The Future (37 page)

In mythology, the lines dividing powers reserved for the gods from those allowed to people were marked by warnings; transgressions were severely punished. Yet no Zeus has forbidden us to
introduce human genes into other animals; or to create hybrid creatures by
mixing the genes of spiders and goats; or to surgically imbed silicon
computer chips into the gray matter of human brains; or to provide a genetic menu of selectable traits for
parents who wish to design their own children.

The use of science and technology in an effort to enhance human
beings is taking us beyond the outer edges of the moral, ethical, and religious maps bequeathed to us by previous generations. We are now in terra incognita, where the ancient maps
sometimes noted, “There Be Monsters.” But those with enough courage to sail into the unknown were often richly rewarded, and in this case, the scientific community tells us with great confidence that in health care and other fields great advances await us, even though great wisdom will be needed in deciding how to proceed.

When humankind takes possession of a new and previously unimaginable power, the experience often creates a mixture of exhilaration and trepidation. In the teachings of the Abrahamic religions, the first man and the first woman were condemned to a life of toil when
they seized knowledge that had been forbidden them. When Prometheus stole fire from the gods, he was condemned to eternal suffering. Every day, eagles tore into his flesh and consumed his liver, but every night his liver was regenerated
so he could endure the same fate the next morning.

Ironically, scientists at Wake Forest University are now genetically engineering
replacement livers in their laboratory bioreactors—and no one doubts that their groundbreaking work is anything but good. The prospects for advances in virtually all forms of health care are creating exhilaration in many fields of medical research—though it is obvious that the culture and practice of medicine, along with all of the health care professions and institutions, will soon be as disruptively reorganized as the typewriter and long-playing record businesses before it.

With exciting and nearly miraculous potential new cures for deadly diseases and debilitating conditions on the research horizon, many health care experts believe that it is inevitable that the practice of medicine will soon be radically transformed. “Personalized medicine,” or, as some now refer to it, “precision medicine,” is based on digital and molecular models of an individual’s genes, proteins, microbial communities, and other sources of medically relevant information. Most experts believe it will
almost certainly become the model for medical care.

The ability to monitor and continuously update individuals’ health functions and trends will make preventive care much more effective. The new economics of health care driven by this revolution may soon
make the traditional insurance model based on large risk pools obsolete because of the huge
volume of fine-grained information about every individual that can now be gathered. The role of insurance companies is already being reinvented as these firms begin to adopt digital health models and mine the “big data” being created.

Pharmaceuticals, which are now aimed at large groups of individuals manifesting similar symptoms, will soon be targeted toward genetic and molecular signatures of individual patients. This revolution is already taking place in cancer treatment and in the treatment of “orphan diseases” (those that affect fewer than 200,000 people in the U.S.; the definition varies from country to country). This trend is expected to broaden as our knowledge of diseases improves.

The use of artificial intelligence—like IBM’s Watson system—to assist doctors in making diagnoses and prescribing treatment options promises to
reduce medical errors and enhance the skills of physicians. Just as artificial intelligence is revolutionizing the work of lawyers, it will profoundly change the work of doctors. Dr. Eric Topol, in his book
The Creative Destruction of Medicine
, writes, “This is much bigger than a change; this is the essence of creative destruction as conceptualized by [Austrian economist Joseph] Schumpeter. Not a single aspect of health and medicine today will ultimately be spared or unaffected in some way. Doctors, hospitals, the life science industry, government and its regulatory bodies:
all are subject to radical transformation.”

Individuals will play a different role in their own health care as well. Numerous medical teams are working with software engineers to develop more sophisticated self-tracking programs that empower individuals to be more successful in modifying
unhealthy behaviors in order to manage chronic diseases. Some of these programs facilitate more regular communication between doctors and patients to discuss and interpret the continuous data flows from
digital monitors that are on—and inside—the patient’s body. This is part of a broader trend known as the “quantified self” movement.

Other programs and apps create social networks of individuals attempting to deal with the same health challenges—partly to take advantage of what scientists refer to as the Hawthorne effect: the simple knowledge that one’s progress is being watched by others
leads to an improvement in the amount of progress made. For example, some people (I do not include myself in this group) are fond of the new scales
that automatically tweet their weight so that everyone who follows them
will see their progress or lack thereof. There are new companies being developed based on the translation of landmark clinical trials (such as the Diabetes Prevention Program) from resource-intensive studies into social and digital media programs. Some experts believe that
global access to large-scale digital programs aimed at changing destructive behaviors may soon make it possible to significantly reduce the incidence of chronic diseases like diabetes and obesity.

T
HE NEW ABILITIES
scientists have gained to see, study, map, modify, and manipulate cells in
living systems are also being applied to the human brain. These techniques have already been used to give amputees the ability to control advanced
prosthetic arms and legs with their brains, as if they were using their own natural limbs—by connecting the artificial limbs to neural implants. Doctors have also empowered paralyzed monkeys to operate their arms and hands by implanting a device in the brain that is wired to the appropriate muscles. In addition, these breakthroughs offer the possibility of
curing some brain diseases.

Just as the discovery of DNA led to the mapping of the human genome, the discovery of how neurons in the brain connect to and communicate with one another is leading inexorably toward the complete
mapping of what brain scientists call the “connectome.”
^*
Although the data processing required is an estimated ten times
greater than that required for mapping the genome, and even though several of the key
technologies necessary to complete the map are still in development, brain scientists are highly confident that they will be able to
complete the first “larger-scale maps of neural wiring” within the next few years.

The significance of a complete wiring diagram for the human brain can hardly be overstated. More than sixty years ago, Teilhard de Chardin predicted that “Thought might
artificially perfect the thinking instrument itself.”

Some doctors are using neural implants to serve as pacemakers
for the brains of people who have Parkinson’s disease—and
provide deep brain stimulation to alleviate their symptoms. Others have used a similar
technique to alert people with epilepsy to the first signs of a seizure and stimulate the brain to minimize its impact. Others have long used cochlear implants connected to an external microphone to deliver sound into the brain and the auditory nerve. Interestingly, these devices must be
activated in stages to give the brain a chance to adjust to them. In Boston, scientists at the Massachusetts Eye and Ear Infirmary connected a lens to a blind man’s optic nerve, enabling him to perceive color and even to read large print.

Yet for all of the joy and exhilaration that accompany such miraculous advances in health care, there is also an undercurrent of apprehension for some, because the scope, magnitude, and speed of the multiple revolutions in biotechnology and the life sciences will soon require us to make almost godlike distinctions between what is likely to be good or bad for the entire future of the human species, particularly where permanently modifying the gene pool is concerned. Are we ready to make such decisions? The available evidence would suggest that the answer is not really, but we are going to make them anyway.

We know intuitively that we desperately need more wisdom than we currently have in order to responsibly wield some of these new powers. To be sure, many of the choices are easy because the obvious benefits of most new genetically based interventions make it immoral
not
to use them. The prospect of eliminating cancer, diabetes, Alzheimer’s, multiple sclerosis, and other deadly and fearsome diseases ensures these new capabilities will proceed at an ever accelerating rate.

Other choices may not be as straightforward. The prospective ability to pick traits like hair and eye color, height, strength, and intelligence to create “
designer babies” may be highly appealing to some parents. After all, consider what
competitive parenting has already done for the test preparation industry. If some parents are seen to be giving their children a decisive advantage through the insertion of beneficial genetic traits,
other parents may feel that they have to do the same.

Yet some genetic alterations will be passed on to future generations and
may trigger collateral genetic changes that are not yet fully understood. Are we ready to seize control of heredity and take responsibility for actively directing the future course of evolution? As Dr. Harvey
Fineberg, president of the Institute of Medicine, put it in 2011, “
We will have converted old-style evolution into neo-evolution.” Are we ready to make
these
choices? Again, the answer seems to be no, yet we are going to make them anyway.

But who is the “we” who will make these choices? These incredibly powerful changes are overwhelming the present capacity of humankind for deliberative collective decision making. The atrophy of American democracy and the consequent absence of leadership in the global community have created a power vacuum at the very time when human civilization should be shaping the imperatives of this revolution in ways that protect human values. Instead of seizing the opportunity to drive down health costs and improve outcomes,
the United States is decreasing its investment in biomedical research. The budget for the National Institutes of Health has declined over the past ten years, and the U.S. education system is waning in science, math, and engineering.

One of the early pioneers of in vitro fertilization, Dr. Jeffrey Steinberg, who runs the Los Angeles Fertility Institutes, said that the beginning of the age of active trait selection is now upon us. “
It’s time for everyone to pull their heads out of the sand,” says Steinberg. One of his colleagues at the center, Marcy Darnovsky, said that the discovery in 2012 of a noninvasive process to sequence a complete fetal genome is already raising “some scenarios that are extremely troubling,” adding that among the questions that may emerge from wider use of such tests is “
who deserves to be born?”

Richard Hayes, executive director of the Center for Genetics and Society, expressed his concern that the debate on the ethical questions involved with fetal genomic screening and trait selection thus far has primarily involved a small expert community and that, “Average people feel overwhelmed with the technical detail.
They feel disempowered.” He also expressed concern that the widespread use of trait selection could lead to “an objectification of children as commodities.… We support the use of [preimplantation genetic diagnosis (PGD)] to allow couples at risk to have healthy children. But for non-medical, cosmetic purposes, we believe this
would undermine humanity and create a techno-eugenic rat race.”

Nations are competitive too. China’s Beijing Genomic Institute (BGI) has installed 167 of the world’s most powerful genomic sequencing machines in their Hong Kong and Shenzhen facilities that experts say
will soon exceed the sequencing capacity of the entire United States.

Its initial focus is finding genes associated with higher intelligence and matching individual students with professions or
occupations that make the best use of their capabilities.

According to some estimates, the Chinese government has spent well
over $100 billion on life sciences research over just the last three years, and has persuaded 80,000 Chinese Ph.D.’s trained in Western countries to return to China. One Boston-based expert research team, the Monitor Group, reported in 2010 that China is “poised to become the global leader in life
science discovery and innovation within the next decade.” China’s State Council has declared that its genetic research
industry will be one of the pillars of its twenty-first-century industrial ambitions. Some researchers have reported preliminary discussions of plans to
eventually sequence the genomes of almost every child in China.

Multinational corporations are also playing a powerful role, quickly exploiting the many advances in the laboratory that have profitable commercial applications. Having invaded the democracy sphere, the market sphere is now also bidding for dominance in the biosphere. Just as Earth Inc. emerged from the interconnection of billions of computers and intelligent devices able to communicate easily with one another across all national boundaries,
Life Inc
. is emerging from the ability of scientists and engineers to connect flows of genetic information among living cells across all species boundaries.

The merger between Earth Inc. and Life Inc. is well under way. Since the
first patent on a gene was allowed by a Supreme Court decision in the U.S. in 1980,
more than 40,000 gene patents have been issued, covering 2,000 human genes. So have tissues, including some tissues taken from patients and
used for commercial purposes without their permission. (Technically, in order to receive a patent, the owner must transform, isolate, or purify the gene or tissue in some way. In practice, however, the gene or tissue itself becomes commercially controlled by the patent owner.)