A Crack in Creation by Jennifer Doudna and Samuel Sternberg ⭐️⭐️⭐️⭐️

I don’t write very many book reviews.  When I do they are usually motivated by one of two reasons: the book is fabulous and compels me to become a book pimp, or the book got an abysmal rating from me that needed explaining.  Every now and again I write a review for a third reason: the book is important.  As in “if you are human you need to read this book.”  A Crack in Creation is that kind of a book and will likely be the most important 249 pages you read this year.  I highly recommend this work for book clubs that look for thought-provoking books that incite serious discussions.

Authors Jennifer A. Doudna and Samuel H. Sternberg give their readers a brief history of DNA, genetics, and gene editing followed by an explanation of their own breakthrough research with a biotechnology known as CRISPR/Cas9.  Building on the research of many of their predecessors, Dr. Doudna and her team made a discovery that vastly simplified the process of gene editing, allowing for cutting a DNA strand at a given sequence and replacing it with an alternate sequence.  While gene editing was possible before, it was complex and so costly that even some universities couldn’t afford to research it.  Using CRISPR/Cas9, scientists—and even hobbyists in their homes—are now able to target specific sequences of DNA, allowing for gene editing that can remove mutations that cause a variety of heritable diseases, add desirable characteristics, or edit out those that are less desirable.

The explanation of what exactly CRISPR/Cas9 is and how it functions is what cost the book a fifth star from me.  The authors struggled to pinpoint their target audience; for the average reader the explanation is rather dense, but for a fellow scientist it would be too simplistic.  If you are the average reader, my recommendation is to power through it even if you find yourself struggling to wrap your brain around the information.  Trust me, the back half of the book makes it well worth it.

Several reviews that I read of the book are critical of the authors, saying that they do not give credit to others who paved the way in the field of gene editing and don’t reveal their own commercial interests involving their technology.  I completely disagree.  The fact that the main researchers have founded biotechnology companies is openly discussed, and all throughout the book the authors lay out the chain of discovery that led them to their breakthrough, mentioning countless scientists whose research was invaluable to their success.  The authors even ponder the curious mix of collaboration and competition that exists in the field of biotechnology.  In the final chapters, they express their excitement or unease as they have watched where their fellow biochemists have taking their discovery.

CRISPR/Cas9 technology is changing the world as we know it, and the jury is still out as to whether it will be for good or for ill or some of both.  Dounda and Sternberg do a masterful job laying out the directions in which their fellow scientists are taking the technology and sketching for their readers the pros and cons of these different uses of the technology.  Their writing is organized, lucid, and thought-provoking.  Even if you struggle through the scientific descriptions earlier in the book, the back half makes it worth it with its presentation of the many sides of this complex issue.  One major concern expressed by the authors is that the technology isn’t 100% en pointe for targeting exactly where in a human’s genome to cut and zipper in the replacement code, which could prove catastrophic if rushed into human clinical trials.  There are also huge ethical considerations that need to be addressed.  As Dr. Doudna and her partner, Emmanuelle Charpentier, pursued their research, they hoped to pave the way to a method that could, on a cellular level, heal those stricken with devastating heritable illnesses.  Other uses such as improving crops, both in terms of yield and disease resistance, editing the human germline (editing heritable diseases out of a person’s DNA, ensuring they cannot pass on to descendants), recreating extinct species, and the eventual possibility of “made to order” babies are discussed.

Dr. Doudna is concerned about the ethics of many possible uses of CRISPR/Cas9, even those that might, on the surface, seem to have no apparent down side.  She addresses the issue in the book and talks about her efforts to engage fellow researchers, legislators, and the public in open discussion about the technology and how it should—or should not—be regulated.  Herein lies the reason that I feel this book is so important.  This technology has the potential to change the future of the human genome, agriculture, the environment, and animal biology, and the implications of that are enormous.  It is crucial that people have a thorough understanding of just what CRISPR/Cas9 makes possible so that they can fully grasp its impact on their lives and those of their descendants and make informed decisions as individuals and members of society.

For me, gene editing became very personal a couple of years ago when I was diagnosed with Ehlers Danlos Syndrome, a rare and inheritable disorder which causes a body to produce insufficient levels of collagen, which leads to serious connective tissue deficiencies.  There is no cure, no surgery, and no medication that can cure or treat EDS.  Currently, the location of the mutant gene that causes my illness is unknown, but my hope is that during the time it takes for CRISPR-Cas9 technology to become more target specific, researchers will locate where the EDS causing mutation is in the human genome.  CRISPR/Cas9 could ensure that my children, grandchildren, and further descendants do not have to endure the pain and medical issues that I live with every day.  Millions of people worldwide suffering from diseases such as sickle cell anemia, cystic fibrosis, Down’s Syndrome, and many, many others, could eventually be cured by this revolutionary discovery, but we need to ensure that the dark possibilities, such as a new brand of eugenics, don’t evolve alongside this bright future of biotechnology.