16 Leaders The Economist May 14th 2022
picture and in effect closed the door to fresh borrowing abroad.
Instead of admitting their errors, the Rajapaksas pretended
things were under control. They continued to defend the rupee
and service Sri Lanka’s external debts of 44% of gdp, even as for
eign reserves dwindled. A ban on imported fertiliser, to save dol
lars, was dressed up as a boost to organic farming—but had to be
scrapped when crop yields plunged, threatening a further de
cline in exports. The war in Ukraine was the final straw, pushing
up the prices of imported oil and food and prompting the gov
ernment to resort to rationing for lack of foreign exchange.
The Rajapaksas and the country are now out of options. The
government will have to slash spending and raise taxes, further
eroding Sri Lankans’ standard of living even as inflation bites.
The plunge in the rupee’s value will eventually boost tourism
and other exports, bringing some desperately needed dollars.
But Gota no longer has the credibility to negotiate with the imf
for fresh loans to tide over the country until that point, nor the
authority to impose painful austerity. Opposition politicians,
meanwhile, have no desire to take responsibility for a mess of
the Rajapaksas’ making or to associate themselves with the un
popular remedies to come. And no economic repairs are pos
sible while bands of arsonists roam the capital.
Put the country first
To calm the mobs and pave the way for a government of national
unity, Gota must go. But the opposition should put the people
before politics, too, and take some responsibility for extricating
Sri Lanka from its predicament. The outlook may be bleak, but
voters will reward the politicians who find a way out of the pre
sent impasse. It was by ending a seemingly endless war, after all,
that the Rajapaksasfirst won the popular devotion that they
have now betrayed.n
I
magine fora momentthatyourunbornchildhasa rarege
netic disorder. Not something at least vaguely familiar, such
as sicklecell anaemia or cystic fibrosis, but rather a condition
buried deep within the medical dictionary. Adrenoleukodys
trophy, maybe. Or EhlersDanlos syndrome.
Would you, when your child is born, want to know about it? If
effective treatments were available, you probably would. But if
not? If the outcome were fatal, would your interest in knowing
about it depend on whether your newborn had five years of life
to look forward to, or ten? Or 30?
Today these questions are mostly hypothetical. Precisely be
cause they are rare, such disorders are seldom noticed at birth.
They manifest themselves only gradually, and often with unpre
dictable severity. But that may soon change. Twenty years after
the first human genome was mapped, the price
of wholegenome sequencing has fallen to a
point where it could, in rich countries at least,
be offered routinely to newborns (see Science &
technology section). Parents will then have to
decide exactly how much they want to know.
Early diagnosis brings with it the possibility
of early treatment. Moreover, sequencing the
genomes of newborns could offer a lifetime of
returns. A patient’s genome may reveal which drugs will work
best in his or her particular case for conditions such as adhd,
depression and cancer. Combined with information about
someone’s way of life, it could highlight easily discounted
health risks such as cancers and cardiovascular disease, leading
to better preventive measures. A database of genomes, matched
to living people, would be a boon for medical research. The fruits
of that research, in turn, would make those genomes more use
ful to their owners as time goes on.
Sequencing children’s genomes at birth would also create op
portunities to develop treatments for rare conditions that are
typically discovered too late and in small numbers. There are
reckoned to be about 7,000 rare diseases in the world, affecting
400m people, and most are genetic. At the moment they are so
unusualastobeunattractivetargets forbig pharmaceutical
firms. With more and earlier diagnoses, that might change.
Such a powerful new technology creates new dangers. Wide
spread screening for thousands of potentially harmful genes
may be counterproductive: some results may worry parents un
necessarily, because some genetic variations, though occasion
ally indicative of disease, are not strongly so. Parents may not
want to unlock all the secrets that their newborn’s genome
might reveal. Some may indeed prefer not to know about condi
tions that cannot be treated. Adultonset illnesses pose a differ
ent dilemma—a reasonable position is that it should be up to the
children themselves, once grown, to decide whether they want
to look at their genomic information. A further concern is that
data will not be kept secure, and may be leaked or otherwise mis
used at some point in the future.
In Britain, where a large project to sequence
the genomes of newborn babies is planned to
start next year, a consultation process is already
grappling with these questions. Some of the
broad principles emerging may be applied to
similar projects in a number of other European
countries, and in America, Australia, China and
Qatar. One lesson is to start conservatively. The
British project is likely to begin with a small number of extreme
ly reliable tests that will improve the way children are treated.
This ensures the testing is for the benefit of the child. Tests that
are not firmly diagnostic, or which involve much followup
work, are not a priority. Control of the data should be passed on
to children at adulthood. Finding the time to educate parents, so
they can make good decisions, is essential.
It remains to be seen whether the economics of this sort of
testing make it feasible on a national scale. These days the cost
has less to do with the technical expense of sequencing than
with the salaries of those providing the services. But countries
that can make this work will be able to start to harness the full
potential of the genomic revolution. It began 20 years ago. Soon,
it will become part of everyday health care.n
Britain’s plan for whole-genome sequencing of newborns poses ethical quandaries
Private letters, public promise
Genetic screening