Changing That One Piece.
The perils of depopulation.
“I can’t do my job without News Items.” — Jim Cramer, CNBC.
1. Jeff Coller:
When KJ Muldoon was born in the summer of 2024, his parents were told he had a disease so rare, it strikes about one in 1.3 million newborns. His condition, a severe deficiency of an enzyme known as CPS1, left his tiny body unable to properly break down protein, flooding his blood with toxins that could cause brain damage or death. A liver transplant could correct the problem, but KJ was too young and too fragile to undergo one. With each passing day, the risk of irreversible neurological damage grew.
What happened next may become the most important medical story of the decade. In just six months, a team at Children’s Hospital of Philadelphia and Penn Medicine designed a personalized therapy that could correct the single misspelled letter in KJ’s DNA using a gene editing technology known as CRISPR. To get the therapy inside KJ’s cells, doctors relied on the same kind of mRNA technology that powered the Covid-19 vaccines. He received his first dose at 6 months old. One year later, KJ is walking, talking and thriving at home with his family.
We call them rare diseases, but there is nothing rare about the suffering they cause. Some 25 million Americans, nearly one in 13, live with rare genetic diseases. More than half are children, many of whom will not live to see their fifth birthdays. Families spend years searching for accurate diagnoses, cycling through misdiagnoses and facing financial ruin and isolation. And even though the direct medical costs of rare diseases are estimated at $400 billion a year, rivaling those for cancer and Alzheimer’s disease, fewer than five percent of them have Food and Drug Administration-approved treatments.
Why so few? Because the economics of drug development work against small patient populations. When a disease affects only a few hundred or a few thousand people, it’s hard to put together a clinical trial, and there is usually insufficient return on investment. Rare disease, in aggregate, is one of the largest unmet medical needs on earth.
What makes this moment different is that the technology to do something about it finally exists. Recent advances in mRNA science and CRISPR gene editing mean that the approach that helped KJ could be used for other children. The technology can be reprogrammed for different diseases by inputting a short stretch of genetic code that tells the molecular machinery exactly where to make its correction. Build the system once, and you can redirect it to a new disease by changing that one piece. (Sources: bme.jhu.edu, nytimes.com. Italics mine.)
Can America continue to prosper, even if our country veers into an indefinite depopulation? The question is not as outlandish as you might think. For the first time in generations—since the Great Depression—the prospect of long-term population decline is again looming on the American horizon. Almost no serious consideration has yet been devoted to how well America might fare in the face of depopulation.
That inattention could prove costly, for it is possible that depopulation could come upon us with surprising—and stunning—speed: conceivably, even before a baby born this year enters high school. A switch from steady population growth to continuous population decline could mean wrenching changes for America, placing unfamiliar new pressures on public finances, businesses, communities, and families—indeed, on our entire national system.
To be blunt: America is not well positioned to pass the “stress test” that depopulation will unforgivingly impose. In fact, the US may actually be less prepared for an eventual depopulation today than it was a generation ago. Our country has developed a whole range of undesirable new habits—political, social, and economic—over the past several decades. With steady population growth, we have managed to “afford” these, to progress despite them. We cannot count on that luxury under depopulation. (Read the rest. Source: aei.org. Next week, Joe Klein and I will be interviewing Nick about this and other matters of demography for a podcast we’ll post a week from today.)
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