This is not exactly a “best of” because I don’t know how that applies to science news, but here are what I consider to be the most impactful science news stories of 2023 (or at least the ones that caught by biased attention).

This was a big year for medical breakthroughs. We are seeing technologies that have been in the works for decades come to fruition with specific applications. The FDA recently approved a CRISPR treatment for sickle cell anemia. The UK already approved this treatment for sickle cell and beta thalassemia. This is the first CRISPR-based treatment approval. The technology itself is fascinating – I have been writing about CRISPR since it was developed, it’s a technology for making specific alterations to DNA at a specific target site. It can be used to permanently inactivate a gene, insert a new gene, or reversibly turn a gene off and then on again. Importantly, the technology is faster and cheaper than prior technologies. It is a powerful genetics research tool, and is a boon to genetic engineering. But since the beginning we have also speculated about its potential as a medical intervention, and now we have proof of concept.

The procedure is to take bone-marrow from the patient, then use CRISPR to silence a specific gene that turns off the production of fetal hemoglobin. The altered blood stem cells are then transplanted back into the patient. Both of these diseases, sickle cell and thalassemia, are genetic mutations of adult hemoglobin. The fetal hemoglobin is unaffected. By turning back on the production of fetal hemoglobin, this effectively reduces or even eliminates the negative effects of the mutations. Sickle cell patients do not go into crisis and thalassemia patients do not need constant blood transfusions.

This is an important milestone – we can control the CRISPR technique sufficiently that it is a safe and effective tool for treating genetically based diseases. This does not mean we can now cure all genetic diseases. There is still the challenge of getting the CRISPR to the right cells (using some vector). Bone-marrow based disease is low hanging fruit because we can take the cells to the CRISPR. But still – this is a lot of potential disease targets – anything blood or bone marrow based. Also, any place in the body where we can inject CRISPR into a contained space, like the eye, is an easy target. Other targets will not be as easy, but that technology is advancing as well. This all opens up a new type of medical intervention, through precise genetic alteration. Every future story about this technology will likely refer back to 2023 as the year of the first approved CRISPR treatment.

Another similar milestone was the fact that 2023 saw the first fully approved drugs that are disease-modifying for Alzheimer’s disease (AD). There are now three monoclonal antibodies that are designed to slow or even reverse some aspects of AD, a first for a neurodegenerative disease. This is partly because our understanding of the disease has been improving over the decades. But these targets have been known and tried before, with multiple failures. Experts believe, with good reason, that it is likely these new treatments are showing an effect because they are simply more powerful than the chemical drugs we tried previously. Monoclonal antibodies, as the name implies, are antibodies that can be engineered to target a specific receptor or protein. This technology has been developed over decades, and again is a powerful research tool. In the last 10 years there has been an explosion of monoclonal antibody based treatments, and they are proving to be incredibly effective. They also often have fewer side effects than chemically-based drugs – they don’t have to be metabolized by the kidneys or liver, and they can be more precisely targeted. It’s simply a great technology. The only major downside is that monoclonal antibody treatments are still very expensive.

To me these are the two biggest science news stories of 2023, and they are very good news. There were many other medical advances, but these signal the beginning of perhaps new eras in medicine.

There were many other science news stories I found interesting, and can only mention a few here. One story is the continuing saga of global warming. One the one hand it seems that we have turned a corner in terms of public perception. The dedicated denialists are still out there, but what has changed is that global warming has gone from something that will happen in the future to something that feels like it is happening now. Heat waves, forest fires, melting ice, and extreme weather are becoming more and more obvious. Over the summer we were plagued by smoke from Canadian forest fires even down in CT where I live. It was bizarre.

Also, 2023 will definitely be the warmest year on record. Those who deny even that warming is happening (they are still out there) are sounding more and more disconnected from reality and desperate. How many warmest years on record can we have before it’s just too much to ignore? This is not some fluctuation, and there was never any global warming pause. The scientists said it was going to continue to warm, and it is, pretty much in the middle of their projections. However, the manifestations of global warming seem to be ahead of schedule. It is impacting agriculture and infrastructure, and will result in more and more climate refugees.

At the same time, our political class has never seemed more feckless and dysfunctional. COP28 was, in my opinion, largely a failure. They failed to get meaningful agreements, something more than vague showy statements. We need specifics. We need agreements with teeth. We need a plan. This year will likely also be the year with the greatest CO2 emissions ever. We are still increasing fossil fuel use and CO2 emissions. It’s maddening.

It is increasingly clear that we do not have the luxury of simply waiting for technology to solve this problem for us. It is already mostly too late not to blow past 1.5 C. That is pretty much a done deal. The question now is, how far will peak warming go beyond that, and how many tipping points will we trigger? I feel like we are living in slow motion through the first act of every disaster movie ever.

There is a silver lining – the Inflation Reduction Act (IRA – really a climate bill) seems to be working better than expected. Biden chose an all carrot approach to industrial policy aimed at accelerating the change to green technology. No sticks. This garnered some criticism from both sides of the ideological spectrum. But it is working – industry, with incentives and reduced risk through guaranteed loans, is investing heavily in green technology, which includes (very pragmatically, in my opinion) nuclear power. This includes next generation advanced nuclear, like the Natrium plant being built in Wyoming, to replace a coal-fired plant.

This is all good, but it’s not enough. We probably need to increase this type of investment by an order of magnitude, and spread it to the other major emitters around the world, like China and India. We need to shut down coal burning as quickly as possible. This will not be easy, as it’s a cheap form of energy for much of the world, but it has to be a priority. We already have the technology, and that technology is constantly incrementally getting better. We need to invest smartly in new infrastructure – those are investments that will pay off many fold. We just need the vision and political will to make those investments. Otherwise we are simply negligently displacing huge costs onto future generations.

So 2023 has seen a dramatic increase in the gap between both the reality and perception of global warming, with the dysfunctional too-little too-late actions of the governments of the world. I fear 2023 may be seen as the last opportunity we had to avoid climate disaster, one that we threw away.