by Prof. Allen Buchanan
The question is not whether science should attempt to alleviate some of the tragedies of the human experience – like this baby with Down syndrome – but whether ‘society’ (i.e. human beings) can rise to the challenge of collectively and effectively controlling the inevitable abusers. To jeopardize the improvement of any child’s lot for any pusillanimous excuse or reasoning should be made a criminal offense.
Consider the case of Michelle, a bright ambitious junior at an elite university. To study more efficiently, she takes Ritalin, a drug prescribed for attention deficit disorder—which she doesn’t have. Ritalin is only one of several drugs developed to treat disorders, including ADD, Alzheimer’s, and narcolepsy, that have been shown to improve thinking in normal people.
Michelle’s boyfriend, Carlos, tells her she shouldn’t take Ritalin. He says, “It’s cheating and it might be dangerous.” Michelle replies: “Calm down. It’s just helps me think better; it’s not cocaine. Don’t be hypocritical. You take a cognitive enhancement drug—and probably in dangerously high doses—namely, caffeine. You also smoke, though you say you’ve quit. Why do you think people drink coffee and smoke? To be more alert. So, if I’m cheating, so are you and a lot of other people. Besides, if you’re worried about unfair advantages, why pick on cognitive enhancement drugs? Just being at this university is a huge advantage. Education is a cognitive enhancement, isn’t it? Or what about the fact that you are really smart and both your parents have Ph.D.s? That’s an advantage, too, and you certainly didn’t earn it.”
This little dialog, which paraphrases an exchange between two of my students, captures the ambivalence and confusion that most of us exhibit when we consider the possibility of biomedical enhancements. Reactions tend to be polarized: breathless optimism on the part of “posthumanists,” versus fear and loathing on the part of biological conservatives. Neither response is right. There are plenty of reasons to be concerned about biomedical enhancements, but just saying ‘no’ to them is not an option. Biomedical enhancements of normal human capacities are already with us, as the case of Ritalin demonstrates, and more are on the way. As with Ritalin, they will make their debut as spin-offs from medical research. Research on genetic disorders has already led to knowledge of how to insert genes in mouse embryos that result in improved memory and strength. Research to provide brain-computer interface technologies that enable paralyzed people to activate a robotic arm simply by thinking about grasping an object will inevitably lead to computerized ‘exoskeletons’ that extend the capacities of normal humans. Research on normal brain activity has already led to techniques for electrical stimulation of the brain that improves mood and cognition. So we don’t have to aim at enhancements to develop them. And once we develop the capacity to enhance, it will be hard—and in many cases impossible—to resist using it.
Enhancement isn’t new. Human beings have already developed impressive enhancements. In fact, the ability to enhance ourselves may be part of what makes humans different from other animals. Literacy and numeracy are dramatic cognitive enhancements, as are computers and the internet. Science is a kind of collective cognitive enhancement. Our remote ancestors enhanced their capacity to digest food by learning to cook it (cooking is a form of pre-digestion and also neutralizes natural toxins, greatly extending the menu of what we can safely eat). So why are people fearful of biomedical enhancements? The answer is that they think that biomedical enhancements are something entirely new, because they “interfere with nature” or threaten to change or destroy human nature.
As the philosopher John Stuart Mill pointed long ago, the idea of interfering with nature is confused. In one sense, nature is simply all of reality along with the laws that govern it. In that sense of nature, you can’t interfere with it (unless you are God). Alternatively, you might think of nature as the way things are, absent of human action. There’s nothing wrong with interfering with nature in that sense; we have to do it to survive. We interfere with nature in this second sense every time we act so as to alter the course of events—for example, when we take insulin for our diabetes.
Why then are some people worried that using biomedical enhancements will destroy human nature or that the particular kind of ‘interference’ with nature they involve is something we ought to avoid? After all, virtually all religious traditions and commonsense as well acknowledge that human nature contains serious flaws. The answer is that they think that human nature is uneditable—they think that if we try to improve on the flawed parts, we’ll destroy the good parts. They may also have a distorted view of evolution: They may think that the human organism, as President Bush’s Council on Bioethics put it, is a “finely-balanced” whole, the work of the “master-engineer” of evolution.
If you think that humans as they are now are the summit of a progressive biological process and also think that our nature is a densely-interconnected, “finely-balanced” whole, then you’ll take a dim view of any effort to improve our nature. You will think that anything we do will fall short of what the “master engineer” of evolution has produced and you will worry that if we try to modify one strand of the densely interwoven fabric of our being, the whole thing may unravel.
Seductive as it is, this way of thinking about human nature is completely wrong. It exhibits a rosy, pre-Darwinian, teleological view of nature that flies in the face of what we now know about evolution. Evolution is not a master engineer; contrary to Richard Dawkins, it is not even like a blind watchmaker. A blind watchmaker knows in advance what he is trying to make and he is making something for the purpose of serving human needs. Not so with evolution. Evolution is more like a morally blind tinkerer. Here’s what Charles Darwin says about nature, as the product of evolution.
“What a book a Devil’s chaplain could write on the clumsy, wasteful, blundering, low, and horridly cruel works of nature!” Humans, like all organisms, have lots of “design flaws.” Here are a just a few. Unlike almost all other mammals, humans can’t biosynthesize vitamin C; this has produced scurvy in human populations for as long as there have been humans. Because of a rapid transition to walking upright at the same time the cranium was enlarging, humans have an exceptionally high incidence of death during the birthing process. Because it combines the ingestion of food with air-intake, the human pharynx is responsible for an exceptionally high rate of death by choking, far surpassing that in other mammals. Human sinuses would drain better if we spent most of our time standing on our heads, with the result that we are prone to sinus infections. The urethra in human males runs through the prostate, rather than around it, which results in infections and urinary dysfunction. (If these don’t impress you, think about your knees or your lower back).
Evolution isn’t progress. The latest version of a species isn’t superior to its predecessors. In evolutionary terms “better” only means better from the standpoint of inclusive fitness—how well organisms do in passing on their genes. But inclusive fitness is always relative to an environment. Traits that improve inclusive fitness in one environment can become lethal when the environment changes. Because there is no constant environment against which progress in terms of inclusive fitness can be gauged, we can’t say that later editions of a species are better. Besides, inclusive fitness is not what we rightly value. It has to do only with the quantity of genes that are passed on, not the quality of life.
The idea that we are seamless webs that may unravel if we touch one thread is also at odds with evolutionary biology. Natural selection changes species incrementally. That means that organisms have to be able to change some characteristics without affecting others. An organism that was a seamless web would not be able adapt. In fact, organisms, including humans, exhibit a number of characteristics that serve to prevent them from unraveling when something changes as a result of random mutations.
For instance, they exhibit modularity: there are subsystems that are relatively autonomous, so that a change here will not disrupt a function there. They also exhibit canalization: the same phenotype can develop from different sets of genes, so that a mutation in some genes doesn’t necessarily mean a change in phenotype. Finally, they exhibit redundancy of function and plasticity. This means that damage to one system need not be disastrous: another system may be able to do the job or a quite different system may be flexible enough to take care of the problem. All of these features show that the seamless web metaphor is inaccurate. If we were fragile, seamless webs in the way biological conservatives think we are, then we would be courting disaster to remain as we are. Any environmental change, including ones we unwittingly cause, could cause the whole thing to unravel. If the biological conservatives were right about our fragility, we ought to use biomedical enhancements to correct this dangerous situation! We should ramp up modularity, canalization, redundancy, and plasticity. We should enhance, not refrain from enhancing!
There is a grain of truth in the seamless web metaphor. Human beings have often failed to understand interconnections among biological phenomenon (think of how we have disrupted ecologies by the introduction of plants or animals that we thought would improve things). But the lesson to draw from these blunders is not that we should never try to improve ourselves; instead, it is that we should take care not to over-estimate our ability to foresee the consequences of what we do. As our knowledge of how we are put together increases, we will be in a better position to take appropriate steps to reduce the risk of bad unintended consequences. We already know how to make important, but discrete changes in mice.
Apart from the worry about unintended bad biological consequences, the main concern about biomedical enhancement is that could exacerbate existing unjust inequalities. I think that is a very serious matter. But I don’t think it is a conversation-stopper. It doesn’t mean we should try to forgo biomedical enhancements. That would make as much sense as prohibiting anybody from learning to read until the whole world could be literate.
Some enhancements won’t remain costly for long. This is true of enhancement drugs. Once they go off patent and can be produced as generics, the price will drop dramatically. (There are now over 100 generic prescription drugs that sell for $4.00 for a month’s supply at Walmart. Cognitive enhancement drugs may be cheaper than lattes). Enhancements that increase productivity may come to be viewed as basic education is now. They may be subsidized by society, and that will do something to limit inequalities. Some enhancements may actually reduce inequalities. For example, there is evidence that cognitive enhancement drugs tend to produce the biggest boost for those who are at the lower end of the normal distribution of cognitive abilities.
Nonetheless, we ought to be worried about inequality. If extremely powerful but expensive enhancements are available only to the wealthy, they may be in a position to dominate the political process or the economy even more than they do now. Instead of declaring all enhancements off-limits, we need to think hard about how to ensure the more rapid diffusion of those enhancements that have the potential to exacerbate injustice if they’re available only to the better off. Doing this might require modifying patent rights as well as subsidies.
We can’t just say ‘no’ to enhancements. They are already here and more are on the way. The question is how to manage them. We’ll have a better chance of managing them well if we bring them into the light of day and acknowledge that the goal of improving human beings through the use of biotechnologies is a legitimate one. Instead of continuing an uncontrolled, unmonitored “experiment” in which thousands of people like Michelle take a drug that may be unsafe, we need well-designed longitudinal studies. We aren’t likely to get that if we throw up our hands and say that biomedical enhancement is illegitimate because it may destroy human nature.