Who is scared of the future?

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More than 100 years ago, humanity developed vaccinations for thyphus, cholera and plague. Back then, these Infectious diseases were the principal cause of mortality, and they were especially deadly for children. There was no anti-vaxxer movement until recently, when those threats had been forgotten.

The anti-vaccination subculture is correct about one thing: vaccines are an unnatural enhancement of the human immune system. In the decades to come, medicine will offer up many more new forms of human enhancement. Just as we today debate how we ensure that vaccines are safe and effective, and that we understand their risks and trade-offs, we will also be asking these questions of emerging enhancement technologies. It will be a debate not just about medicine, but also about what changes we need in society.

Therapy or enhancement?

Human enhancement technologies allow ordinary people to do things at the top of, or beyond, the ordinary range of human capacities. They allow everyone to be as healthy, long-lived, happy and able as possible. Transcending the limitations of the human body has always been the goal of medicine, and there is no clear dividing line between a «therapy» and an «enhancement». Stimulants for ADHD, drugs that prevent diabetes and breast reconstruction after mastectomy are neither treatments for a disease, nor promises of superhuman health. Therapies in this gray zone are already pushing the boundaries of medicine beyond curing disease.

How much enhancement can already be implemented within a human body? Prosthetics for lost limbs and poor hearing, for example, have been around for thousands of years, and are probably the best accepted form of enhancement. Despite vast improvement, today’s prosthetic limbs do not yet return the full function of organic limbs. Cochlear implants are not quite as sharp as organic hearing, and artificial retinas are not as good as human eyesight. Within the next decade, however, there will be prosthetic limbs and exoskeletons that give tactile feedback, with greater strength, mobility and endurance than organic arms and legs. Cochlear implants can already be connected to bluetooth devices, and within a decade or two they could allow users to hear in the subsonic and supersonic. Artificial retinas could allow us to see in the infrared, and record our experiences and play them back.

So long as these prosthetics are replacements for lost abilities only few object to them, even when they offer more than ordinary function. More people do object however to the idea of an ageless future promised by the drugs and gene therapies being shown to slow aging in animals. Few countries’ medical regulators are prepared to oversee human trials for therapies that slow aging. Yet some countries see this as an opportunity and are rushing to approve trials: The U.S. firm Libella is conducting a «trial» of an anti-aging gene therapy in Colombia – for patients willing to pay one million dollars – in order to avoid other countries’ more stringent research regulations. The Libella case illustrates the danger of regulators refusing to approve trials of enhancement therapies: therapies of dubious value will still be available through medical tourism, but only for the affluent.

Rich superhumans

In December 2020, a team at UC San Francisco reported that the compound ISRIB rapidly repairs brain damage in mice, returning brains to a youthful state. This drug could be a breakthrough treatment for traumatic brain injury, Down syndrome, hearing loss, and other neurological damage, and clinical trials will likely be conducted to see if it helps humans with these conditions. However, ISRIB could also reverse «ordinary» age-related declines in memory and cognition. Shouldn’t we also conduct trials in healthy seniors? And shouldn’t all seniors have the right to take such a drug if it is beneficial with few side-effects?

The discussion about the rapid spread of the CRISPR gene-editing method has focused on the possible uses of gene therapies in adults, but raises even more difficult questions around the rights of parents, children and future generations. Are gene therapies that fix our children’s genetic problems more acceptable than gene-editing to make children superhumanly smart, happy, healthy or strong? The Chinese scientist He Jiankui has already admitted (and been punished for) adding HIV resistance genes to two embryos that are now little girls. He was without doubt rash in doing this experiment. But shouldn’t we eventually be able to modify our own eggs, sperm, or embryos to avoid passing on propensities for depression, obesity, or chronic disease?

Researchers have been connecting brains to computer chips for decades: tens of thousands of patients today have «deep brain stimulators» to short-circuit epilepsy, tremors and depression. Elon Musk promises that his new Neuralink chip, with ten times as many connections to neurons as its competitors, will be able to treat dementia, depression, blindness and spinal cord injuries. He also wants it to eventually be small, safe and powerful enough that we will all want one to connect our brains directly to computers.

«If you have an accident, your implants and wearables could stabilize

your condition while they call for emergency workers.»

While few object to the profoundly disabled having access to such a chip, many object to the prospect that the rich might use brain chips – or smart drugs or gene therapies – to make themselves and their children into supermen. The concern about inequality shouldn’t come as a surprise to society: We already live in an unacceptably unequal world. Covid has demonstrated that the poor are more at risk from disease and have less access to advanced therapies. It doesn’t have to be that way. A more egalitarian future is possible – it is only a matter of political will. And there is indeed a strong argument, that a society with an accessible use of safe enhancement technologies for everyone is socially desirable.

A healthier future for everyone

Imagine how we might respond to a future pandemic using emerging enhancement technologies. First, everyone could start with lower disease risk because they are healthier, with better nutrition, drugs and gene therapies maintaining their immune systems at their peak. Everyone has implanted sensors and a wearable device to monitor for emerging diseases, sharing surveillance data in real time with public health agencies. As with computer viruses, the public health agencies can share data globally, reporting back to our home medical units which vaccines to make. Such an infrastructure would control potential pandemics and bioterrorism before they start, while monitoring and treating other threats such as cancer.

If you have an accident, your implants and wearables could stabilize your condition while they call for emergency workers. Perhaps you have some artificial red blood cells, carrying reservoirs of backup oxygen, so that when you have a stroke or heart attack you have hours to seek help before you are unconscious. Building an infrastructure this invasive will require that we address the legitimate concerns that our privacy is respected, that the system can’t be hacked, and that the diagnoses and therapies it proposes are safe and effective. If we can build trust in these technologies and the social and political systems they are embedded in, then the political case for making it available to everyone will be overwhelming.

Human enhancement technologies inspire legitimate concerns about safety and social justice. Our national regulatory agencies need to begin funding basic research on anti-aging and cognitively enhancing therapies, and approving human clinical trials. We need to start debating how safe they need to be to be approved for general use, and how we ensure that they are available for everyone who wants them. Hopefully this horrible year of 2020 can focus our attention on how to use emerging technologies to build a healthier world for all.