[Paleopsych] Robert Sapolsky: Should Science Make Us Better Than Well?

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Robert Sapolsky: Should Science Make Us Better Than Well?
http://www.popsci.com/popsci/futurebody/article/0,20967,1088740,00.html
Popular Science - August 2005

One preeminent scientist tackles the moral and ethical issues that come
with the business of genetically enhancing our biology.

The point of medicine is to make sick people "well," which is really
just another way of saying "afflicted with roughly the same diseases as
everyone else." But as we've seen in this special issue, we are
belly-flopping our way into a world in which more and more medical
interventions hold the promise of making us better than well, to borrow
a memorable coinage from Peter Kramer's 1993 book Listening to Prozac.
We're working on an entire suite of biological enhancements: smart drugs
to improve memory beyond normal, doping methods that promote muscle
growth by inhibiting certain proteins, gene therapy to stimulate the
birth of neurons in the brain to above-normal levels. If you can imagine
it, some scientist is mucking around in it. I know this firsthand. In my
lab at Stanford University, we're developing gene-therapy approaches to,
among other things, transfer genes into the hippocampus-an area of the
brain involved in learning and memory-with the goal of making a rat
learn better under stress, a state that typically impairs cognition.

What we're really talking about here is becoming above average, and
that's where things get tricky. The average person often has trouble
with the mathematics of averageness. So even though air travel is safer
than traveling by car, most people fear the former more than the latter
because people like to be in control and because the average person
considers himself to be a better-than-average driver. Or there's the
physician who ignores findings in clinical research in favor of her gut
feeling, because the average physician thinks she is a
better-than-average physician. And then there are the mathematically
challenged social critics who sincerely believe that our schools should
be producing nothing but above-average children. The ideal of fostering
an above-average society is, by definition, doomed.

Still, with an imagination steeped in science-fiction literature-and a
deep-rooted trust in our ability to solve humanity's problems-it's not
hard to dream up fanciful ways in which science will make us better than
well. But I think it's a good idea to consider whether this sort of
tinkering is a good idea. What are some of the worrisome aspects of us
White-Labcoat Guys futzing with our bodies and minds? A partial list:

What if a wondrous intervention backfires?

This is the scenario of "Wait a second . . . this gene-transfer
breakthrough was supposed to make humans photosynthetic, and instead now
we're just vulnerable to Dutch elm disease." This concern had better top
the list, given the rich history of such disasters, stretching from at
least as far back as the Medieval Medical Association advocating leeches
for when you're feeling under the weather all the way up to the recent
discovery that a gene therapy designed to cure a life-threatening
immunological disorder happens to cause leukemia. And the earnest
assurance of "But we're being extra, extra cautious this time" doesn't
cut it-we scientists have always been careful people intent on not
screwing up, but nonetheless, unpredictable things happen when cruising
the unknown. The unpredictable isn't the only peril we face, though.
There are all sorts of things that should worry us even when the
intervention works exactly as planned.

What fun is it now?

So we figure out how to get a bunch of bumblebee mito- chondria into the
fingers of some pianist, who can now play the fastest trills in the
history of music. Great, but it's unlikely to make the playing actually
sound better. Or suppose the big question this season is whether the
Pistons, with the new titanium fibril implants in their quads, will beat
the Spurs, with their prosthetic forearm extenders. Who cares? It's as
exciting as watching to see if the PC team defeats the Macs at virtual
synchronized swimming.

Where does the line go?

There is nothing intrinsically wrong with making us better than well,
but there are certain lines that should not be crossed. One boundary I
hear often is that we should not alter the normal chemistry of the
brain. In this scenario, it would be fine to perform gene therapy in,
say, the bladders of aging men, to banish the inevitable increase in
what a polite doctor might call urinary urgency, so that middle-aged men
would need to go to the bathroom only once a day, at exactly noon. The
problem with this "keep the brain sacrosanct" strategy is that we
already alter the brain's neurochemistry all the time. The average
person who has gotten no sleep the previous night is pretty
useless-unless she makes herself neurochemically better than well with
the timely ingestion of a cup of caffeine.

Another popular do-not-cross line involves inheritance: We should not
manipulate the germline, which would allow hardwired genetic changes to
carry on to the next generation. In this view, if you want to splurge
for cosmetic surgery to get some fancy neon antler implants, that's your
puzzling prerogative. Just don't manipulate your germline so that you
pass on the antler trait to your kids.

But couldn't controversial science also determine what traits are not
passed between generations? Consider Tay- Sachs, a congenital disease in
which massive deposits of lipids build up in the brain, destroying
it-and the child-within a few years. Most people would agree that this
constitutes a less-than-well disease state, and they would be
comfortable with prenatal screening to eliminate the disease from the
gene pool. But what about other ideas for manipulating the germline by
elimination? It is generally considered an example of "well" to be able
to have healthy children. But in parts of China and India, being
guaranteed to have a healthy boy would count as better than well. Is it
OK to determine the gender of a child through in-vitro techniques,
allowing only a certain type of sperm to cozy up to an egg?

Who here wants superpowers?

Once we have the means to make someone better than well, what should we
do with that ability? Suppose Big Pharma develops a smart drug to
manipulate cognition so that an individual thinks better and learns
better under stress instead of having those abilities impaired. What's
wrong with that? As I mentioned, my lab is working on this; to me it
seems like a good idea to give such a drug to safety workers whose
actions could determine whether the next Chernobyl occurs. But should it
be something a student can take in preparation for an SAT exam? How
about the stressed-out death-squad commander making a snap decision as
to how best to ethnically cleanse a village of civilians?

The rich get richer. Do the well get better than weller?
The great promise of technology in Western civilization is that it will
make all our lives better. It's a nice sentiment, but it rarely works
this way. In their book The Axemaker's Gift, James Burke and Robert
Ornstein document how most technological innovations have done precisely
the opposite of leveling the playing field, concentrating more power
into the hands of the few, starting with the first dawn-of-man guy to
invent a really good cudgel.

The same applies in medicine. It is those high on the socioeconomic
ladder who are most likely to hear about a medical innovation, to
understand its implications, to have a cousin whose friend's sister can
get them at the top of the list to receive it, and to be able to afford
it (whether thanks to health insurance or deep pockets). During the past
few decades, the U.S. has had an unprecedented economic boom, has been
at the core of the biotech revolution, and has spent the highest
percentage of its GDP on health care of any country on Earth. Despite
that, we rank something like 29th in life expectancy, in large part
because we're moving in the direction of a dichotomized nation-where our
urban poor are elderly by age 60, crippled with heart disease, obesity
and diabetes, while our wealthy septuagenarians are wrestling with the
decision of whether to go for the knee replacement this close to ski
season. The best of our biomedical science doesn't always trickle down
very far.

Who's well, anyway?

Before you opt for prosthetic x-ray eyes or genetically engineered
opposable big toes-or whatevers -to make you better than well, you have
to have de-cided what constitutes well. And this is where we, as
individuals and societies, have a pretty bad track record of making
sensible judgments about what counts as normal. For example: In the
early 1990s a hormone called leptin, which suppresses appetite, was
discovered. People went hog-wild at the news, assuming that we'd found
the magic fat pill for society at large. As it turns out, though, most
overweight people don't suffer from a shortage of leptin.

There are certain people, however, who have a mutation resulting in
extremely low leptin levels. An article in the journal Science reported
on three Pakistani families whose members were described, in an
unexpected departure from scientific argot, as "chubby." You know what
happens next-in swoops the Leptin SWAT Team to give these people
synthetic leptin, suppress their appetites, melt away their chub, propel
them toward a successful life of winning elections, having strings of
highly publicized affairs with glitterati, appearing on the cover of
People, et cetera.

But here's where the leptin Albert Schweitzers ran aground: The family
refused the treatment. "These people are from a culture that considers
it a status symbol to be chubby," reported Science. And thus you are
left with the boggling specter of having to convince people that
according to the dominant culture, there's something wrong with them, in
order to then cure them of their wrongness. This is a disturbing domain.
We are already in a world that promises ways to make people better than
well with a nose job, breast implants, cosmetic products to straighten
out their kinky hair, or tanning salons to keep them bronze year-round.
Such modifications sometimes do wonders for the quality of someone's
life. But we don't need fancier science to be even better at egging on
and then accommodating people's insecurities or their shame at who they
and their people are.

Ironic ending department

Finally, one of the best reasons to stop and question some of these
better-than-well advances is that when they work, they may ultimately
accomplish nothing. We are a terribly invidious species. Psychology
studies have shown that, for example, people are not happy receiving x
more dollars in salary if it means that their neighbor gets 2x more. In
reality, none of us wants to be rich; what we want is to be richer than
other folks. Similarly, there are few reasons to be tall, in absolute
terms; in fact, there are some health risks associated with being
extremely tall. There are, however, ample societal benefits to being
taller than other people.

Which brings us back to the mathematical difficulties so many people
have with averageness: No matter how marvelous the state-of-the-art
science, no matter what miracles are accomplished by my kindred
Bio-Elves of the Laboratory, the majority of society will still not be
able to be taller than average, smarter than average, more beautiful
than average, and so on.

You can imagine plenty of better-than-well interventions that would be
appealing for their own sake. Personally, I would find it very
pleasurable to have genetically engineered cochleas that would allow me
to hear gorgeous birdsong from many miles away, or gills that would make
exploring coral reefs simpler or, as long as we're at it, a nifty
prehensile tail. But if science is being recruited to make someone
better than well to gain the advantages it would bring in society, it's
a dead end. All you'll be doing is buying into an ever-spiraling arms
race of needing to be better than well, and then needing to be better
than the new and improved well, and then . . . well, you get the
picture.

I think it's scarier than average.

Robert Sapolsky is a professor of neuroscience at Stanford University, a
MacArthur "genius" Fellow, and author of five books, including Why
Zebras Don't Get Ulcers.