MEDICINE & HEALTH: THE RADICAL FUTURE HAS BEGUN
By Maynard D. Poland, M.D.
As presented to his DePauw University Class of 1957
Medical advances in the last 50 yearsimmunizations, organ transplants, heart surgery, pharmaceuticals, joint replacement, flexible endoscopy, and imaging, among othershave helped increase expected life span 17 years . Although dramatic, those innovations have been gradual enough that they did not suddenly change most of our lives in a radical way. But fasten your seat belts for the coming wild ride of rapid change due to the accelerating pace of technologic advances.
Many scientists and U.S. government agencies believe we are quite close to enormous, difficult-to-imagine changes in how we live and what it means to be human. Those changes are predicted to eliminate most disease, thus reducing the problem of cost and access to acute and chronic care , but they will also introduce new ethical problems about changing humans.
The basis for those predictions is that "human scientific [and technologic] progress is exponential: It expands by repeatedly multiplying by a constant (10 times 10 times 10, and so on) rather than linear (10 plus 10 plus 10, and so on). Exponential growth starts out slowly and virtually unnoticeably, but as it accelerates, on the upswing of the graphic curve, it turns explosive and profoundly transformative...models show that we are doubling the paradigm-shift rate for technology innovation every decade." Thus, "the twentieth century was gradually speeding up to today's rate of progress. Those 100 years of achievements from 1900 to 1999 "were equivalent to about 20 years of progress at the rate [of the year] 2000. We will make another '20 years' of progress in just 14 years (by 2014), and then do the same again in only seven years." 
To express it in another way, in the twenty-first century, human scientific and technologic progress will be "1,000 times greater than...in the twentieth century."
We are advised that we should "anticipate...the social repercussions that follow as a consequence of such explosive change. We [should] see the future as being different from the present, far more surprising than most people realize, because few observers have truly internalized the implications of the fact that the rate of change is itself accelerating. The pace of technologic change will be so fast and far-reaching that human existence on this planet will be irreversibly altered. We will combine our brain powerthe knowledge, skills, and personality quirks that make us humanwith our computer power in order to think, reason, communicate, and create in ways we can scarcely even contemplate today."
According to predictions, "This merger of man and machine, coupled with the sudden explosion in machine intelligence and rapid innovation in gene research and nanotechnology, will...allow us to transcend our frail bodies with all their limitations. Illness, as we know it, will be eradicated. In the next 20 years, a significant number of people will live to 115, and there are now alive people who will live to be 150 years old. Beyond that, human existence will undergo a quantum leap in evolution to the point that we will be able to live as long as we choose."
Radical Future Seen
Recent developments in reproduction and genetics should help convince us that the radical future is upon us. Genetically altered bacteria produce human insulin. Assisted reproduction enables lesbian and single mothers to have children; enabled a surrogate South African woman to give birth to her own grandchildren, triplets; enable men with low sperm counts to father genetic offspring by means of intracytoplasmic sperm injection, a type of in vitro fertilization in which a sharpened pipette launches sperm into an egg; enable a woman with aging eggs to gestate an embryo produced by her husband's sperm and a young donor's oocyte (egg), thereby bearing his child, or children, since in vitro pregnancies often result in multiple births; enable gay male couples to choose a young egg donor who is screened for looks, family history, and SAT scores, then contract with a surrogate mother (who has done this before) to carry their child or children. One such gay couple's surrogate bore twins, and one of the twins was one of the gay man's genetic offspring, and the other twin was the other gay man's genetic offspringan immense source of pride to both men .
Genetics is now being used to prevent cancer, as illustrated by the case of the identical twin sister of a 31-year old woman who was treated for metastatic breast cancer. The twins' grandmother had breast cancer at age 50, and an aunt died of ovarian cancer at age 43. After the twin's breast cancer was diagnosed, both twins underwent genetic testing. Both tested positive for a mutated gene that increases the likelihood of developing breast and/or ovarian cancer, and the twin without known breast cancer had both breasts removed as a preventative. Both twins, also genetically predisposed to ovarian cancer, will have their ovaries removed at age 35 as a preventative .
But we are just at the beginning. Following the mapping of the human genome , a number of large-scale projects are now underway to survey large segments of the population to correlate individual's genetic make-up with the person's and that person's family history of health and disease.
This is no small undertaking. For instance, Northwestern's Center for Genetic Medicine is working to define the genetic basis of disease by detailing the phenotypic characterization in conjunction with DNA samples of over 100,000 individuals in the diverse Chicago population . To enable this investigation, the U.S. government is in the process of passing laws to protect the privacy of the genetic information .
Molecule Replacements Fix Flaws?
Those large-scale population studies, rapidly disseminated through unrestricted public databases, will aid in the eventual understanding of how genes work and exactly what happens at the molecular level to cause disease. That range of diseases varies from those caused by a single gene (cystic fibrosis, sickle cell anemia) to more common diseases like cancer, Alzheimer's disease, diabetes, and heart disease, where several genes in interaction with environmental factors influence who develops a disease and when. Alterations in our genes are responsible for an estimated 5,000 clearly heredity diseases, and alterations in the genetic amino acid "spelling" of the instructions for making proteins influence the development of common illnesses that arise through interaction of genes with the environment.
Gene-based therapy  may include replacing the protein in the gene that would cause a disease , a simpler and perhaps more effective treatment than trying to replace the gene. Or, it may be possible to administer a small molecule that interacts with the proteinas many drugs doand change its behavior, as has been done already .
Some scientists believe that gene therapy will also involve replacing a misspelled gene with a functional gene, or even adding a new chromosome .
One scientist and futurist believes that by the year 2020, the full effects of the genetic revolution will be felt across society, that "Accelerating progress in biotechnology will enable us to reprogram our genes and metabolic processes to propel the fields of genomics (influencing genes), proteomics (understanding and influencing the role of proteins), gene therapy (suppressing gene expression as well as adding new genetic information), rational drug design (formulating drugs that target precise changes in disease and aging processes), as well as therapeutic cloning of rejuvenated cells, tissues, and organs." And that, "Genetic and molecular science will... not only correct obvious flaws (such as our vulnerability to disease), but also will drastically extend the usability of the 'house' each of us call his body and brain ."
In regard to extending "the usability of our bodily house," one estimate is that eliminating 50% of medically preventable conditions would extend human life expectancy to 150 years, and if we were able to prevent 99% of naturally occurring medical problems, we'd live to be hundreds of years old .
But controversy in Gene therapy arises over germ-line interventions, which changes the genetic makeup and is propagated forever, as envisioned by most authorities. Thus the controversy over "designer babies"; it is one thing to intervene to cure or prevent disease, but quite another thing to enter the world of "designer genes" that are aimed at producing individuals with "off-the-chart" IQs and physical attributes. It is one thing to envision people selecting the color of their kid's eyes, but some people worry that the next thing you know, we will have clusters of genetically enhanced super humans who will dominate, if not enslave, us . Or, could a genetically altered microbe destroy humanity?
Messing with our genes is very tricky because of the possibility of unintended results. Nonetheless, there are those who believe that we are in the early stages of the genetic revolution today, that by understanding the information processes underlying life, we are learning to reprogram our biology to achieve the virtual elimination of disease, dramatic expansion of human potential, and radical life extension, and that, "To not be human in the sense we use the term now, is the fate of our descendants. We will soon see humans as physically and intellectually divergent as poodles and Great Danes... as we fast-forward our evolution as the inevitable outcome of the decoding of the human genome. We have spent billions to unravel our biology, not out of idle curiosity, but in the hope of bettering our lives, " as does in vitro fertilization for millions of couples now.
Rebuild Bodies with Nanotechnolgy
Another technology that will drive radical change in the near future is nanotechnology, which works in the size of one billionth of one meter. Predictions are that "the effects of the nanotech revolution will be widespread by the mid to late 2020s, and ultimately will allow us to rebuild our bodies and our brains and the world with which we interact, going far beyond the limitations of biology...[and that] around 2030, nanobots will be able to expand our minds through the merger of biological and nonbiological, or "machine" intelligence, and so the development of so-called "super intelligence," going far beyond the limitations of biology.
An early example is the development by MicroCHIPS of Bedford, Massachusetts, of a computerized device that is implanted under the skin and delivers precise mixtures of medicines from hundreds of nanoscale wells inside the device. Future versions of the device are expected to measure blood levels of substances such as glucose, and the system could be used as an artificial pancreas, releasing precise amounts of insulin based on the blood glucose level...or the system could also be capable of simulating other hormone-producing organs .
Ray Kurzweil, inventor and futurist, says that, "The most powerful impending revolution [will be] artificial intelligence in all its variations and including computer thinking ability that exceeds the thinking ability of humans. We are very close to the day when fully biological humans (as we now know them) cease to be the dominant intelligence on the planet. By the end of this century, computational or mechanical intelligence will be trillions of trillions of times more powerful than unaided human brain power...The merger of these two worlds of intelligence is not merely a merger of biological and mechanical thinking mediums, but also a merger of method and organizational thinking that will expand our minds in virtually every imaginable way ."
Are such predictions likely to come true?
Do you know about DARPA, The U.S. Defense Advanced Research Projects Agency, one of the world's foremost drivers of human enhancement? DARPA thinks and funds 20 to 40 years into the future, and its only charter is radical evolution, to "accelerate the future into being" according to its strategic plan . Among many actions that DARPA has pioneered  has been the Internet, computers that recognize human speech and translate languages, the global positioning system, the cell phone, night-vision sensors, weather satellites, spy satellites, the stealth airplane, and various military robots. DARPA sponsored the development of the first fully integrated prosthetic arm, completed ahead of schedule earlier this year. The prosthetic arm looks real, can be controlled naturally, and provides sensory feedback .
Since the late 1990s, DARPA has increasingly focused on human biology, and today is in the business of creating better humans, human enhancement. It is particularly interested in creating human beings who are unstoppable in combat, thus DARPA programs are developing a pain vaccine to block pain, methods of overcoming fatigue, drastic acceleration of wound healing, mental control of bleeding, blocking pathogens used in terrorism, and control of cellular metabolism with the aim of tuning up every soldier's metabolism to the level of Olympic endurance athletes. DARPA programs are also looking at connecting living neurons inside the brains of humans with wires that lead to computers .
The DARPA list goes on and on. Of course, civilian applications of the results of DARPA-sponsored programs are numerous.
Still not convinced that the radical future is upon us? Consider the National Science Foundation and the United States Department of Commerce's 415 pronouncement entitled Converging Technologies for Improving Human Performance . It states, "It is time to rekindle the spirit of the Renaissance" to achieve "a golden age that will be a turning point for human productivity and quality of life." Among the bullet points summarizing the predictions as a result of radical evolution in the next 10 to 20 years are that:
The World Transhumanist Organization is betting strongly on these predictions, and is willing to help ensure that they happen. They believe in the engineered evolution of "post-humans," defined as beings "whose basic capacities so radically exceed those of present humans as to no longer be unambiguously human by our current standards." "Transhuman" is their description of those who are in the process of becoming posthuman, and they believe some of us are entering that metamorphosis right now. A "way-out" fringe group? Consider that a conference called "The Adaptable Human Body: Transhumanism in the 21st Century" was co-sponsored by the World Transhumanist Association and the Yale Interdisciplinary Bioethics Program Working Research Group on Technology and Ethics .
And consider the 330-page report of The President's Council on Bioethics, entitled Beyond Therapy: Biotechnology and the Pursuit of Happiness. The report states, "Biotechnology offers exciting and promising prospects for healing the sick and relieving suffering. But exactly because of their impressive powers to alter the workings of body and mind, the "dual uses" of the same technologies make them attractive also to people who are not sick but who would use them to look younger, perform better, feel happier, or become more 'perfect'. These applications of biotechnology are already presenting us with some unfamiliar and very difficult challenges ."
"We now have techniques to test early human embryos for the presence or absence of many genes: shall we use these techniques only to prevent disease or also to try to get us 'better' children? We are acquiring techniques to boost muscle strength and performance: shall we use them only to treat muscular dystrophy and the weak muscles of the elderly, or also to enable athletes to attain superior performance?
“We are gradually learning how to control the biological processes of aging: should we seek only to diminish the bodily and mental infirmities of old age or also to engineer large increases in the maximum human lifespan? We are gaining new techniques for altering mental life, including memory and mood: should we use them only to prevent or treat mental illness or also to blunt painful memories of shameful behavior, transform a melancholic temperament, or ease the sorrows of mourning? Increasingly, these are exactly the kinds of questions that we shall be forced to face as a consequence of new biotechnical powers now and soon to be at our disposal. Increasingly, we must ask, 'What is biotechnology for?' 'What should it be for?'" 
And what about access to biotechnological advances? "If, as is now often the case with expensive medical care, only the wealthy and privileged will be able to gain easy access to costly enhancing technologies, we might expect to see an ever-widening gap between 'the best and brightest' and the rest." 
But enhanced people walk among us already. Prescription drugs are being used in the workplace to enhance mental capacity. Athletes are using drugs. Scientists at the University of Pennsylvania have created genetically modified "mighty-mice" that are shockingly large and muscular, built like steers, with massive haunches and necks wider than their heads. The scientists have been deluged with calls from athletes and coaches who want to try this technology themselves. And scientists say that such "gene-doping" could work in humans.
And there are those who think if humans stay unchanged in our present state, we are unlikely to last very long; but also, there are those who think that radical evolution poses many risks, from uncontrolled nanobots eating everything in sight so that all that's left of the world is a gray goo, to uncontrollable artificial intelligence coupled with robots that rule humans . Or, maybe human control over the machines will be retained, but only by a tiny elite .
The Future Is Today
And how will the radical future affect human relationships and what it means to be human?  Is that radical future here already, as evidenced by some people's interaction with their computers? 
It seems apparent that preparation of our young people to live the radical future is of utmost importance, and undergraduate education has the responsibility, the obligation to do so by training its students in what is being called futurism or futuring. Today's college students face quite a different future world than we did 50 years ago, and they will need innovative instruction to make decisions about technologic and ethical challenges they will face. An academic course in futuring will equip young minds to understand the overall history and future of change, understand the systems approach of dealing with change, and to better deal with the ethical problems and a myriad of other issues that are not covered in the standard curriculum.  I would urge DePauw to consider offering such a course in futuring.
"Science is a magnificent human achievement. But it cannot tell us how to live or what we should live for."  How to live and what we should live for, in the future as well as in the present, is the business of the liberal arts college.
Maynard D. Poland, M.D.
You may write Dr. Poland at firstname.lastname@example.org
After gradating from DePauw University in 1957, Maynard Poland graduated from Northwestern U. Medical School, served an Internship and Internal Medicine Residency at Methodist Hospital in Indianapolis, and finished his training with an NIH fellowship in Diabetes at the Joslin Clinic and New England Deaconess Hospital in Boston. He then served in the Army Medical Corps for two years, including a tour in Vietnam.
After military service, Maynard joined a multi-specialty group in Milwaukee, Wisconsin, where he practiced for 29 years. During the last six years with that 90-physician group, he was the Medical Director and the Associate Administrator of Patient Care Services. He left practice to become the Medical Director for a large physician network in the Milwaukee area for two years, then for the last four years before retirement, was the Medical Director for Utilization and Quality Management for a group of hospitals in Milwaukee. During his medical career, Maynard was on the clinical faculty of the Medical College of Wisconsin.
During his years in Milwaukee, Maynard campaigned a racing sailboat on Lake Michigan with wife and DPU grad Elly.
Since retirement to Ft. Myers, FL, in 2001, Maynard has taught Anatomy & Physiology, and Medical Terminology at Edison College in Ft. Myers. He also spends considerable time writing, has published the memoir of a woman who was a Navy and a commercial pilot, titled On Wings of Trust, and has begun work on a medical novel. He is active in the Gulf Coast Writers Association of Southwest Florida.
Even without the predicted radical changes mentioned in the foregoing text, modification of risky lifestyle and harmful behavior (use of tobacco and drugs, excessive use of alcohol, and accident-prone activity), could dramatically improve health and duration of life. Further, the cost of the consequent development from obesity of diabetes, cardiovascular disease, chronic renal disease and kidney failure, and blindness, all caused by the adoption of western lifestyle involving decreased physical activity and over consumption of cheap, energy-dense food, is projected to overwhelm the economies of some developing countries in the next 30 years. 
What about present day concern regarding affordable access to quality medical care? There are many opinions about what can be done to address the delivery, quality, and affordability problems of medical care. In fact, there is good data to show that the cost of medical care in the United States could be reduced by 30% and the quality of care improved.  The Federal Agency for Healthcare Research and Quality is making some inroads in this effort through its compilation and release to the public of its data and ranking by state of hospitals, ambulatory care, nursing home care, and home health care. This information has caused health care providers to intensify their efforts to improve quality, and nationally, hospitals have shown significant improvement in some quality measures. 
However, the interests of the multiple involved parties, patients, doctors, nurses and other medical professionals, hospitals, employers, insurers and third party payers, and government are so disparate, and each is so engrossed in self-interest on so many levelspolitical, economic, social, ideologicaland pulling in so many different directions, that there appears to be little hope in the near future for meaningful health care reform in the U.S. As others have said, it is not just that the system is broken, in fact, we have no system, and thus 47 million Americans are without health insurance.
As a consequence of ever-increasing cost, some Americans are now traveling to foreign countries for medical care, especially for surgical procedures (including hip replacement and heart surgery) by U.S.-trained and Board-certified surgeons in Joint Commission International accredited hospitals. Total costs, including airfare and hotel stays are a fraction of the same care in the U.S., and some U.S. insurers are paying for this foreign care. In 2006, an estimated 150,000 Americans traveled abroad for medical care, saving individuals between 15 and 85% of the cost of the same care in the U.S. Two states, Colorado and West Virginia, are considering laws that would require insurers of state employees to cover procedures in overseas hospitals, including travel expenses and hotel stays for the patient and a travel companion, and requiring that the insurers give patients an incentive for choosing the less expensive overseas treatment by passing along 20% of the cost savings to the patient, and depositing the remaining 80% of savings in an account to reduce health premiums for all covered employees. 
Concerns about cost, accessibility, and convenience have resulted in increasing amounts of care by non-M.D.s, including employer-sponsored diabetes counseling by pharmacists, and express treatment centers with nurse practitioners in commercial establishments (CVS and Walgreens' pharmacies, Target, Wal-Mart). On-line access to health, medical, and pharmaceutical information also bypasses or supplements physician services.
As people demand more care and physicians are pressed for time and pressured by financial considerations, the generalist has abandoned the hospital so that we now have a purposeful discontinuity of care with Family Practitioners and Internists giving up their hospital practices to Hospitalists, physicians who are full-time in the hospital. Some opinion holds that this movement may technically improve care, but it may also impair the human caring connection between doctor and patient because of the transient relationship between the patient and hospitalist.
Finally, while we live in the present, and until those predicted technologic advances bring about the changes suggested in the foregoing text, consider the following comment: "The irony is that the healthier western society becomes, the more medicine it cravesindeed, it regards maximum access as a right and duty. Especially in free-market America, immense pressures are createdby the medical profession, by medi-business, the media, by high-pressure advertising of pharmaceutical companies, and dutiful (or susceptible) individualsto expand the diagnosis of treatable illnesses. Scares are created. People are bamboozled into lab tests, often of dubious reliability. Thanks to diagnostic creep or leap, ever more disorders are revealed. Extensive and expensive treatments are then urged, and the physician who chooses not to treat may expose himself to malpractice accusations. Anxieties and interventions spiral upwards like a space-shot off course.
"The root of the trouble is structural. It is endemic to a system in which an expanding medical establishment, faced with a healthier population, is driven to medicalizing normal events like menopause, converting risks into diseases, and treating trivial complaints with fancy procedures. Doctors and 'consumers' are becoming locked within a fantasy that everyone has something wrong with them, everyone and everything can be cured.
"Medical consumerismlike all sorts of consumerism, but more menacinglyis designed to be unsatisfying. The law of diminishing returns applies. Extending life becomes feasible, but it may be a life exposed to degrading neglect as resources grow overstretched and politics turn mean.
"History...suggests that medicine's finest hour is the dawn of its dilemmas...Today, with 'mission accomplished.' it triumphs are dissolving in disorientation. Medicine has led to inflated expectations, which the public eagerly swallowed. Yet, as those expectations become unlimited, they are unfulfillable: medicine will have to redefine its limits even as it extends its capacities." 
Recent Developments & Additional References by Topic
• Gene Quest: Clues to disease culled from 3 billion bits of DNA by Colin Nickerson, The Boston Globe, May 21, 2007.
• The Mixed Promise of Genetic Medicine by Carl Elliot, M.D., Ph.D. N. Eng. J. Med., Vol.356, No. 20, May 17, 2007. Pp. 2024-2026.
• Scientists allowed to experiment on hybrid embryos by Nic Fleming, Science Correspondent. Telegraph Media Group Limited, May 19, 2007, available at http://www.telegraph.co.uk.
• Genetics of Complex Human Diseases, Center for Genetic Medicine, Northwestern Institute on Complex Systems, http://www.northwestern.edu/nico/centers/gchd.
• What Genome-wide Association Studies Can Do for Medicine by Christensen and Murray, N. Eng. J. Med., Vol. 356, No. 11, March 15, 2007. pp. 1094-1097.
• Structural Variation in the Human Genome by James R. Lupski, M.D., N. Eng. J. Med., Vol. 356, No. 11, March 15, 2007. pp1169-1171.
• The Next Human Genome Project: Our microbes by Emily Singer, Technology Review, May 2, 2007.
• Bots on The Ground: in the Field of Battle (Or Even Above It), Robots Are a Soldier's Best Friend by Joel Garreau, Washington Post, Sunday, May 6, 2007.
• Robot Wars: An attempt to build an ethical robotic soldier, from Economist.Com Science Technology
• Quarterly, April 17, 2007.
• MRI-enabled brain surgery robot revealed, NewScientist.com news service, April 18, 2007.
• Scientists to build robot society, BBC News, April 24, 2007.
• Neuron-Microchip Interface: Scientists foresee new possibilities in cell-based computing, The Futurist, July-August, 2006. p.14.
• Hearts & Minds: Since Plato, scholars have drawn a clear distinction between thinking and feeling. Now science suggests that our emotions are what make thought possible. By Jonah Lehrer, The Boston Globe, April 29, 2007.
• Pentagon to Merge Next-Gen Binoculars With Soldiers' Brains by Sharon Weinberger, May 1, 2007, available at http://www.wired.com.
• Virtual reality gives helping hand in advancing physical therapy by Steven Stanek, Associated Press, December 8, 2006.
• Nanotechnology could be the basis of future cures by Jon Van, Chicago Tribune, April 23, 2007.
• Unbounding the Future: the Nanotechnology Revolution, Chapter 1. The Foresight Nanotech Institute, available at http://www.foresight.org.
• Nanotechnology offers hope for spinal cord, diabetes, Parkinson's by BJS, April 23, 2007, available at http://www.scienceblog.com.
• 3D Nano Images: IBM researchers have developed a nuclear MRI technique that can see features as small as 90 nanometers, Technology Review, Published by MIT, April 23, 2007.
PREDICTIONS FOR TECHNOLOGY
• Startling technologies promise to transform medicine by C. Donald Combs, BMJ 2006; 333; 1308-1311. See bmj.com.
• Bostrom Responds to Fukuyama's assertion that Transhumanism is World's Most Dangerous Idea by Nick Bostrom, September 10, 2004. http:/www.transhumanism.org/index.php/WTA/more/451/
ETHICS & RELIGION
• Robo-quandry: Marquette professor looks a growing debate of using technology to enhance humans by Mark Johnson, Milwaukee Journal Sentinel, May 8, 2007.
• The Ethics and Politics of Compulsory HPV Vaccination by James Colgrove, Ph.D., M.P.H., N. Eng. J. Med., Vol. 355:2389-2391, December 7, 2006. Vol.23.
• Science that Backs Up Faith, Interview by Rob Moll of Lee Strobel, ChristianityToday, June 1, 2005, available at http://www.christianitytoday.com/ct/2005/122/33.0html.
• Talking Points by Philip M. Boffey, The New York Times, January 18, 2006. This is a review of the 2005 legal battle over intelligent design vs. evolution.
• In 'Design' vs. Darwinism, Darwin Wins Point in Rome by Ian Fisher and Cornellia Dean, The New York Times, January 19, 2006.
• A good general text reviewing the Evolution-Creationism debate which covers the controversy from all viewpoints is Evolution vs. Creationism by Eugenie C. Scott, Greenwood Press, 2004.
* * *
Recent novels that dramatize various aspects of the radical changes from technology in the near future include:
• Breakpoint by Richard A. Clark (Putnam, 2007). By way of background, Clark was National Coordinator for Security and Counterterrorism for both President Clinton and President George W. Bush. His previous book, Against All Enemies, covers his disagreements with Bush that led to his leaving that administration.
While not particularly good literature, Breakpoint does explore the impact in the year 2012 of emerging technologies. From a review: In the book, "'Globgrid,' a high-speed global network, links supercomputers worldwide. Combined with advanced AI software, it promises to reverse-engineer the brain, revolutionize genomics, enable medical breakthroughs, develop advanced human-machine interfaces, and allow for genetic alterations and even uploading consciousness. But it spurs a terrorist-fundamentalist Luddite backlash against Transhumanists, as hackers take down the power grid, and destroy vital international data and telecom links, communications satellites, and biotech firms."
Clark comments: "Breakpoint…is meant to be predictive, at least about technology. It may read to some like science fiction, but it is based on emerging technologies…Scientists and engineers differ in their views…but their differences are most often a discussion of 'when,' not 'if.'" Taken from KurzweilAI.net: http://kurzweilai.net/articles/art0703.html.
• Next by Michael Crichton (Harper Collins, 2006). Crichton's book includes an author's note that contains his conclusions and practical recommendations regarding laws regulating genetic science and application. The book also has an excellent bibliography, which was also a valuable addition to his previous book, State of Fear. Critics of State of Fear badly misquoted Crichton as saying that there is no such thing as global warming, when what he was really saying was that both sides of the issue were harming their case by quoting bad science and misquoting good science.
1. The average human life span throughout human history has been about 18 years (the Extreme Future by James Canton, Ph.D., Dutton, 2006. p. 121). For someone born in 1800, life expectancy was about 30 years. For people born in 1935, the birth year of most of the DPU class of 1957, life expectancy for U.S. citizens averaged about 61 years. By the time the class of '57 graduated in '57, the average American life expectancy had improved to about 69 years. The most recent life expectancy for persons born in 2005 is 75 years for men and 80 years for women (World Health Organization 2007 Report). Thus, the expected human life span in this country has more than doubled in the last two hundred years.
Non-medical factors were important in the increase in life expectancy in the 1800s and early 1900s. Deaths from infectious disease began decreasing in England in the 1830s. Special TB hospitals slowed the spread of disease, but many non-medical factors were mainly responsible for the increase in longevity in the 18th and early 19th centuries: economic growth, improved education and literacy (even more important than income), better urban sanitation, pasteurization of milk, better nutrition, and individuals became more resilient and self-confident, which improved strength of immune systems. Medically, diagnosis and treatment then moved from the general (use of toxic mercury, purging and bloodletting to restore the proper balance of the body's "humors"black bile yellow bile, blood and phlegmstopped), and medical science and physicians began to focus on the cause and localize diagnosis and treatment (from Why Things Bite Back: Technology and the Revenge of Unintended Consequences by Edward Tenner, Knopf, 1996, pp. 27-34).
The APPENDIX contains comment on the effect on health and longevity of risky lifestyle and harmful behavior.
2. See the APPENDIX for a brief comment on decreasing the cost and improving the quality of medical care in the present time.
3. This quote and those that immediately follow until the next attribution are from Reinventing Humanity: The Future of Machine-Human Intelligence by Ray Kurzweil in The Futurist, March-April 2006. Pp. 39-48. Many of the ideas and statements in this text are taken from this article and also from Radical Evolution by Joel Garreau (Broadway Books, 2005).
4. This paragraph was taken from the book review, Children on Demand, of Everything Conceivable by Liza Mundy, Knopf, in THE NEW YORK TIMES BOOK REVIEW, Sunday, April 22, 2007.
5. From: When woman gets cancer, twin takes drastic step by Cynthia Sewell, McClatchy News Service, April 10, 2007.
6. The Human Genome Project began in the U.S. in 1990, when the National Institutes of Health and the Department of Energy joined forces with international partners to decipher the massive amounts of information contained in our genomes. Completed ahead of schedule in 2003, at less than predicted cost, the accuracy of mapping the human DNA was greater than 99.99% (National Human Genome Research Institute & National Institutes of health at www.nhgri.nih.gov , and NIH publication No. 00-4873).
8. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 prevents the use of genetic information in making employment decisions and in setting insurance rates for an individual in a group contract. Congress is on the verge of passing legislation, The Genetic Information Nondiscrimination Act, which would expand protection for persons undergoing genetic testing, and President Bush has said he will sign that Act into law (see: U.S. to outlaw corporate prejudice based on genes, NewScientist.com 10:00 06 May2007). This legal protection is immensely important to the large-scale testing necessary to determine the genetic basis for a wide range of diseases (Prohibiting Genetic Discrimination by Kathy Hudson, Ph.D., N Eng J Med 356;20 May 17, 2007, pp. 2021-2023). The American public can now access genetic tests, feel safe about their genetic information not being misused, and participate in research that involves genetic information. It will be illegal to deny U.S. citizens jobs or insurance simply because they have an inherited illness or a genetic predisposition to a particular disease. But this is just the beginning of many ethical and legal decisions that will arise because of genetic and other scientific and technologic advances.
9. There are two kinds of genetic engineering. The first, somatic gene therapy, intends to fix genes gone bad in one person. It treats diseases such as cystic fibrosis, immune deficiency disorders, sickle-cell anemia, and hemophilia. Somatic gene therapy usually is not very controversial, except when it kills the person on whom it is being tested, and especially when that person was not adequately informed of the risk, as happened in the 1999 death of Jesse Gilsinger. The reason somatic therapy is not hugely debated is that it only swaps out bad genes in specific areas, the lungs, the liver, of the person being treated. Changes are not passed on to succeeding generations, and thus it is usually viewed as not tremendously different from surgery (from Radical Evolution by Garreau, p. 116).
The problem with the second kind, "germ-line intervention," as stated in the following text and addressed in footnote no. 12, is that, "Messing with our genes is very tricky because of the possibility of unintended results" (among other contentious sequellae), which would be passed on to subsequent generations.
10. Within the approximately 30,000 genes in the human genome, mapping of human genetic variation (completed in 2005) has revealed 10 million snippets (single nucleotide polymorphisms, or SNPs, pronounced "snips") or sections of genetic material that vary from individual to individual. The SNPs are responsible for individual traits, but are also "lairs" for disease (Gene Quest by Colin Nickerson, The Boston Globe, May 21, 2007).
11. One of the first examples of such therapies is a drug that targets the genetic flaw that causes chronic myelogenous leukemia. In that disease, an unusual joining of chromosomes 9 and 22 produces an abnormal protein that spurs the uncontrolled growth of white blood cells. Scientists have designed a drug that specifically attaches to the abnormal protein and blocks its activity. In preliminary tests, blood counts returned to normal in all patients treated with the drug, and, compared with other forms of cancer treatment, the patients experienced very mild side effects.
12. Gregory Stock, Director of the Program on Medicine, Technology, and Society at the School of Medicine of the University of California at Los Angeles, proposes adding a new chromosome, pair nos. 47 & 48 to the embryo, and the possibilities will be endless. It will add plug-in points where you can stick gene modules and their controls. The auxiliary chromosome would be a universal delivery vehicle for gene modules fashioned by medical geneticists, minimizing unintended consequences. In addition, the insertion sites could have an off switch activated by an injection to stop what was started, if that was needed, giving future generations a chance to undo whatever we did. It would also allow us to stick modifications into our kids that they could choose to turn on or off later in life. Stock sees that auxiliary-chromosome-that-could-be-turned-off idea as disarming the ethical argument of the Council for Responsible Genetics that germ-line engineering should be unconditionally banned because future generations screwed up by wrongful or unsuccessful germ-line modifications would have no control over the matter (from Radical Evolution by Garreau, pp. 115-118. Also, see footnote no. 16).
13. Reinventing Humanity by Kurzweil, pp. 39-46. See also The Singularity Is Near When Humans Transcend Biology by Ray Kurzweil (Penguin Books, 2005).
15. Is that worry a real possibility? Remember Eugenics, a pseudoscientific American movement of the early 20th century based on selective breeding of humans that included coercive/involuntary sterilization of over 60,000 "unfit" Americans, one-third of them after Nuremberg declared such practices crimes against humanity. Begun in laboratories on Long Island and supported by the most prominent organizations and leaders in the U.S.Carnegie Institution, Rockefeller Foundation, Harvard, Yale, Princeton, Stanford, American Medical Assn., Margaret Sanger, Oliver Wendell Holmes, Woodrow Wilson, and a sweeping array of government agencies, among othersthis movement extended to Nazi concentration camps (See War Against The Weak: Eugenics And America's Campaign To Create A Master Race by Edwin Black (Thunder Mouth Press, 2003), and Better For All The World: The Secret History of Forced Sterilization and America's Quest for Racial Purity by Harry Bruinius (Random House, 2007).
A current traveling historical exhibit on Eugenics was developed by the United States Holocaust Memorial Museum in Washington, D.C. (Associated Press release 3/12/07).
16. From Radical Evolution by Garreau, p. 115, taken from Gregory Stock and John Campbell, eds. Engineering the Human Germline: An Exploration of the Science and Ethics of Altering the Genes We Pass to Our Children (New York: Oxford University Press, 2000. ISBN: 0-195-13302).
17. Reinventing Humanity by Kurzweil.
18. Ibid. This article from the March-April 2006 The Futurist also contains rebuttals by skeptics of Kurzweil's predictions. Even though some predictions may not become exactly true, skeptics would do well to remember that "In 1913, U.S. government officials prosecuted Lee DeForest for telling his investors that his company, RCA, would soon be able to transmit the human voice across the Atlantic Ocean. This claim was so preposterous, prosecutors asserted, that he was obviously swindling potential investors. He was ultimately released, but not before being lectured by the judge to stop making any more fraudulent claims (from Radical Evolution by Garreau, p. 6).
19. This section is taken from Radical Evolution by Garreau, pp. 22-44.
20. DARPA creates institutions to support the future it desires, and invests 90 per cent of its publicly acknowledged three billion dollar budget outside of the federal government, mainly in universities and industry. If it feels that companies need to exist, DARPA helps foster those, including Sun Microsystems, Silicon Graphics, and Cisco Systems.
21. First DARPA prosthetic limb comes with virtual reality training by BJS, Science Blog, April 26, 2007.
22. The first commercial step of such connections was cochlear implants that allow the profoundly deaf to hear by wiring tiny computers directly to the nervous system. The next step will be retinal implants, computer eyes wired to the brain of the blind.
Then there's the DARPA program that has developed a functioning prototype exoskeleton suit at the University of California at Berkeley. That suit allows a soldier to carry 180 pounds as if it were 4 pounds. The suit picks up the wearer's muscle movements and greatly amplifies them. But suppose that the exoskeleton was responding to brain commands. Work on that is being done at Duke University, where an owl monkey named Belle is "telekinetic". Simply by thinking, she has learned to move mechanical devices. Probes thinner than the finest sewing thread have been inserted next to individual neurons in regions of Belle's motor cortex, so when Belle thinks about moving her arm, a mechanical arm moves (Radical Evolution, pp. 19-20). What if a pilot could fly a fighter with just his thoughts? What if people who are paralyzed could manipulate machines with their thoughts? And what if you reverse the flow, and allow the human brain to directly receive signals, not just send them?
23. In 2002.
24. Quoted from Radical Evolution by Garreau, pp. 112-114.
25. Transhumanists view human nature as "a work in progress: a half-baked beginning that can be remolded in desirable ways through intelligent use of enhancement technologies". They advocate enabling those who so wish, to live much longer and healthier lives, to enhance their memory and other intellectual faculties, to refine their emotional experiences and subjective sense of well-being, and generally to achieve greater control over their own lives. Transhumanists say that, for them, this positive goal has replaced customary injunctions against playing God or messing with Nature or tampering with our human essence. They believe it is naïve to think the human condition and human nature will remain pretty much the same for much longer. Instead, they believe that the accelerated advances in genetics, robotics, artificial intelligence, and nanotechology are fundamentally changing the rules of the game. Ibid., pp. 231-232.
26. Beyond Therapy: Biotechnology and the Pursuit of Happiness, pp. xv-xvi. The President's Council on Bioethics, 1801 Pennsylvania Avenue, N.W., Suite 700, Washington, D.C. 20006. October 2003. www.bioethics.gov.
27. Ibid., p.4. The report considers "beyond therapy" uses, and explores both their scientific basis and the ethical and social issues they are likely to raise, with the comment that "...if we don't prepare ourselves in advance to think about these matters, we shall be ill prepared to meet the challenges as they arrive and to make wisely the policy decisions they may require." p. 10.
28. Ibid., pp. 281-282.
29. Or, what about a somewhat more benign enslavement, artificial intelligence and robots that do so much for humans that humans no longer have incentive to do for themselves. Maybe humans become so dependent on artificial intelligence that they would have no choice but to accept the machines' decisions; maybe the decisions necessary to keep the system running will be so complex that human beings will be incapable of making them intelligentlythe machines will be in effective control. People won't be able to just turn off the machines because they will be so dependent on them that turning them off would amount to suicide.
30. Previous comment and reference in footnote #11.
31. The following non-academic books speak to what it means to be human:
32. Consider the statement of Thomas Lewis, a psychiatrist at the University of California, San Francisco. He says that dealing with machines that are more and more a part of us is comparable to dealing with a parallel personality. He says that when you look at another person, you are reacting to them and them to you. You are engaged in that kind of synchronous duet or ballet, and it's a novel development to expect that of a machine. Emotionally, people have a general disposition to a bond of affection with their companions that help them out. Nowadays, they are distraught if they're separated from their computer, their helpful mechanical friend. They turn to their computer for emotional support, to be entertained by it, to encounter a social presence in the form of online communities and chat groups. Lewis says that he has spoken to people who say that they consider regular human relationships superfluous and outdated, that they get everything they need from their computer. They say it and mean it; they're not kidding around (from: Radical Evolution, by Garreau, p. 63.). Consider another view: "No human being is adequately understood if he or she is considered in isolation from other human beings. A human being becomes fully human only by entering into dynamic relationships of friendship and love, enmity and hate, subordination, and collaboration with other humans." From A Marginal Jew by John P. Meier (Doubleday, 2001). Introduction, pp. 1-2.
33. I understand that a few DePauw professors touch on futuring within the context of specific subject matter courses they teach. I have not been able to find any undergraduate program that has a course in futuring, but I have found some enthusiasm of considering such a course, particularly by Professor Janet Davis, who teaches a course in The History of Technology at Grinnell College in Iowa. Professor Davis includes futuring among other topics in her course, and uses other guest lecturers from the Grinnell faculty. She uses an academic text, Futuring; The Exploration of the Future (by Edward Cornish, Editor, The Futurist magazine, published by the World Future Society, 2005) in her course, and has remarked to me that she believes that "there is likely enough meat here for a full course." At least 43 colleges and universities are using this text in various courses.
34. Will Religion Still Seem an Illusion? by Wilfred M. McClay in The Wilson Quarterly: Reading The Future, Winter 2006, p. 38.
35. Obesity and Diabetes in the Developing WorldA Growing Challenge by Hossain, Kawar, & ElNahas. N Eng J Med Vol 356:213-2151/18/2007 No. 3.
36. From work pioneered by Brent James, Susan Horn, John Wennberg and others, action in the following areas can achieve that goal: reduction/elimination of unnecessary hospitalization, surgery, and hospital stay; unnecessary testing and treatment; unnecessary duplication of testing equipment; standardization and universal usage of "what works best" (practice guidelines/evidence-based medicine); and systems-of-care improvements in hospitals. Other important items include a program/system that reduces or eliminates excessive insurance administrative costs, fraud, nuisance litigation, excessive malpractice awards, and addresses the impact of the cost of malpractice insurance.
The CEO of Lee Memorial Health System, a multi-hospital group in Florida, estimates that the system could save 20% of its entire operational expense if, instead of dealing with more than 50 insurance companies and a multi-layered claim and payment system, there was one agency that handled all claims and payments (from Heavy costs threaten our health system, The News-Press, Fort Myers, Florida, 4/18/2007, p. B11).
37. The most recent report, State Snapshots, from the Agency for Healthcare Research and Quality, is available online at www.JSOnline.com/links .
39. From The Greatest Benefit to Mankind: A Medical History of Humanity by Roy Porter. Norton, 1997. pp. 717-718.