In this lesson, we will explore a revolutionary new medical technology called CRISPR. It allows scientists to "edit" our DNA, the very code of life. This technology has the potential to cure genetic diseases that were once considered untreatable. However, it also raises complex ethical questions about cost, access, and what it means to be human. We will discuss the recent approval of the first CRISPR-based therapy and debate the challenges of bringing this powerful tool to patients.
Hook: What Do We Value in Healthcare?
Think/Pair/Share
Before we begin, think about what is most important in healthcare. Rank the following four values from 1 (most important) to 4 (least important). Be ready to share your reasoning with a partner.
- Access: Everyone who needs treatment should be able to get it.
- Safety: Treatments must be proven to be safe and effective.
- Cost: Treatments should be affordable for the healthcare system.
- Consent: Patients must fully understand and agree to a treatment.
Now, listen to a short story from a patient with sickle cell disease.
Jasmine's Story
Transcript
My name is Jasmine, and I'm 28. Since I was a baby, I've lived with sickle cell disease. It's a genetic condition. It means my red blood cells are the wrong shape, and they get stuck. The pain, it's like a fire spreading through your body. Some days, I can't get out of bed. I've been hospitalized more times than I can count. I had to quit my dream job as a teacher. Now, doctors are talking about a new therapy, a one-time cure. They say my own cells could be collected, edited in a lab, and then returned to my body. It sounds like a miracle, but it's incredibly expensive, and the process is intense. It might not even work. For the first time, there's hope, but it feels a million miles away.
Anchor: A Medical Breakthrough
CRISPR technology can find, cut, and replace specific genes in our DNA.
In late 2023 and early 2024, health regulators in the U.S., U.K., Europe, and Canada approved the first-ever CRISPR-based gene therapy. It’s called CASGEVY (also known as exa-cel) and it's a revolutionary treatment for sickle cell disease and beta-thalassemia—two inherited blood disorders that affect millions worldwide.
This is a major breakthrough in medicine. However, the excitement is met with caution. The treatment process is complex and can be very difficult for patients. Furthermore, with a price tag of over $2 million USD per patient, its uptake has been slow. Hospitals and public health systems are now facing a difficult question: Who gets access to this life-changing, but incredibly expensive, cure?
Explainer Jigsaw: Understanding CRISPR
Instructions Group A Group B Group C
Instructions
Your teacher will divide you into three groups: A, B, and C. First, click on your assigned group tab and read your text carefully. Then, you will form new groups with one person from each of the original groups (one from A, one from B, and one from C). In your new groups, take turns teaching your peers about your topic.
What is CRISPR?
CRISPR is often described as a pair of "genetic scissors." It's a technology that allows scientists to find a specific part of a person's DNA, cut it out, and replace it. For a disease like sickle cell, the problem is caused by a single faulty gene. With CASGEVY, a patient's blood stem cells are removed from their body. In a laboratory, CRISPR technology is used to edit the faulty gene in these cells. The edited, healthy cells are then infused back into the patient. If the procedure is successful, these new cells will produce healthy red blood cells for the rest of the patient's life.
Global Approvals
Getting a new medical treatment approved is a long and careful process. CASGEVY was first approved in the United Kingdom in November 2023. A month later, on December 8, 2023, the U.S. Food and Drug Administration (FDA) also gave its approval for sickle cell patients. In early 2024, the European Union and Canada followed, expanding the approval to include beta-thalassemia as well. These approvals were celebrated as a historic moment. For a therapy to be approved, it must go through years of clinical trials to prove that it is both effective and safe for patients.
Costs and Risks
The biggest challenge for CRISPR therapies is the enormous cost. In the United States, the price for CASGEVY is $2.2 million per patient. This does not include the cost of the long hospital stay required for the treatment. Patients must first undergo chemotherapy, a difficult process that weakens their immune system. This is done to make space for the new, edited cells. Because their immune systems are weakened, patients are monitored very closely for infections and other side effects. There are also long-term risks that are not yet fully understood. This combination of high cost and medical risk is making many health systems hesitant to offer the therapy widely.
Vocabulary Check
| Breakthrough (n.) | An important discovery or development. |
| Uptake (n.) | The rate at which people start to use a new service or product. |
| Procedure (n.) | A medical operation. |
| Trials (n.) | Tests to discover if a new drug or treatment is safe and effective. |
| Hesitant (adj.) | Slow or unwilling to do something because of uncertainty. |
Ethics Jury: A Difficult Decision
Imagine you are on an ethics committee at a major public hospital. Your hospital has received a special one-time grant. You have enough money to provide CASGEVY therapy to exactly three patients this year. However, five patients are eligible and waiting.
In your group, take on one of the following roles. Read your role description and prepare your arguments. Your goal is to discuss the situation and decide on a fair way to proceed.
Role 1: The Patient Advocate. You represent the five patients who are waiting. You argue that cost should not be the main factor. These are people whose lives could be saved. The hospital has a moral duty to treat as many people as possible.
Role 2: The Clinician (Doctor). You are a doctor who treats these patients. You want what is best for them, but you are also realistic. You know the treatment is very demanding and has risks. You believe you should choose the patients who are strongest and have the best chance of a successful outcome.
Role 3: The Budget Officer. You manage the hospital's finances. You are concerned that this one treatment will use a huge amount of money that could help hundreds of other patients with different, less expensive needs. You think the hospital might need to consider other factors, like if a patient has a family to support or can contribute to society in the future.
Role 4: The Ethicist. Your job is to think about fairness and morality. You argue that choosing patients based on who is "strongest" or their "value to society" is discriminatory. You suggest that a lottery may be the only fair way to choose. You also believe patients should be fully informed about the uncertainty and risks.
Discussion Questions:
- What are the strongest arguments from each role?
- How should the hospital choose the three patients? Should it be based on medical need, age, chance (a lottery), or something else?
- Is it fair for a treatment to exist that only a few people can access?
Language Clinic: Sounding More Academic
When discussing complex topics, using precise language is important. Let's look at two grammar structures that can make your opinions sound more thoughtful and formal.
1. Modals for Probability and Advice
We use modals to show how certain we are (probability) or to give advice.
For advice: should / ought to
Simple opinion: "The hospital needs to inform patients."
Upgraded opinion: "The hospital should ensure patients are fully informed about the risks."
For possibility/probability: may / might / could
Simple prediction: "This therapy will cause problems for budgets."
Upgraded prediction: "This therapy might create significant budget challenges." or "A lottery may be the fairest solution."
2. Passive Voice for Processes
When the action is more important than who is doing it, we use the passive voice. This is common in scientific and medical contexts. The structure is Subject + be + past participle.
Active voice: "Doctors remove the patient's cells."
Passive voice: "The patient's cells are removed." (Focus on the cells and the process)
Active voice: "Scientists use CRISPR to edit the gene."
Passive voice: "CRISPR technology is used to edit the gene." (Focus on the technology)
Active voice: "Nurses will monitor the patients closely."
Passive voice: "The patients will be monitored closely." (Focus on the patients)
Exit Ticket: Your Final Thoughts
Reflection
Think about everything we have discussed today. In your head, formulate two sentences:
- One sentence explaining why public funding for CRISPR therapies is a good idea right now.
- One sentence explaining why we should be cautious about public funding for now.