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The ‘circle of trust’ behind the world’s first gene-edited babies (sciencemag.org)
54 points by sohkamyung 56 days ago | hide | past | web | favorite | 70 comments



Is there any news on whether or not it worked?

I read the article (albeit quickly as I'm on lunch break), but I can't find anything reporting on whether or not the experiment resulted in healthy children, or if they are immune to HIV (if that can be tested without infecting them, of course - I don't know anything about immunity detection either).


There is, for now, little to no news as to what has happened to the babies.

For reporting on the experiment itself, see one of the linked articles [1] which does not end on a hopeful note:

> [T]he editing of CCR5 in Lulu and Nana could have no detectable consequences at all. With no one providing updates on the health of the children, that outcome, perhaps the most likely one, may never be headline news.

[1] https://www.sciencemag.org/news/2019/08/did-crispr-help-or-h...


It "worked" is binary and that doesn't exist in medicine. The people who have the naturally occurring deletion 32 CCR5 mutation aren't immune. they have decreased risk of infection. There are safe and approved medicines that can greatly reduce the risk of transmission whether given before or shortly after exposure. Unconsented Germ line genetic modification of humans cannot justified, at very least for this use case.


>Unconsented Germ line genetic modification of humans cannot justified

How are you going to get consent from a human that isn't even conceived yet?


I don't believe that speaking of "future consent" of a "potential person" is useful. A child was never asked if he or she wanted to be born. After birth, parents essentially own their children until majority.

Parents make many, many decisions that will shape their child's future. Maybe editing an embryo is just one more. How is that different than choosing to feed your baby formula, put them in front of a TV all day, or drinking/smoking while pregnant (neither of which is illegal)?

This is the essence of the law: figuring out what happens when various rights intersect. I don't think there are right answers here but I think we need to generate some precedent in this area, and quick.


Well, I think most people would look poorly on (say) signing a deal with the Mob eight months before birth to steal your child from the hospital and sell them into slavery. Another argument that gets bandied about is how we shouldn't pollute the planet and ruin Earth for our presently nonexistent grand-children. Another example of worrying about the life of non-existent children is when people start saving early for a college fund.

I'm not sure about the exact philosophical mechanics required to transfer rights from the future to the present (or however you want to phrase it) but parents should not be drinking during pregnancy; and it's for their future child's sake that they shouldn't.

Foolishly subjecting your child to an unproven genetic therapy could ruin their future to an extent closer to the mob example than the TV example.


But what if ruining the future is not the outcome? If the therapy is beneficial, or even more so, required for the child to survive?

Not editing in this case could be construed as future child abuse or even murder.

As a note, chances of a child given the therapy, if it's randomly working, are no different than general population, most likely. And if they're better, there goes this argument.

Fearing known unknowns more than unknown unknowns is not logical. Of course people do it all the time. Why does nature get to play the dice but we cannot?


>As a note, chances of a child given the therapy, if it's randomly working, are no different than general population, most likely.

That's not true - the average gene is more likely to be working than not, and the average mutation is more likely to break something, if it changes anything, than not.


Exactly! I don’t see how anyone can justify permanently altering a human life like this, in the absence of a clear pathology.

Wouldn’t it be better to simply not have a child?


Easily. If it is an improvement with low chances of failure and even lower of catastrophic failure, why leave all the failures to nature?

Not having, say, HIV resistance could be considered a failure of nature, a deficit.

We're not talking about frivolous modifications for no reason here.


If one views the genetic material as belonging to the parent until conception, one simply needs to get the consent of the parent. If one views the fetus as part of the mother until some stage of conception, it is even simpler to justify.

You might as well be asking when did any two parents get consent to produce their child with the specific DNA that child has (say in a situation where both parents are at risk to genetic defects).


>If one views the fetus as part of the mother until some stage of conception, it is even simpler to justify.

Many people only believe that one until you use it to justify things other than abortion. For example the mother can get weird permanent cosmetic body modifications done to her (like, I don't know, getting a finger taken off), but the popular support would probably not be in favor of allowing the mother to get them done to her child in the womb. The best way I can explain what the popular opinion seems to be is as non-existence being neutral, as opposed to unnecessarily messed-up existence which is seen as bad.

This doesn't square with utilitarianism where the difference between 0 and 5 is the same as the difference between -5 and 0, but then again it's not like most people's opinions square with utilitarianism.


That is sort of his point, whether you agree or not.


I wonder if 23andme shows CCR5. Or is there anyway to check from 23andme data if we've decreased risk of catching HIV.


Yes, it does. Alongside other similar variants, like the FUT2 mutation that prevents norovirus.


I never saw this, on what screen can we find it? Do you've any screenshot or navigation URL?


Looks like they took that part out after the FDA told them to. You you still download your genome and look that part up yourself from them, though. Possibly by using something like Prometease.


What decisions would you be making that are impacted by that information?


Only serves curiousity, won't be basis for participating in any risky activity.


I'm not sure that the mutation conferred actually proves to be beneficial, even if it took place without any offsite modifications. It is associated with a fairly large increase in mortality.

https://www.sciencedaily.com/releases/2019/06/190603124709.h...


Maybe it is possible to take skin cells and infect them in a laboratory.


HIV infects White blood cells. it won't infect skin cells. Its trivial to draw blood and infect them in the laboratory, but that isn't an interesting experiment. His poorly executed (and unethical) experiment was attempted to be based on the established knowledge that there is a subset of people that have a CCR5 mutation that confers some resistance to HIV infections. That is established and wasn't an experiment that needed to be done on humans.


And why is modifying a human unethical, or more so than modifying any other animal which we do all the time?

Technically, there should've been phase 1 trials. How do you propose to do that otherwise with genetic modification of germline cells otherwise?

Someone will have to be risked, like with any unproven treatments.

Either you can ban human modification on shaky grounds (not really ethics), or you will have to take that risk to just see if modification can take. There is no third way, no amount of animal studies proves the technique works in humans.

You could test it on embryos, but then you have to either kill them or are back in the same place. And it does not provide complete information - only about relatively early development.


"That circle included leading scientists—among them a Nobel laureate—in China and the United States, business executives, an entrepreneur connected to venture capitalists, authors of the NASEM report, a controversial U.S. IVF specialist who discussed opening a gene-editing clinic with He, and at least one Chinese politician. "He had an awful lot of company to be called a ‘rogue,’" says geneticist George Church, a CRISPR pioneer at Harvard University who was not in the circle of trust and is one of the few scientists to defend at least some aspects of He's experiment."

"an entrepreneur connected to venture capitalists" made me chuckle.


Holy cow. Jeffrey Epstein funded George Church, which is also on the front page right now: https://www.buzzfeednews.com/article/peteraldhous/jeffrey-ep...

These tentacles are all over the place.


Epstein himself also was interested in eugenics for this purpose.

It's incredibly chilling.


"He had an awful lot of company to be called a ‘rogue,’" says geneticist George Church

Was Church referring to He or Epstein as a rogue? /s


It's only matter of time before gene-editing becomes commonplace. March of progress can't be stopped. He Jiankui will eventually be vindicated and possibly lauded as visionary and pioneer.


Gene editing humans was not per se the problem. The huge issue was that it's not obvious that this gene would in fact not cause other issues to these people, and the fact that it was done at a later stage in fetal development, causing possibly some of the cells not having the same genetic code as the rest. This is reckless and stupid, apart from the whole experimenting on humans thing.

Someone who jumped off a cliff while trying to build an airplane, was not lauded as a visionary, but as a splat on the ground.


Why is it stupid or reckless?

In fact, this is a good way to mitigate risk. Most genes in mosaicism, even if parts of the mosaic is faulty, continue to function or partially function.

Would you rather risk complete failure? (Potentially killing the fetus or embryo.)

Also, someone has to take those (potentially reduced) risks if germ line modifications are needed.


As we are now living in a "reality show" world, maybe. But if such decision is based on scientific, ethical, and clinical rational, that is very unlikely. The details of his work were sloppy and unethical including, (not exhaustive): He generated mutations in CCR5 that are uncharacterized. That is he didn't even use the 'delta 32' mutation observed in the gene pool). Beyond that, there is not solid rational that the kids are at risk for HIV transmission sufficiently to justify any procedure, let alone an unconsented, germ-line genetic modification. The physicians that ran the Tuskegee Studies thought they would be lauded. That hasn't happened and won't.


You're confusing a work of one scientist and the whole field. Gene edited babies are inevitable, as soon as we start seeing massive benefits (lack of genetic disease, increases IQ, increased speed, increased muscle mass, improved cardiovascular and immune systems).

Parents already spend ridiculous money for the tiniest benefits for their kids. Genetic editing will be huge.


I saw the parent's comment more countering the grandparent's assertion that He Jiankui will be lauded. He will not.

He may go down in history, but he will appear in the ethics chapter alongside Dr. Rascher and will not be lauded.


Biology is complicated and there are always unintended consequences even with simple drugs or other procedures. you've listed outcomes, but not how to get there. do we increase muscle mass by overexposing growth hormone? in which exact cells and how do we time it? Do we increase IQ by increasing Nerve growth factor or some synaptic channels? What if the wrong cells are expressing them at the wrong time? We barely understand what many of these factors do on a cell to cell level. chasing the things you list WILL come with toxicities and/or a failure rates. Perhaps in 'patients' whom we will have to look in the eyes and explain why we did what we did. Maybe we will get where you suggest but it won't be a straight road there.


You're asking specifics of how it will be done, and we don't know it yet. It will be done, because we do know these variations do exist.

I don't see how a targeted genetic alteration is any worse than the millions of random ones that you get though regular fertilization.

As for looking in the eyes, well, progress always has victims. If you don't want to do it, then don't do it. Some other parents will.


I think this is fairly shortsighted. While I do think that germline gene modification will probably become routine, He specifically was a serious doofus who shat the bed for this area- he made a collection of poor decisions that would easily have been caught in hindsight, ignored multiple suggestions to improve his plans, ignored multiple suggestions to not proceed, and then managed to make a change that probably didn't achieve what he intended. Getting all those things wrong mean he's not going to be considered a visionary or pioneer.


What prevents us from using traditional selective breeding on humans? Why can't women just go to a sperm bank and buy premium DNA?


I believe the term you're looking for is Eugenics. If you google it for some background, it has been tried before and uh, didn't end out so well.


only thing that actually speaks against it is being associated with [godwin's law]. As far as everyone involved is consenting this shouldn't be an issue.


Trying to make better babies through breeding / genetics feeds right into the white supremacy narrative however. It is a really slippery slope, one I'd rather we not try again.

Will we inevitably have "designer" babies at some point in the future morals / legality be damned? Probably so. Is this a good thing? Not necessarily.

The area I can see it being acceptable is fixing congenital defects or genetic abnormalities. "We've made your fetus 10x less likely to develop vascular disease or we've prevented cyctic fibrosis in your baby" vs "We made super strong soldiers who don't feel pain".


> Trying to make better babies through breeding / genetics feeds right into the white supremacy narrative however. It is a really slippery slope, one I'd rather we not try again.

So.. we'll make them non-white, and sidestep that issue? I mostly kid. Yet, it's a shame that even a fairly tame discussion about selecting sperm based on DNA has to be dragged through the mud with racism and godwin-eugenics.

At some point humanity needs to stop being so anti-racist-racist. I'm not saying I don't understand where you come from, I just long for the day when we can discuss DNA selection without someone bringing up skin color.


It's not just skin color, though. It's height. It's face structure. It's the fact that some Sneeches have stars while others are without thars. It's a natural diversity of _everything_. Yes some aspects of that diversity are devastating congenital issues, but IMO we're not ready — socially or technically — for such power to be safely applied through gene editing.


I agree that we're in over our heads; but your comment makes it sound like I should be concerned with accidentally wiping out square jaw or blond hair people for moral reasons. I am not.

In the same way that I don't care about skin color; I also don't care about features continuing to exist and be diverse.

As mentioned, I recognize that we're in over our heads technically. I respect that if we were to "wipe something out" it very likely could end up a huge negative to humanity, due to unknown genes and etc.

However the discussion largely took a moral twist when racism/etc got brought up, and frankly I just don't care. I'm not one for history; so the moral implication of not having a physical-feature-group of humanity around, be it freckles, blue eyes, brown hair, light skinned, tall people or whatever, is entirely lost on me.

Humanity from my perspective seems far worse off having cared so much about our differences that I see little reason to be morally concerned about their absence. I imagine we would be better off for it, since we clearly fail with diversity now, it's not buying us any favors.

Likewise, with or without diversity, we will still certainly find reasons to hate each other. The conversation will just change. We're good at hate.


> I'm not one for history; so the moral implication of not having a physical-feature-group of humanity around, be it freckles, blue eyes, brown hair, light skinned, tall people or whatever, is entirely lost on me.

It might be worth reconsidering that viewpoint. As you say, we're good at hate. We've been good at it, too.

We've seen that something as simple as preferring male children to female children has dramatic societal consequences. It might be reasonable to decide you want to bias your child against being left-handed — lefties do have higher rates of accidents due to using right-handed tools after all. What might the societal shifts be as a result? Might we effectively loose some diversity of _thought_ and progress in our society at large? How might remaining lefties be perceived?


The bigger question I think is would it increase hate? This is not something easily measured, imo.

But if we're that worried about even something as minor as lefties, should we not release products either? How are people on phones all the time perceived? If I release a tanning product, should I be concerned about how tanning users are perceived? If I engineer kids with longer hair, am I concerned how they are perceived?

I think we run the risk of anything being hate-able, and thus nothing matters in that regard. Or at least, roughly speaking. Any big change has potentially huge and unknown societal consequences. I mean hell, people were freaking out about a McDonalds McNugget sauce a year ago over a TV Show. I'm not sure the worst of humanity is what we need to nix life saving medical procedures over.


This so much is literally my point ^


I'd be curious what your thoughts are on my reply to that point: https://news.ycombinator.com/item?id=20812273


Given the current situation (here in the US at least) where white supremacy is very much on the rise, I feel it is very important to politely discuss, so we don't repeat the past.

Just because I'm a privileged cis white male doesn't mean I think it is easy for everyone else.


It would be interesting to start a eugenics-esque program, but focus on DNA superiority combined within equal races mixed in. Ie, fully embrace "melting pot".

It's of course a silly dream to promote all skin colors equally. While I'd like it, it would immediately cause problems with the people who prioritize skin color over all else.

It's such a tiring state of the world.


> but focus on DNA superiority combined within equal races mixed in

“Superiority” is always subjective; the fact that the phenotype you are maximizing doesn't happen to be the same ideal sought by white supremacists doesn't really make a difference to the ethics of such a eugenics program (the steps you are taking to advance it might be a legitimate differentiator, but the purpose would not.)


Is superiority subjective? We have hundreds of fatal flaws in our genetics. Would someone defend that those are superior? I'm not talking about subjective traits like hair. I'm talking about scientific markers of health, disease, retardation, death.

Not advancing this technology because of how it could be used seems awkward, like not making medicine because it could save bad people. Cutting our nose off to spite our face.


> Is superiority subjective?

Pretty much by definition.

> We have hundreds of fatal flaws in our genetics.

Pretty much by definition, we (living humans) have no necessarily-fatal flaws in our genetics. We may have some that are fatal when they combine in certain ways or in certain circumstances, but the fatal effects in those conditions aren't the only effects they have.


I'm a bit lost. I get that genetics are not typically isolated to "just one bad thing", but I feel like you're dodging the point.

To say that say a trait we only know to be a significant marker to mental retardation isn't inferior, due to moral reasons seems in bad faith.

I am very accepting that technically (as I mentioned in other posts) we are in over our heads, and are likely to make mistakes. Frankly, these are games we don't have the understanding to be playing. However that is not what we're discussing here.

What we're discussing is whether or not we can morally proceed with any type of engineering. As if doing so would without fail become "lets make black people more dumb, because we don't like them" or w/e. This seems poorly thought out to me.

If I view engineering as yet another medical tool, then lets look at the existing medical tools. Could I not make pills that selectively hurt specific groups more than others? Yes. So while the stakes are likely higher with genetic engineering, I'm arguing that I don't think we should, or even can, be making scientific medical decisions based on wishy washy what-ifs and moral gut feelings of right and wrong.

Lets focus on saving lives.


> To say that say a trait we only know to be a significant marker to mental retardation isn't inferior, due to moral reasons seems in bad faith

(1) traits aren't markers: mental retardation is a trait, some Gene may be a marker.

(2) I'm not saying that anything “isn’t inferior, due to moral reasons”. On the other hand, I'm saying that any designation of “inferiority” is (not restricted to genes, but ever, anywhere) a subjective value judgement. And that because of the complexities at play in genetics, people will quite vehemently disagree on judgements about which genes are inferior and should be eradicated, both because they will disagree about which traits should be eradicated and because very often the relationship between traits and genes is complex.

> What we're discussing is whether or not we can morally proceed with any type of engineering.

Sure, that's part of the discussion, and I'm saying, on that question, if it is morally permissible and Nazi eugenics is not, it because you are making tools available that people can choose to use the same way they choose partners potentially for genetic reasons, not imposing their use top-down on society and culling “undesirables.” And not because “the traits we've decided to eliminate are really bad, and those we've decided to promote are really good, unlike the Nazis who made dubious decisions as to the targeting of their eugenics program.”

> As if doing so would without fail become "lets make black people more dumb, because we don't like them"

Are you guaranteeing that all the resulting technology will be freely available to all? Because even if we except that the techniques themselves will be “good” in individual application, that's literally exactly what they should be expected to become except not for the “because we don't like them” reason, but instead for the “because their poor” reason.


> (1) traits aren't markers: mental retardation is a trait, some Gene may be a marker.

Ah, I should be clear I was trying to use vague terms. Any overlap with real terms is coincidence, and not intended. Just for clarification :)

> I'm not saying that anything “isn’t inferior, due to moral reasons”. On the other hand, I'm saying that any designation of “inferiority” is (not restricted to genes, but ever, anywhere) a subjective value judgement. And that because of the complexities at play in genetics, people will quite vehemently disagree on judgements about which genes are inferior and should be eradicated, both because they will disagree about which traits should be eradicated and because very often the relationship between traits and genes is complex.

I agree. Yet, isn't that the case with all medicine? Hell, much of the deaf community wants to stay deaf - should we stop working on hearing impairment to placate one group that likes a thing? This seems like backwards development to me.

> not imposing their use top-down on society and culling “undesirables.”

Oh, I'm not sure where I gave the impression that I wanted to cull society. Nothing I said was intended to be forced. Well, beyond the obvious forcing in that the baby has no say in the matter lol.

I wouldn't advocate for culling in the same way I'm not advocating we forcibly implant deaf people with hearing implants. In my view, that's not a reasonable discussion. You can argue against it if you like, but I'm not the counterpart for that argument haha :)

> Are you guaranteeing that all the resulting technology will be freely available to all?

Nope, definitely not. In the same way medicine is hugely corrupt and not available to all, currently. However just because there are society based problems in distribution of advancement is not an argument to avoid advancement, imo.

If so, we should throw modern medical science out the window. Millions, hell billions of people are unable to get even "old" treatment, let alone modern or bleeding edge treatment. I don't believe that invalidates the usefulness of said advancements, though. It's just a different problem entirely.


Confused. This happens all the time. Sperm banks. They don't hand out random stuff. There's a rigorous screening and selection process.


I'm not at all convinced that sperm banks have procedures that are in any sense "rigorous." For example, there's a Dutch man who fathered 200 children through a sperm bank.

https://www.theguardian.com/science/2018/nov/24/sperm-donor-...


Well, they purported to be. Questionaires to select donors; catalogs for the recipients to peruse and choose.

In many banks other than the strawman provided, it meant that 'eugenics' was alive and well most places.


Not really a strawman. In reality, sperm banks are not regulated closely at all. Most of the laws have to do with parental rights, not "quality control." Even self-regulation is just that and nothing more.

The idea that people choosing donors from a catalog amounts to eugenics assumes that the people choosing the donor (in the case of anonymous donors, which is only a portion of all artificially inseminated children) have some rigor in choosing; i.e., that marketing doesn't influence them somehow. Most of the supposed rigorous screening is nothing more than checking boxes for physical characteristics such as height and eye color, education level attained, and family history of certain diseases.

There have been quite a few sperm bank scandals, including one where the proprietor of the sperm bank used his own seed even though he told his cutomers they were selecting someone else's from a catalog. The Dutch case is notable because it violates one of the recommendations (no law in the U.S.) that limit a donor to 25 births per 800,000 population. [0] But it is certainly not the only case.

[0] "The closest thing to a regulatory body overseeing sperm donation throughout the U.S. is a nonprofit called the American Society of Reproductive Medicine. The ASRM has a set of recommendations that physicians, fertility specialists, and sperm banks are encouraged to follow."

"The ASRM also recommends setting a limit of 25 births per donor within a population of 800,000, in order to lower the risk of accidental incestuous relations. In many other countries, there are laws putting caps on the number of births per single donor within populations of a certain size, but the U.S. doesn’t have any such law."

https://www.theatlantic.com/family/archive/2018/07/sperm-don...


> What prevents us from using traditional selective breeding on humans?

Much human breeding is traditional selective breeding (whether using sperm/egg donors or more ancient methods, pairings are often selected based in part on the expected genetically-determined qualities of any offspring), but it's just not a program maintained over many generations with consistent selection criteria, outside of conspiracy theories and science fiction (e.g., Heinlein’s Howard Families.)

Shorter term (usually not by intent) eugenics programs have been tried, and they are usually moral disasters tied to movements that are rapidly (sometimes violently) rejected, or at least the eugenics portion of the program is abandoned before long.


>Why can't women just go to a sperm bank and buy premium DNA?

They can. High end sperm banks that do thorough background checks and create profiles on donors already exist.


What is a premium DNA?


Presumably sperm from a donor that had desirable traits.


[flagged]


>What prevents us from using traditional selective breeding on humans?

It's happening, just that we do not acknowledge it. People are always selecting for the traits they see as favourable either consciously or subconsciously. Women do not date me because I look scary (as terrorist as some woman put succinctly) it means they are selecting for man who look less scary. Some women also told me that I do not respect women, so they are selecting for men who respect women. I am cool with that because I also select for a woman who is comfortable with me without I changing myself completely.


It goes the other way in countries where matches are based on sexual attraction. Families decay when bright, successful men choose women for their beauty.

In societies where matchmaking is done by parents or by recognized matchmakers, the outcome is likely much better in terms of creating and maintaining high achieving strains.


Men select for youth, fertility, beauty and agreability.

Even in countries where there is arranged marriage, successful men are matched up with more beautiful women (but within equal cast and somewhat equal socio-economic status)

>Families decay when bright, successful men choose women for their beauty.

I don't follow how family decays when beauty is selected. Women can be beautiful and successful at the same time.

>In societies where matchmaking is done by parents or by recognized matchmakers, the outcome is likely much better in terms of creating and maintaining high achieving strains.

It might lead to a stable family on average but it doesn't mean people in such setting are happy.

What I've observed is that countries were arranged marriage is common, women when they are young have lovers in college but they flush down their social media, dress more conservative when time for arrange marriage come, often they also take up a job for short duration to signal independence/education.

In west, where there is more freedom. Young women date handsome men but if such relationship doesn't last long, their priorities change and they look for financially stable average looking men, though if they are lucky they might also get handsome and financially well off man.

It's quite rare for a woman to marry a man who doesn't make as much money as her if not more.


Yes, but isn't it scary that at some point you can't stop that? I mean, all of the research is taken place 'somewhere out there' in the world and all we get is just a few articles that say it all was a super secret operation and no-one wants to speak about it openly. I have nothing against progress but will it still be one when it bursts and can't be controlled?


I look at it as a huge pile of obfuscated code. So yes, it's all there...


The article doesn’t seem to mention any of the risks of this type of procedure, only the potential benefit (possible immunity to AIDS)

Is this benefit worth what I assume is a massive risk of developing cancer?


Probably not cancer? Cancer is usually caused by a large enough number of mutations occurring in some cell over its lifetime that it starts reproducing uncontrollably. It's very bad in that a single bad cell can kill you but it takes a bunch of mutations to occur.

A typical child has 0-3 or so new mutations depending on chance, how old their parents are, etc. We might very well expect that if this treatment was badly targeted it would produce many more. Generally a random mutation won't hit anything that has an effect at all on a cell's operation. Fairly often a mutation occurs in an area that's critical to a cell's function and the fertalized egg never turns into a pregnancy. Rarely the embryo turns into a child which survives to birth but has some problem with missing some protein or other that you need. If this was, e.g., AMY1 which is used to digest starch and which you probably have a bunch of copies of if your ancestors were farmers no big deal. But if it hit Factor VIII then you've got hemophilia and that really sucks.

Only a small fraction of the genes in your body are involved in cancer and it's very unlikely that if you get a germline mutation that it will be one of these that it affects. Again, it's different as an adult because mutagens affect different genes in different cells and you only need the mutations to line up the right way once across essentially all the cells in your body to give you cancer. If one cell in your body gets Factor VIII knocked out then it doesn't matter, other cells can keep making the clotting factor you need and you'll be fine.




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