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Benefits and Dangers Pervade Use of Human Enhancement Tools, Bioethicists Say
Whatever the activity—baseball, taking exams, fighting in a war, or even simply living longer—the desire to improve is inherently human. Now that science and technology have equipped us with some ways to enhance our natural abilities, should we use them all the time, or even at all? A panel of experts outlined developments in human enhancement tools and discussed the ethical implications of their use during an 8 May session at the 33rd annual AAAS Forum on Science and Technology Policy.
Enhancement is not always a good thing, said Thomas Murray, president of The Hastings Center, a bioethics research institute based in Garrison, N.Y. Murray discussed how while training, practicing and studying are all successful and ethically acceptable strategies to improve performance, pharmaceutical enhancements have crept into our toolbox of ways to enhance performance. Such tools for enhancement have shown success—at least in the short-term—but their use creates profound ethical dilemmas and concerns about the integrity of sport and the health effects of long-term use.
More than 500 policymakers, scientists and students and over two dozen journalists gathered at the AAAS Forum to discuss the challenges facing the next presidential administration, the outlook for federal research investment and the prospects for innovation. The Forum was held 8-9 May at the Ronald Regan Building and International Trade Center in Washington, D.C.
In his presentation, Murray asked the audience to consider their own values: Would you be outraged to learn that an athlete won a marathon by rollerblading? Would you be incensed to hear that a neurosurgeon performed more successful surgeries by taking anti-tremor medication? Both situations involve a performance-enhancing tool, but the contrasting scenarios point to how it's not the means but rather the reason for using enhancers that determines the situation in which use is ethically acceptable.
Enhancement in a surgery, Murray said, "is not to display the skills of the surgery but to cure patients." In this situation, we value human health and prolonging life.
In sport, however, we tend to value natural talents and the perfection of those talents, he said. But cases abound of athletes using performance-enhancers, including anabolic steroids and human growth hormone. Therefore, Murray argued, it is very important to be clear about the ethical foundations of sport and the arguments for and against the use of performance enhancing technologies.
Now, compounds are emerging that can tweak our genetic code, potentially making athletes stronger and faster. "The world of genetics has opened up new doors and ethical dilemmas," said Theodore Friedmann, professor of pediatrics at the University of California-San Diego School of Medicine.
"Sport is enhancement, it's overcoming natural limitations," added Friedmann. Just as better equipment, training and nutrition can improve performance, so can a more robust genetic makeup. Genetic enhancement in sports is possible and even inevitable, he emphasized.
"Gene doping" was an emerging concern during the 2000 Olympics in Sydney, but no one really knew what it meant or how to test for it, said Friedmann, who leads a gene-doping panel for the World Anti-Doping Agency. One of the agency's goals is to develop assays to detect gene doping in athletes.
How can genetic modification build a better athlete? The targeted genes—such as those that boost muscle size and growth, blood flow to tissues and use of energy—are "no secret," Friedmann said. The anemia gene therapy Repoxygen, for example, has already attracted attention for its ability to initiate a cascade of biological events leading to improved oxygen flow to muscles.
Coaches know the technology is becoming more effective—at least in disease therapies—and could be used in a sports setting, Friedmann said. "It will happen," he predicted. "It's too easy and too straightforward." This is not to say that genetic technology is risk-free. The health effects, short or long term, are unknown.
The same hazards are true for drugs used to improve memory and attention. Adderall—a drug prescribed for attention deficit hyperactivity disorder—is increasingly popular among college students who use it, unprescribed, to fuel all-night study sessions. Various surveys estimate that 4-25% of college students use cognitive enhancers like Adderall. Aging baby boomers and professionals working long hours are other potential markets for pharmacological cognition-boosters.
Martha Farah, director of the Center for Cognitive Neuroscience at the University of Pennsylvania, described cognitive enhancers ranging from a tried and true cup of coffee to an experimental electrode array implanted in the brain. Many technologies for cognitive enhancement in healthy humans are already available, Farah said citing the drug modafinil as able to thwart fatigue from sleep deprivation. Users can take it and stay awake for 48 hours and feel fine.
In other circumstances, enhancements can be effective at suppressing natural mental function, rather than boosting it. "We all have things we don't want to remember," Farah said. Traumatic experiences including combat, car accidents, and sexual assaults can lead to post-traumatic stress disorder (PTSD), for which the memory-dampening drug propranolol can be effective.
About 10-15% of soldiers develop PTSD after deployment to Iraq, said John Parmentola, director of research and laboratory management for the U.S. Army. "An additional 10% have significant symptoms of depression, anxiety or PTSD and may benefit from care," he said.
Behavioral approaches show promise in treating soldiers with PTSD, Parmentola said. The behavioral treatment involves gradually exposing PTSD patients to virtual recreations of traumatic episodes, complete with the sounds and smells of the Iraq battle zone. PTSD symptoms were significantly reduced in 12 of 15 PTSD sufferers following treatment employing the virtual immersion technique, dubbed "Virtual Iraq" by its creators. The study was led by researchers from the Institute for Creative Technologies, an Army-sponsored University Affiliated Research Center.
In Virtual Iraq, PTSD patients navigate Iraqi battlezones designed to recreate traumatic episodes so that the soldiers can become de-sensitized to them. Soldiers are passive in this virtual world where their firearm is programmed not to return fire. During a presentation at the AAAS forum, Parmentola showed a video clip to demonstrate that the intent of the virtual experience is to promote healing by addressing the trauma, not to engage in a video game or to create a cathartic experience.
The military is also using cognitive approaches to enhance its training regimens. Video game-like programs allow soldiers to practice and hone interpersonal and negotiating skills with avatars representing members of the local population. "Demands on soldiers are rapidly shifting from the physical to the informational, cognitive and cultural," Parmentola said. The training program aims to teach soldiers a variety of negotiation tactics, adapt to shifting coalitions and build credibility among civilians they encounter while on missions.
So with all these enhancement technologies that could allow us to excel as athletes, students and soldiers, shouldn't science come up with some way for us to enjoy these capabilities longer? Like, forever?
Not according to epidemiologist S. Jay Olshansky. "Living forever is not in the cards," said Olshansky, professor in the School of Public Health at the University of Illinois, Chicago. "We're not talking about stopping aging, searching for the fountain of youth, making a younger version of ourselves—no dramatic extension of life," he said.
While most demographers believe that the human lifespan will continue to rise, there is tremendous disagreement about how much it will rise. Optimistic researchers say there is still substantial room for improvement and that human life expectancy could reach 100.
Other demographers, including Olshansky, have more conservative projections. Olshansky, whose research has focused on the upper estimates of the human lifespan, estimates that humans would have a maximum life expectancy of about 90 years if the three main causes of death—heart disease, cancer or stroke—were eliminated.
Olshansky argues that the most significant gains in life expectancy don't result from getting rid of the three main causes of death. Instead, he said, we should focus on how to prolong healthy life. Olshansky said prolonging the healthy years and slightly decelerating aging—by just a few years—is the disease prevention model of the 21st century that complements other efforts to treat disease.
"We're not going to get a significant increase in life expectancy by getting rid of heart disease, cancer and stroke," Olshansky said. But that's not to say that "we should take money away from existing health promotion activities," he emphasized. Research aimed toward extending youthful years should be done in concert with finding disease treatments.
If we were to understand the basic biology of aging, Olshansky said, then we could figure out how to increase the youthful, healthy and vigorous years of life while limiting the frail, brittle and disabled years. Genetics of long-lived people and mechanisms of why eating less extends life are two approaches to increasing the healthy years.
The panelists agreed that the use of various human enhancement tools could create inequalities. Use of cognitive enhancers, for example, could spur "ratcheting up" situations and widen socioeconomic gaps between users and non-users, warned Farah, a cognitive neuroscientist and the Walter H. Annenberg Professor of Natural Sciences at the University of Pennsylvania. She asked the audience to consider how much we can change ourselves and still be human. "Enhancement may transform us in ways we can only begin to imagine," Farah said. "Sometimes I find that a little scary. I'm human and I kind of like Homo sapiens version 1.0."
6 June 2008