on population averages, you go to your doctor and you're treated a certain way because you're a human. And here's how humans tend to respond and which is a perfect better than anything we've done in the past. But as we move into the world of precision medicine, it won't be the N of 7 billion, it will be the N of 1, the N of you. And that means that what you mentioned, pharmacogenomics, like we don't want to do right now, we do a lot of trial and error. We'll take this drug, let's see if it works. If it's helps you, great. If it kills you, that's bad. If it doesn't help you and doesn't kill you, we'll try something else that could kill you. Yeah, and better. We should say, here's what we know about your unique biology. So we're going to narrow down the options of what is something more likely to work for you. And that's why it's not going to be that everyone's going to send in their 23andMe swab or do a blood sample because it's fun, or they want to know, you know, whether, you know, where their ancestors came from. This is going to be required. Everyone's going to have to do it as a foundation of healthcare, of their healthcare. In a world of precision medicine.

I remember I was working with a fellow at Northwestern, this is probably pushing 15 years ago and he was one of the first in the area there. And then I think UFC was the other one that had a sequencer. And it was the aspect of thinking about there might be a number of drugs that had sort of been abandoned by big pharma because of not meeting a criteria of efficacy across a broad enough sample. And then to, in the concept of precision medicine, of being able to say, well, this person with this kind of genomic code, you know, would be a responder to this and would not have toxicity with it. So it's, it's interesting locally here also there's a, like you go to your primary care physician and you get a cheek swab just like you get a blood draw. And at least they're starting to collect it. Now, I never read a follow up about how that's being articulated into a treatment plan. But you write that in 2018, Geisinger Health System started doing that. Do you have any feel or how patients are responding to that? Did they say, hey, this is cool, cool, I feel like I'm on the cutting edge, or, oh, this is intrusive and I'm paranoid?

No, I think so far from what I know, and obviously I don't, I don't know everything, but I think people are pretty comfortable with it. They get. When you're, when you're going to your doctor, you're not and the doctor is giving you some kind of cutting edge Test like, and especially in our crazy system, you're not, you're, in most cases your health insurer is paying for it anyway. You're not going to say, hey, what is this test? That's not the way our system works. People are excited about it. It's not that people are afraid in the medical context. I think that the problem, in some cases people have such monumental expectations for what we're going to be able to do, that in many cases they may even be disappointed. But we're seeing miracles in areas like gene therapy, which is just, you know, it's just getting its second start and there's just incredible. These untreatable cancers are now being treated and that's incredibly exciting. So we are going to see that the Children's Hospital of San Diego, they are leading the way in saying they're doing whole genome sequencing on every kid who comes to the neonatal intensive care unit. And that is going to be the standard of care relatively quickly. Just because there's so much actionable information. Why would we, why would we want to have health care in the dark? And that's going to lead that. It's going to be very, very difficult for physicians to practice this kind of medicine on their own. And that is a separate topic, maybe for another day. But that's going to lead toward this recognition that doctors without artificial intelligence partners will have a very, very difficult time practicing medicine just because the computational requirements to be effective will in many cases be well beyond the capacity of the human brain.

Right. So are, are those databases sort of like, like eventual things will be predicated on like what decode genetics is doing with, with the folks in Iceland or.

Yeah, so. Well, certainly Iceland now the, the most accessible genetic data pool is the hundred, it's called 100,000 Genomes, which is in the United Kingdom. And so most of the really high profile, population wide genetic studies are drawing on that really incredible resource. But every country, most countries are recognizing that cracking the code of biology, the codes of biology and certainly of genetics is a big data problem and a big data challenge. And so you need large data pools. In the United States there's, it's a program called all of Us. China is moving extremely aggressively to build these kinds of data pools. And that's where the information is going to come from. And that's why these data pools are so important and that's why issues like privacy are so essential. And we don't know, I mean China has probably the least privacy of the countries that are building these data pools. And that may end up being an advantage because we're going to have to probe this data in all sorts of different ways to really understand it.

So and part of that gets back to not just what your DNA is saying about you, but then also what, how in a sense how that's expressed. So and then that gets back to like the, in the US with the precision medicine initiative because if memory serves back, I think Obama era initiative that's continuing to go on, people could get like a Fitbit or some kind of, you know, biometric thing to monitor. So then you started to see, well, if this, you know, what's the level of activity, what's that mean vis a vis their DNA, if they have a diet like this or if they're obese or if they're, you know, whatever it is to be able to actually take the large data pools of what a genomic sequencing says, what that individual says and then what do we do about that?

Yeah, it's absolutely right. So it's not just genetics. We're going to need all kinds of information, genetic information, life history, electronic health information, biometric information. And all of this will, it will not just be that you do it once. It's going to have to be dynamic because your biometric information, for example, it's changing second by second. And so that's why we're going to need much more sophisticated systems to be able to integrate all of these pieces.

Gotcha. So last couple little things about the health side of things because there's a lot more to genomics that I want to get into. But one of the things I found fascinating in your book, you talk about like even what now seems probably like, like eons ago, 2013, like using CRISPR and Cas9 to treat cystic fibrosis. In 14 it was to use to correct liver cells and 16 to extract HIV from human immune cells DNA and prevent reinfection. 17 human embryo to correct defects, it causes cardiomyopathy. So these are the kinds of things does that occur in a functioning adult. Right. This is not pre implantation or anything.

Well, so the reason why I included that list of just here's like one, I mean I could have had thousands of things for each year is just to show how quickly this technology is advancing. I mean it was only 2012, seven years ago that CRISPR, Cas9 was identified as a tool for editing the human genome. That's nothing. And we have come so far and it is advancing so incredibly rapidly. So we are already seeing the first application of this technology inside of humans. A lot of the early stuff, until very recently was outside of humans and to make changes, to make genetic changes inside a human. And one is on a human where it's one person in a somatic cell that isn't passed on to future offspring, but even more in a germline cell, an egg, sperm or embryo where you're going to change the heredity. I mean it's a really big deal. It requires a very high level of precision. But we are very, very rapidly moving in the direction of having that kind of precision. And that's really going to change so much about how we think about healthcare, how we think about the immutability of

biology and I don't know, the flip side of that coin in a sense then becomes enhancement.

Yes.

And you and I have talked before. I mean one of my favorite movies is Gattaca. I just love that for so many different reasons. But in your book, I mean it's it's things of like looking for editing for extra strong bones, lean muscle and sensitivity to pain, lower odor production, virus resistance, etc that, that then just opens up a. No, a whole nother Pandora's box of, of ethics and like the proverbial like the couple in the movie, you know, like well why wouldn't we do that? You know, well that sounds good. So why roll the dice and take a risk?

So and, and it's really, I mean that's a great movie. I actually watched it again a few weeks ago and but it's real. And on one hand people have this gut feeling that genetic engineering for therapeutic purposes, that's probably okay and for enhancement, that's probably not okay. But the problem is there is no clear boundary between those two things. Like if you're having a child and that child is going to be, be 2ft tall, let's say. And you know how anyway, you know how difficult it would be for somebody to be two feet tall. And there's an intervention that you can make to a pre planted embryo to change that. And I think people would say, some people would say well that seems like it's worth doing. But if somebody, if you're going to have a kid and that kid was going to be six feet tall and you say well you know, I really love basketball, maybe I'll try to see if I can make him 7ft tall. Then people say well that, that seems kind of weird, but where do you draw that line? Is like is three feet tall. And there's, and so there's this whole gray area and for example, like let's Say you have you. Somebody has a terrible genetic disease or they have a mutation that will cause a terrible genetic disease. Well, it's probably okay to fix that so they don't get the disease. But let's just say that you could also that it's a non genetic disease and you could create an immunity for that terrible disease like hiv aids. Would it be so wrong to have an edit that would make your child immune to hiv? Like, I mean, I, I'm not, I don't, can't answer that question, but it's for sure a legitimate question worth asking.

Wow.

Yeah.

I mean again, it just, it's, it's, it will be fascinating to see the, not just the evolution of the science, but the evolution of the ethics and philosophy around these kinds of things.

And they have to, and they have to. Sorry to interrupt you, but they have to co evolve and they have to co evolve at scale and at pace because the science is racing forward. And that's not to jump ahead. But that's why I've written this book, is that I want to tell the story of the genetics revolution in a way that everybody can understand because this is all of our future and we all have to be part of the conversation about where this is heading. Every person, every person listening to this podcast has the same right and obligation to weigh in on this topic as our political leaders or scientists. But you can't do it if you're not, not informed. Yes. Is that, that's the essence of everything.

Well, and so let's, let's do a little bit of a shift then, because this has certainly been something where it seems like there's a lot of opinion and policy and outcry. It seems to vary by maybe geography to a certain level of level, and that's GMOs. You note in your book food tweaks such as gene editing, the arctic apple that can be sliced and left out and open without browning. About the virus resistant rainbow, rainbow papaya gene, tomatoes that can grow better in warm climates, hyper hypoallergenic chicken eggs, things like that. I think maybe some of the fear is like if I eat a genetically modified whatever that somehow that's going to impact my health or my, you know, it's going to be like eating, you know, I'm going to be gene editing by virtue of what I eat. Is, is that urban myth or what's, what's the pushback about gmo?

You know, so you use the word urban myth. I will use the Yiddish word that my grandmother would have Used, which is a Bubba Mysa.

Well, I was gonna say that, Jamie, but

that's funny. So people have this feeling that genetically modified crops are wrong. And why do they have this feeling? Well, part of it is that in the early stages of this, of the scientific process of developing these technologies in 1970s, the scientists who were actually extremely responsible established guidelines for how what was then called the recombinant DNA revolution would play out. And these guidelines were largely. They largely held, but there wasn't a broad public conversation about what was happening. People weren't educated. And I think people have this feeling, one, that the GMOs kind of happened to them. They weren't part of the process. So that's certainly number one. And number two is we, many of us, have this innate sense, whether right or wrong, and in many cases wrong, that there is some kind of divine organization of the world and when we kind of play God or mess with nature, we are doing something terrible. And my view on that is it's a little bit late because the second we invented agriculture and medicine and all of that, you know, that's that those. Those weren't. We just didn't find those things. We invented them. When we immunize our kids, we are fighting nature. And the reason we're fighting nature is nature sucks. Nature has been. Nature's been trying to kill us for a long time.

That's right.

And so that's why we have fought back. That's the entire history of our species. That's why we're having this. We're able to have this conversation. And so with GMO crops, and there are some real reasons to be cautious about GMO crops. For example, we don't want to have a monoculture where we just have, for example, one kind of rice or one kind of wheat. We need to make sure that we have sensible regulation of companies that are. Have a significant influence over our food supply. Those are very legitimate. But there is no evidence whatsoever that consuming GMO crops is less healthy for a person than consuming non GMO crops. And 40 years of research by everybody, there's not been one piece of evidence ever that consuming GMO crops is unhealthy. And I was talking with somebody about this the other day who would say, well, I'm against GMOs, I'm against consuming GMOs. And I said, well, why? She goes, well, I had a stomach ache one day and I had drank some milk earlier that day. And then the next day I went and got non GMO milk. And I had that, and I didn't have a stomachache. And I said, well, what have I told you? And I said, 40 years of tons of research, no evidence. Pretty much every living science Nobel laureate has signed a, a petition saying that GMOs are safe for human consumption. It just wouldn't change. I believe what I believe, and it's really important because this sense that GMOs are bad has just sunk in so deeply that people are in effect willing to kill millions of people in Africa and South Asia because they're so afraid of GMOs. And what I mean is, in Europe, the anti GMO feeling is so strong that any country that has GMO crops is in most cases barred from exporting their agricultural products to Europe. And so given that countries in Africa and South Asia, the poorest countries, what else can they do other than agriculture? And they have to export to keep their economies going to get the currency they need to buy whatever other resources they can't produce at home. So they can't use GMOs. And these are the countries that are having the worst problems from climate change, from soil erosion that would be the beneficiaries of these technologies. And so people are dying of terrible malnutrition and malnourishment. And it's because of all of this fear and, and lack of information in GMOs. And I think that it's a really important warning that the scientific community cannot be smug, can't just say, oh, we think this is really great stuff. It's going to help a lot of people. And the benefits are self evident. The scientific community needs to engage the general public. And that's, and certainly that's what I'm doing. And we have to, and everybody has to have a seat at the table. We need to have a table that's big enough that we can have the, the right to life fundamentalists on one side and the biohacking transhumanists on the other side and everybody in the middle. Because whatever our views, we are all one human species. And we have to figure out a way to come together to find a way to manage this incredibly powerful technology in a way that keeps us together and utilizes our best values.

So, looking to the future, one of the things that you talk about that I want to shift into is the concept of synthetic biology. And you kind of set the stage of that of like looking at kind of trans species kinds of things of pig and cow valves for repairing human hearts and, and insulin from cows to treat human diabetes and things like that. You had a quote in the book that I just loved from. I forget who it was from, but they said something like, what we're planning to do is far beyond crispr. It's the difference between editing a book and writing one. So can you share to the listeners what synthetic biology is and kind of where we are?

Sure, yeah. So humans, we are made up of these building blocks. And so our genetic code are these instructions to our cells to make proteins. And it's so. And that's how we become. And so now what synthetic biology is, is using genetic code to instruct biology to do things different from what they otherwise would or in some cases could have done. And that means there's a range of applications. But right now, for example, most people who are taking insulin are not taking insulin from cows and pigs, which used to be the case, but they are taking insulin that is grown from, in most cases, yeast. But there are going to be all kinds of applications where we are in many ways tricking biology to do things that we want. And there's an idea of bio bricks that, using code strung together, we can create in many ways new forms of life or new functionalities for existing life. And that really is going to blow open the realm of possibility for us. And just one point that's connected to this is that we tend to think of the passage of time based on our historical experience. Like one week of time, you kind of have a sense of what that is because you had a last week, and that was one week. And next week it will feel like it's one week. But because so much of this technology is on an exponential J curve, it's getting. The rate of change is getting faster and faster. So just your sense of how long it's going to take for something really revolutionary to happen will be too conservative if you're looking in the rear view mirror, because this change is coming in many cases, so much faster than people are prepared for.

Wow. And does that then segue into. You talk about. In your chapter on stealing immortality, you talk about NAD and metformin. And I know there's a lot of research into that. I just read a snippet about metformin being used with diabetic patients in the context of maintaining weight loss. And yeah, some people are talking about, you know, like, you know, again, just better health style, lifestyle, health span kinds of things.

Yep.

Can you speak to that in the. In the context with your book as well?

Sure, yeah. Yeah. So right now, anybody who wants to live a long and healthy life, you should essentially just do what they do in the famous blue zones, the parts of the world where people live longer on average than other places. Everybody knows what they are. You eat healthy, you exercise, you have a meaningful life, social connections and things like that. If you do all of those things, the longest you can possibly imagine living is 122 years, because that will make you the tide for the longest person who's ever lived in recorded history. But some of us are greedy. Some of us want more. Some of us believe that if we had, I certainly believe this, if that if we had more old people around with all the wisdom that they've accrued over their lives, the world would be such a so much of a better place. And so for that, if we want that, and I certainly do, then the question is, well, what are the types of interventions? And there are lots of drugs of small molecules that people are experimenting with, and I use the word experimenting purposefully, that are shown to extend healthy lifespan in model organisms. And so some of those include the nad, NAD boosters like NMN and nr, metformin, rapamycin. So that's certainly one class of interventions. Then there are people who are pruning senescent cells, and those are cells that are causing inflammation in the cells. And that's connected to one theory of aging. And then there are things that are going to happen in the medium term. There are people who are experimenting with what's called parabiosis, which it's kind of gruesome, but you basically cut open an old and a young mouse and stitch them together. And in effect, the old mouse gets biologically younger and the young mouse gets biologically older, which leads people to think there's some kind of magic in plasma, in blood. And then as we unlock the secrets of the genome and do the genetic analysis, which is already happening of these superagers, people who live healthy well into their hundreds, we're going to be able to identify what are genetic patterns associated with living a healthier, longer life. And then we'll be able to use that information either in selecting embryos, in IVF and embryo screening, or in developing small molecules and other interventions that will mimic what those genes are doing, the genes that these superagers have. So the idea that kind of the core issue, the core point of all of this, is that we think of biology as fixed, but biology is extremely variable. And we know this intuitively because somehow we evolved from single cell organisms into what we are today. And we can see the incredible diversity of all of life on earth starting from that same point, 3.8 billion years ago. So there's a lot of play in biology, way more than I think most of us appreciate.

You also, you just mentioned earlier in this conversation and also in the book around the transhumanist movement. And in the book, you cite Nietzsche in the Ubermensch or Superman, Uberman kind of thing for folks that aren't. And I don't know that I'm super aware of exactly what transhumanists are into and what the controversy is around that.

Yeah, yeah. So I'm in. I'm doing this interview from San Francisco right now, which is one of the epicenters of the transhumanist movement. So transhumanists are essentially people who think that we should apply technology, the technology that we have to enhance our biology, and whether that is through extending our lives, if you. Extending our capabilities. The transhumanists are futurists who believe that we should be pushing forward as aggressively as possible in that direction. Many of them feel that there shouldn't be any significant restrictions on what people can experiment, how people can experiment on themselves, perhaps on their children. And it started out as a fringe movement. I wouldn't say it's mainstream, but it's certainly far more popular than it's been in the past. So I talked earlier. It's one end of the spectrum. On one end are the transhumanists who tend to say kind of all systems go. And on the other hand, there are the conservatives who say this is playing God, we shouldn't be involved at all. And those are the bookends. In my view, neither of those is a viable response because we have such an incredible opportunity to do wonderful things that we all want and should want. We should all want to have healthier lives. We should all want, not want young kids to die of terrible diseases, but we're talking about the future of life and it must be regulated. This can't be just anything goes.

That's great. And you have been very generous because I know you are on quite the schedule. So it's a good thing you're an endurance athlete.

Yeah, exactly.

Last couple of things as we wind up, you've mentioned throughout our conversation today, I think a very important point, and you end your book on the same very important point about having, I think you say in the book, like every country, develop its own national public education program and open dialogues and everybody has a seat at the table, PhD or not, all perspectives, all opinions are valued and weighed. And I think I read separately that you were also congratulations Appointed to the World Health Organization's expert Advisory Committee for developing global standards for governance and oversight of human genome editing. And I think, if memory serves, did you all have a meeting in March? Was that the.

Yes. So we had our. It wasn't in, you know, I get my months. It was, maybe it was March, but yes, I was certainly very honored to be appointed to the WHO committee.

Fitting man.

Yes. Yes. Yeah. And what we're trying to do is to say, well, how do we think about what a global regulatory environment might look like? And this job is so absolutely enormous and it's bigger than what our committee or even the World Health Organization can do, even though we are really working hard. And it's a very important job I'm proud of. But that's why in the book and in life, I'm calling for something bigger. And this is my mission in my life these days. Is that what I am calling for and trying to launch is a species wide dialogue on the future of human genetic engineering. Which sounds like a crazy thing, but we've never been more literate as a species. We've never been more connected. And we have an opportunity at the beginning of this revolution that's going to transform so much of life on Earth. We have an opportunity to have a global and inclusive conversation about what's at stake and what are the values that we want to weave into our decision making. And the goal in my view is we have this species wide dialogue. In the book, I outline a structure of how it can be organized and that leads to emerging global norms that can then underpin some kinds of global regulations. And it will never be perfect. It will always have to be dynamic because the technology will change, the capabilities will change and our culture will change. Things that feel very frightening to people now will become absolutely normal in the future. And we don't want to lock ourselves in to this moment. At the same time, we need to have a structured process to bring us together and explore how the values, which is really the most important issue, how our best values can be woven in to every part of our decision making process.

Wow, that's great. Well, I really, again, I want to thank you for your time today, Jamie and I. So encourage the listeners to get a copy of your book and take a look at it. It's so engaging, it's hard to put down, honestly.

And it tries to be a little funny. I have jokes in there, so in case, in case you want a little levity.

You are very transparent right off the bat and so I appreciate that. So That'll be a little teaser to get people, to get people into it. And the other cool thing about your book is that you, as you have in this, in our conversation, is to encourage people. And I do the same for folks listening to join in the conversation. And you kind of put your technology where your mouth is with that because you created a forum@hackingdarwin.com we'll put this in the show notes too, where people can come in and share their views and engage with others. Right. I mean, it's, it's absolutely.

And as I really encourage people and this is who I want people to say, this is your conversation. And some people are afraid and some people think, well, maybe I don't know enough. And what I'm telling you is you do enough. And if you need enough information to enter the conversation, my book is designed to give you what you need. But at the end of the day, everybody who's listening, you are a human and you are an equal stakeholder. And so I certainly encourage people to go to the Hacking Darwin site. I've been talking to people at UNESCO. I think that we should be doing something much bigger and much more global. And we all need to be part of this conversation because this is a conversation about us and it's about our future and it's imminent. And this isn't far off sci fi. This is something that is going to touch every person's life in a very deep and intimate way.

That's fantastic. So we've got the hackingdaroin.com and then are there other ways for folks that are interested in learning more about your work or follow you or learn more? I see you on CNN all the time. It's open up any quality newspaper. You'll have an op ed in it.

So I'm trying to spread the word. So there's the hackingdarwin.com site, there's my jamiemetzel.com site. And all of my content is on there. I have a newsletter that on the JamieMetzl.com site, people can sign up for my newsletter. And at the end of the Hacking Darwin book and on the Hacking Darwin site, I have a reading list for people. There's some really some wonderful books that I highly recommend. And so if you're going to read one book, I have my preferences, but I think read four books, read five books and join this conversation. There's lots of great ways to do it. And listening to your podcast.

Well, thank you, thank you. I appreciate that. I think yours is a great distillation of that It's a good primer. It's a good. It's not Cliff Notes. It's because it's so broad and detailed, like I said earlier, but it's just a fantastic work. So, Jamie, thank you for your book. Thank you for being so generous with your time today and come back on the show and good luck with the rest of the book tour and I will be in touch soon. Good to talk to you, my friend.

Wonderful. Thanks so much, Chris.

Thank you. Living a Life in Full is a production of Stout Media, a subsidiary of Gordian Knot, LLC. Assistant Producer Gracie Wong Music Dan O' Brien Executive Producer and Host, Dr. Chris Stout to learn more, stop by our website at Life in Full for show notes and please recommend us to your friends and subscribe on your favorite platform. And as for the obligatory disclaimer, this podcast is for general information uses only and does not constitute the practice of psychology, medicine, nutrition or other professional health care services, including the giving of medical or psychological advice. No doctor patient relationship is formed. Lastly, and perhaps most importantly, I take conflicts of interest seriously. For all of my disclosures as well as show notes, please see livingalifeinfull.org podcast and my LinkedIn profile. Thanks. And until next time,