This is an edition of The Atlantic Daily, a newsletter that guides you through the biggest stories of the day, helps you discover new ideas, and recommends the best in culture. Sign up for it here.

I spoke with my colleague Sarah Zhang about a breakthrough in CRISPR therapy, and when it is ethical to use the gene-editing technology.

First, here are three new stories from The Atlantic:

My father, my faith, and Donald Trump Why the Fifth Circuit keeps making such outlandish decisions Substack has a Nazi problem.

A Transformative Treatment

Earlier this month, U.K. regulators approved a new therapy that uses CRISPR—a gene-editing technology that allows scientists to make cuts to DNA—to treat people with sickle-cell disease. FDA approval is likely in the coming weeks. I spoke with my colleague Sarah Zhang, who has been covering CRISPR for more than a decade, about this landmark treatment, ethical use of the technology, and what fair access to CRISPR therapy could look like in the future.

Lora Kelley: What makes sickle-cell disease an obvious match for CRISPR therapy?

Sarah Zhang: As soon as scientists started talking about what we can do with CRISPR, treating sickle cell rose to the top of the list for two reasons. One is that with sickle-cell disease, you can take the blood cells out, edit them in the controlled environment of a lab, and then put them back in someone’s body. And with sickle cell, we know exactly the edit to make to treat the disease. For patients who have gotten the therapy, it’s been transformative. They’ve gone from being hospitalized multiple times a year to having virtually no symptoms.

Lora: Where does the scientific community draw ethical lines on when to use CRISPR?

Sarah: If you’ve heard about CRISPR and humans, you probably remember the CRISPR babies that were born back in 2018. A Chinese scientist went rogue and edited embryos that were then born as twins in China, purportedly to make them resistant to HIV.

CRISPR babies were an unnecessary and reckless use of gene editing. That moment catalyzed the community to think about how we want this technology to be used.

After that, there was a widely accepted consensus among scientists: no editing in sperm, eggs, or embryos. Edits in the DNA of your blood cells or muscle cells or brain cells don’t get passed on if you have children, the way they would be in sperm, eggs, or embryos. The rewards are also not clear. There aren’t really good applications where you could prevent a genetic disease from being inherited with gene editing that you can’t already do using IVF and embryo selection.

But everyone I talked with feels like this sickle-cell treatment is an appropriate use of CRISPR. The big question going forward is: Who can actually get access to this therapy?

Lora: What would equitable and fair access to CRISPR therapy to treat sickle-cell disease look like?

Sarah: This therapy is likely to be very expensive. It may cost around $2 million a person. It’s also hard to get physically. You’re basically doing a bone-marrow transplant on yourself. Your blood cells are taken out of you and edited; meanwhile, you’re undergoing chemotherapy to kill your remaining bone marrow. And then you’re getting your edited cells infused back into you, and rebuilding your blood and immune system over the course of several months.

So you have to be either in the hospital or going to the hospital and going to see doctors for about a year. If you live near one of these transplant centers, you may be able to do that. But if you live in a rural location, or maybe you are in school, or you have kids, or you have a job, you can’t take a year out of your life to undergo this therapy. Most people who have sickle-cell disease live in developing countries, largely in sub-Saharan Africa. So this therapy is logistically unfeasible for them.

Still, there’s some amount of justice to the fact that this groundbreaking therapy is helping treat a disease that predominantly affects Black people, who have been historically—and still are—marginalized in the medical system. The idea is that one day this treatment can be something more like a shot, which would be cheaper and easier to get.

Lora: How do you anticipate CRISPR being used to treat diseases in the future?

Sarah: The next step will be: How do we treat CRISPR right in the body? We’re starting to do that. There was a recent trial to lower people’s cholesterol using CRISPR. Lipid nanoparticles were used to send CRISPR to the liver, which is a relatively easy target. Changing things in the brain, the heart, or muscles is a lot harder. A big question now is: How do we get CRISPR to the cells that we want to edit?

Even though CRISPR has been described as a very precise gene editor, it’s actually still quite limited. It’s not the same thing as opening up Google Docs and changing some letters around. But now there are new technologies where you can change a single letter, or paste in a sequence, and that will allow for much more precise edits in the future. CRISPR is quite easy to use. But making sure you do all the right edits is harder.

Still, these breakthroughs have been exciting for me personally. I started covering CRISPR very early in my career, when it was a thing you did to cells in a petri dish in a lab. Now it’s being used to treat humans. It’s only been a little bit more than 10 years, which feels like a long time, but in the medical world, it’s really a blink of an eye. It’s extraordinary that it happened so quickly.

Related Links

The CRISPR era is here. CRISPR has a terrible name.

Today’s News

Forty-one workers were rescued after a tunnel collapsed in the Indian state of Uttarakhand; they had been trapped for more than two weeks. Americans for Prosperity Action, a political network founded by the billionaire brothers Charles and David Koch, has endorsed Nikki Haley in the Republican primary for president.    Israel and Hamas will extend a temporary pause in fighting until tomorrow, maintaining the possibility of further extensions and hostage-prisoner exchanges.

Evening Read Painting by Fulton Leroy Washington (MR WASH). Source: Malike Sidibe for The Atlantic.

This Is Not Justice

By Jake Tapper

Editor’s Note: As of yesterday, C. J. Rice, the subject of our November 2022 cover story, could be very close to freedom after a federal court overturned his conviction. The Philadelphia District Attorney’s Office now has 179 days to decide whether to retry Rice’s case or release him from custody. Read our update here.

On Tuesday, September 20, 2011, a young patient walked haltingly into a medical office in South Philadelphia to have his bullet wounds examined.

The patient was a 17-year-old named C. J. Rice, who lived in the neighborhood. The doctor was a pediatrician named Theodore Tapper.

My father had been working as a physician in South Philadelphia for more than four decades and had known Rice since he was a child. Rice had been brought in for a checkup soon after he was born, and as a doctor my father had seen Rice several times a year, along with other members of the family. Two weeks and three days before his September appointment, Rice had been shot while riding his bike, in what he believed was a case of mistaken identity. To remove one of the bullets, a surgeon had made a long incision down the middle of Rice’s torso. The wound was then closed with a ridge of staples—more than two dozen. After his discharge, Rice was in severe pain and could barely walk. He needed help to get dressed in the morning and help to go up and down stairs …

The timing of that visit is significant because, six days later, the Philadelphia police announced that they were seeking Rice and a friend of his, Tyler Linder, in connection with a shooting that had occurred in South Philadelphia on the evening of September 25 and left four people wounded, including a 6-year-old girl.

Read the full article.

More From The Atlantic

Trump wants to create a national university? The latest victims of the free-speech crisis Your friends don’t all have to be the same age.

Culture Break

Moviestore Collection Ltd / Alamy

Read. Paul Beatty’s The Sellout is a novel that our staff writer Jennifer Senior is “positively evangelical” about, and one of her entertainment musts.

Watch. ​​Anxious? Here are some of the best and most rewatch-friendly movies to soothe your mind (From 2020).

Play our daily crossword.

Did someone forward you this email? Sign up here.

Katherine Hu contributed to this newsletter.

When you buy a book using a link in this newsletter, we receive a commission. Thank you for supporting The Atlantic.

In June 2016, Rodrigo Duterte, the former mayor of Davao City, on the southern Philippine island of Mindanao, easily defeated four other candidates in the country’s presidential election. Within hours of taking office, the new president began to make good on his campaign promise: killing those whom he called the “sons of bitches” involved in the country’s illegal narcotics trade. The first corpse, described by the police as an “Unidentified Male Person” in his 20s, turned up around 3 a.m. in an alley just a five-minute walk from the sports complex where Duterte had declared victory. The victim had been shot once behind the left ear. The killers had placed a cardboard sign on his chest that read I AM A CHINESE DRUG LORD.

Over the following months, the killings spread across the Philippines. Men wearing masks burst into homes and shot people in front of their children. They snatched others off the streets in unmarked cars and disposed of their bodies in trash heaps. Dealers—most selling crystal meth, or shabu, the drug of choice of the Filipino poor—as well as addicts, former addicts, and small-time criminals became targets. National Police Chief Ronald dela Rosa described a rising tide of bodies: “The dead who were just found floating along canals, the dead who were dumped along the road with their hands tied and their faces, eyes, and mouths taped.” Dela Rosa classified those deaths as unsolved homicides. In the first six weeks of Duterte’s presidency, according to the police count, 899 people were killed in “deaths under investigation.” In many other cases, the police took responsibility but always claimed that they had acted in self-defense. Three years into his administration, when I traveled to the Philippines to report on the drug war, the number of estimated extrajudicial killings neared 30,000.

Patricia Evangelista’s Some People Need Killing: A Memoir of Murder in My Country is, on one level, a powerful story of disillusionment. The granddaughter of a Manila newspaperman, Evangelista grew up in the immediate aftermath of the 1986 “People Power Revolution” that brought down the dictator Ferdinand Marcos, an exhilarating transformation that she describes early in the book. It was “one part myth, two parts magic, peopled by giants, all thunder and power and bright yellow hope.” A prodigy on the debate stage in college, she embraced journalism as a means of safeguarding the country’s hard-won democracy. Evangelista began her career as a reporter for the country’s biggest broadcaster, ABS-CBN, where she distinguished herself covering political killings. In 2011, she joined Rappler, a feisty online start-up co-founded by the investigative reporter and future Nobel Peace Prize Laureate Maria Ressa.

[Read: Maria Ressa on how to fight fascism before it’s too late]

Then, five years later, Duterte swept into office. Evangelista seamlessly segues from her own life story into a riveting police procedural. Joining up with a band of photographers who were sometimes called “nightcrawlers,” a term derived from a movie starring Jake Gyllenhaal, she prowled the slums of Manila after dark, chasing tips and interviewing survivors, family members, neighbors, and police. All along she was tormented by the question: How did a country that had won admiration for its peaceful ousting of a dictator choose, one generation later, a murderous autocrat as its leader? Evangelista reaches back into her own past to examine how infatuation with charismatic authoritarians, apathy, and instincts for self-preservation might have induced people to make such a choice. In one withering moment, she describes her shock and sense of betrayal upon learning that her grandfather, whom she had believed was a fervent democrat, was actually a supporter of Marcos.

Marcos was a U.S.-backed kleptocrat who ruled the Philippines for two decades, most of that time under a state of emergency that granted him absolute power. On August 21, 1983, a year before Evangelista was born, the opposition leader Benigno “Ninoy” Aquino Jr. defied Marcos’s warnings and returned to Manila from a self-imposed exile in the U.S. Moments after stepping off China Airlines Flight 811, he was shot dead by a soldier in front of horrified journalists and supporters. Marcos denied that he was behind it. But abuses and corruption were sapping the government’s authority. In 1984, I visited Samar, a large, jungle-covered island about 400 miles south of Manila; a leftist priest told me that “80 percent” of the island was in the hands of the anti-Marcos Communist New People’s Army. Two years later, U.S. President Ronald Reagan pressured Marcos to hold elections, and Corazon Aquino, Ninoy’s widow, defeated him. The Philippine armed forces backed Aquino, and the dictator and his wife, Imelda, flew into exile in Hawaii. “We Americans like to think we taught the Filipinos democracy,” declared the CBS correspondent Bob Simon that night, referring to the country’s nearly five decades as a U.S. colony. “Well, tonight, they are teaching the world.”

At the moment that Aquino was consolidating her power in Manila, a young prosecutor was beginning his political rise in Mindanao. The son of the provincial governor, Duterte was a crudely charming figure with a violent streak: At 27, he had shot and wounded a fellow law-school student. The circumstances of the shooting were unclear and no charges were filed. Elected Davao City mayor in 1988, he allegedly created the Davao Death Squad, which gunned down drug dealers, drug users, petty thieves, and, eventually, political rivals.  

Reports about Duterte’s hit squads were well-known when he announced his candidacy for president in 2016. And he made no secret of his intention to run Malacañang Palace the same way he managed Davao’s city hall. “There’s been enough warning during the campaign,” he declared just after his victory. “There will be no blaming here. I told [the drug dealers] to stop. Now if anything happens to them, it’s on them. They asked for it.”

Some Filipinos dismissed his talk as political rhetoric. Others had grown weary of the ineffectual outgoing president, Benigno Aquino III (the son of Ninoy and Corazon), and disgusted by corruption. Evangelista describes an oft-used scam in which airport security staff planted bullets in the luggage of travelers at Manila’s airport and then demanded payoffs in return for not arresting them. Duterte—a macho populist with a fondness for profanity and a “tell it like is” message—exerted an almost-religious hold over his supporters. Like Donald Trump, to whom he has frequently been compared, Duterte had a performer’s instincts, an  earthy humor, a misogynistic streak (he often made comments seeming to endorse rape, which his fans shrugged off as jokes), and a visceral message. Aware that many Filipinos were terrified to walk in their barrios after dark, Duterte promised to take care of the problem—without regard to cumbersome, tainted judicial procedures. “She saw him on television,” Evangelista writes of one Duterte enthusiast, in what could also be a description of a MAGA acolyte. “It was like seeing Jesus.” To vote for Duterte, Evangelista writes, in one of the many lyrical—and chilling—passages that run through the book, “you had to believe in certain things”:

You had to believe, for example, that he was a righteous man … You had to believe that God had a peculiar preference for deadly autocrats, because the presidency is destiny and Rodrigo Duterte was destined to lead … You had to believe that a mayor who kept peace by ordering the undesirables out of his city could succeed in a country where undesirables were citizens too. You had to believe the intended dead would be drug lords and rapists, only drug lords and rapists, and not your cousins who go off into Liguasan Marsh to pick up their baggies of meth. You had to believe there would be a warning before the gunshots ring out.

Duterte’s language became more vicious as the killing campaign intensified. In August 2016, he claimed to have 144,202 names on a drug watch list. “If your name is there, son of a bitch, you have a problem, I will really kill you,” he declared. Street dealers, meth addicts, and small-time pushers would “have to perish,” he said later in his administration. He would “slaughter those idiots,” and hang them with sharpened barbed wire so that “when you drop, you leave your head behind when your body falls.” But the exact circumstances of the murders were deliberately kept vague, and a new vocabulary arose that reflected the murkiness. People weren’t murdered, they were salvaged—an English-language euphemism derived from the Spanish salvaje, or “wild.” Tokhang, a portmanteau from the Visayan words for “knock” and “plead,” was allegedly a police policy that encouraged low-level dealers to identify themselves and surrender, but that often resulted in their executions.

Evangelista introduces a memorable cast of villains, heroes, and victims. Lieutenant Colonel Domingo, the commander of a prolific death squad, is presented as an affable killer fond of bestowing nicknames on reporters. Domingo takes a liking to Evangelista and, against her wishes, keeps calling her “Trish”—a sinister reminder of who holds the power in their relationship. Efren Morillo, a fruit vendor who survived a police attack that killed four others, found the courage to testify against the murderers. After Morillo’s testimony and the abduction-murder by the police of a South Korean businessman in October 2016, Duterte seemed to turn his back on the hit squads, calling the police “corrupt to the core.” Evangelista was one of the first journalists to report on a shift in tactics: the use of local vigilante groups to carry out the homicides, with the police compiling target lists and directing their movements in the shadows. No hard evidence links Duterte to this change of policy, but Evangelista makes the case that the president had, with a wink and a nod at least, given it his approval.

[Read: The paradox of Rodrigo Duterte]

By the time I arrived in the Philippines in 2019, Duterte’s drug war was still playing out—though the numbers had dropped significantly from the dozens of corpses that had filled Manila’s streets each night early in his presidency. When I visited Malacañang Palace, Duterte’s spokesperson was unrepentant about the killings, insisting that hundreds of police had died in shootouts while trying to arrest drug dealers. And Duterte remained wildly popular. At a political rally I attended in Davao for the senate candidates from his party, supporter after supporter told me how grateful they were that Duterte had cleaned up their neighborhood. This may have been more perception than reality: In 2020, the head of drug enforcement for the Philippine National Police said that “drug supply is still rampant” and that the “shock and awe” of the Duterte years had not worked.

Duterte reburied Marcos, who had died in exile in Hawaii, as a hero at the national cemetery in Manila. Obliged by the Philippines’ constitution to step down after one term, he endorsed Marcos’s son, Ferdinand “Bongbong” Jr., to be his successor. The country had come full circle. Evangelista’s book is an extraordinary testament to half a decade of state-sanctioned terror. It’s also a timely warning for the state of democracy in 2024. Eight years ago, most Filipinos shrugged off Duterte’s homicidal rhetoric as political buffoonery. The horrors that followed suggest that demagogues with a violent message might well be taken at their word.