Andrew M. Subica is with the Department of Social Medicine, Population, and Public Health, University of California, Riverside School of Medicine.
Am J Public Health. 2023 Aug;113(8):874-882. doi: 10.2105/AJPH.2023.307315. Epub 2023 May 18.
CRISPR (clustered regularly interspaced short palindromic repeats) is a Nobel Prize-winning technology that holds significant promise for revolutionizing the prevention and treatment of human disease through gene editing. However, CRISPR's public health implications remain relatively uncertain and underdiscussed because (1) targeting genetic factors alone will have limited influence on population health, and (2) minority populations (racial/ethnic, sexual and gender)-who bear the nation's greatest health burdens-historically suffer unequal benefits from emerging health care innovations and tools. This article introduces CRISPR and its potential public health benefits (e.g., improving virus surveillance, curing genetic diseases that pose public health problems such as sickle cell anemia) while outlining several major ethical and practical threats to health equity. This includes minorities' grave underrepresentation in genomics research, which may lead to less effective and accepted CRISPR tools and therapies for these groups, and their anticipated unequal access to these tools and therapies in health care. Informed by the principles of fairness, justice, and equitable access, ensuring gene editing promotes rather than diminishes health equity will require the meaningful centering and engagement of minority patients and populations in gene-editing research using community-based participatory research approaches. ( 2023;113(8):874-882. https://doi.org/10.2105/AJPH.2023.307315).
CRISPR(成簇规律间隔短回文重复序列)是一项获得诺贝尔奖的技术,通过基因编辑,有望彻底改变人类疾病的预防和治疗方式。然而,CRISPR 的公共卫生影响仍然相对不确定且讨论不足,原因有二:(1)仅针对遗传因素将对人口健康产生有限的影响;(2)少数群体(种族/民族、性和性别)——承担着国家最大的健康负担——在历史上从新兴的医疗保健创新和工具中获得的不平等利益。本文介绍了 CRISPR 及其潜在的公共卫生益处(例如,改善病毒监测、治愈对公共健康构成威胁的遗传疾病,如镰状细胞贫血),同时概述了对健康公平的几个主要伦理和实际威胁。这包括少数群体在基因组学研究中的严重代表性不足,这可能导致这些群体的 CRISPR 工具和疗法效果较差且不受欢迎,以及他们在医疗保健中对这些工具和疗法的预期不平等获取。为了确保基因编辑促进而不是削弱健康公平,需要以公平、正义和公平获取为原则,以社区为基础的参与式研究方法,让少数群体患者和人群切实参与基因编辑研究。(2023;113(8):874-882. https://doi.org/10.2105/AJPH.2023.307315)。