Monday, February 28, 2011

The supernormal and the pathological

Posted by Nathaniel Comfort on 02/28 at 09:14 AM

Over at Eveloce, Steve Potter, a pediatrician at Children’s Hospital Medical Center in Cincinnati with a new book on “designer genes,”* writes about “radical cloning.” There is a quiet revolution going on the world of cloning, he says. One in which we are not merely making carbon copies of individuals but improved versions. “Another you,” he writes, “but smarter, healthier, and maybe a bit better looking.”

He’s talking about cloning adult-derived stem cells--turning back the clock on normal, mature cells such as skin cells, and converting them to the equivalent of pluripotent embryonic stem cells. Such cells sidestep the ethical thicket of embryo disposal and hurdle many of the technical difficulties of gene replacement therapy. Therefore, he writes, it is time to reconsider once again some of the ethical dilemmas surrounding human cloning.

I know, I know: “Oh god, not that tired old human cloning again.” The scientists *always* believe that now, at last, they understand the biology well enough to proceed with a program of human engineering. Charles Davenport believed it. HJ Muller believed it. Jim Watson believed it. Craig Venter believes it. Medical genetics has always been about two things: relief of suffering and human improvement. Both cheerleaders and skeptics profit from overselling and overhyping genetic technology, and I suspect the brave new biotechnical world is still, as always, further in the future than he thinks. It just always turns out to be more complicated, somehow, than we thought it was going to be.

At the same time, the future has a way of sneaking up on one. One need not wait till we break ground on the first full-blown Designer Baby Clinic to take some of these questions seriously. Some ethical questions are slippery precisely because we cannot identify a particular threshold moment when they become pressing. We need to grapple simultaneously and seriously with both key questions of human biotechnology: “What if it doesn’t work?” and, “What if it does?”

For example, where does the medical begin and end? Since the beginning of the last century, preventive medicine advocates have been promoting a science of health rather than a science of disease. The province of medicine thus expands to include anything that makes you feel better--even if you weren’t feeling poorly in the first place. The more medicine succeeds at this, the more we tend toward a) an iatrocracy, a society run by doctors, and/or b) the dissolution of medicine, its gradual incorporation into the fabric of everyday life. (Neither are these mutually exclusive, nor need they fully come to pass to be worth thinking about.)

So then. Should these new technologies be the province of doctors? If so, are doctors equipped to tease out the ethical tangles Potter raises? Or will they inevitably end up in the sticky hands of entrepreneurs more interested in their own wealth than the public good? Or, possibly worse, in the hands of a short-sighted public that drives large segments of the population rapidly into evolutionary debacles, for the sake of some momentarily fashionable trait? In short, we may take control of our own evolution without realizing it.

Fear of government-controlled eugenics programs is so twentieth-century. My concerns are populist impulses for genetic improvement propelled by people who don’t know and don’t care about the consequences of tinkering with our descendants’ hereditary endowment. As with the global climate, the gradualness of change in human evolution is a critical buffer against short-term fluctuations. The “stupidity” of the process--the lack of a designer--is compensated for by enormous momentum. Errors, false starts, and bad “ideas” tend to get crushed. Massively accelerating that change removes that buffer. We hurtle headlong into tomorrow, making decisions that irremediably alter what will happen next week, next month, and next year.

Our greatest concern should not be malice, but lack of foresight.

*note: not to be confused with the creationist book of the same title. Ouch!

Tags: bioethics, biotechnology, cloning, designer babies, eugenics