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A
Okay, welcome back everyone to the 2nd of our August Comte lectures. I'm Alex Voorhoeven, I teach in the philosophy department here. And it's a great pleasure to have back after yesterday's stimulating lecture and very good discussion, Alan Buchanan. And he'll be speaking on enhancement. And again we should have about half an hour at the end, so from around 7:30 onwards for discussion. Okay, thank you.
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B
Thank you. If some of you were here yesterday, you know that by mistake yesterday I gave tonight's lecture. So tonight I'm giving yesterday's lecture, but not by mistake this time. I'm going to go over some things that may be redundant for those of you who were here, but just to sort of fix ideas and make sure we're on the same wavelength. To enhance, typically just as understood as meaning to improve or to increase, to augment, to make better. I'm particularly interested in the idea of enhancing normal human capacities, mental capacities, emotional capacities. And you can think of an enhancement as an intervention that's aimed at such an improvement. I'm focusing on biomedical enhancements and these are interventions that are intended to improve normal human capacities by working directly on the brain or body. And they're guided by scientific knowledge. And I'm making this definition explicit because in a moment you'll see that enhancement's not new. There are lots of non biomedical enhancements that human beings have developed over the ages. Now there are different modalities or means by which enhancements might be made biomedically. And perhaps the most radical controversial is the one that I talked about last night, selection and or genetic engineering of human embryos or gametes, that is sperm or eggs. There are pharmacological enhancements. I talked about those yesterday, for example, cognitive enhancement drugs, drugs that were developed originally to treat particular diseases like attention deficit disorder or narcolepsy or Alzheimer's dementia, but which turn out to have the effect of improving normal cognition, human machine interfacing, superior artificial joints, brain computer interface technologies. In fact, the artificial hip replacements that many people have now are designed to replace the normal joint, but in fact they're superior to normal joints in some way. So even if you weren't looking for an enhancement, you might have gotten an enhancement if you've had an artificial hip replacement and also improved laboratory grown organs and tissues using stem cell technologies. Now those are the modes of enhancement that people are discussing the most. And there are different types of enhancement, different types of capacities that might be enhanced. Increased longevity is something I think a lot of us are interested in and that can be achieved in different ways by ramping up the immune system or treating more successfully some of the diseases that typically shorten our lives. But more radically, and you might regard this as more of a real enhancement retarding the natural aging process that is attacking the problem perhaps at the cellular level, to try to slow down the process of, of cell senescence. And one of the things that people are looking for in biomedical enhancements is not just longer life, but increased years of peak mental, physical, motivational and emotional functioning. And then of course, increases in what are now considered normal mental, physical, motivational and emotional capacities. Now, I mentioned this last time, but I think it's worth bearing in mind again because it's going to have a direct implication for what I say later in the talk. That is the simple point, that enhancement isn't new. We've had a long history of non biomedical enhancements, including some of the most impressive non biomedical enhancements have been cognitive enhancements. And I would include here literacy and numeracy, the practices of science, the development of computers, cell phones, et cetera. You can also think of some major cultural developments in our species, like the agrarian revolution, domestication of animals and the planting of crops as increasing our capacities to live together in large numbers year round. This then leads to lots of other developments, including the growth of institutions. And I think it's perfectly reasonable to think of institutions as enhancing our capacity for coordinated action. Now again, I mentioned this briefly last night, but I think it's worth bearing in mind again, some people say, well, you know, maybe there have been historical non biomedical enhancements, but this is really different. Biomedical enhancements are really different. They change our biology or biomedical enhancements would transform us profoundly, as I suggested last night. I don't think either of those are things that distinguish the traditional non biomedical enhancements from biomedical enhancements. Clearly, some of the traditional enhancements have changed us as profoundly as anything we could imagine, changing us in fact, perhaps more profoundly than we're likely to be changed by biomedical enhancements. And as I also argued last night, biomedical enhancements do change our biology in various ways. Now this is a laundry list of some of the objections to or worries about biomedical enhancement. And I'm going to list these just to open up scope for discussion later. But obviously I can't talk about all of them. There are worries about, to put this in a way that's not offensive, unnatural acts, that is about tampering with the works of nature. I talked about that a lot last night, altering or destroying human nature. There are character concerns of the sort that Michael Sandel has made famous. There's the dual use concern and the concern about unintended bad consequences is what I focused on last night, especially unintended bad biological consequences of genetic enhancements. And by genetic enhancements, I mean germline changes in human beings for the sake of enhancement. And then the last item is unfairness. Mentioned that briefly last night, but that's the focus of tonight's lecture. And I'm going to try to approach the question of unfairness. That is the worry that some people, namely those who are already better off in various ways, will have access to new biomedical technologies. Other people won't. And this will create problems of injustice. I'm going to try to distinguish several versions of that problem first, and then I'm going to suggest that one way to look at the problem is, is in terms of what some people call the ethics of development. So that's going to be the strategy. Now, the unfairness objection really turns out to be several different objections. And so I want to distinguish those. There's what I call the simple distributive injustice problem. And that's just the worry, as I suggested a moment ago, that yes, biomedical enhancements may be very valuable, but there won't be anything like equitable access to them. Their distribution will be unfair. They'll tend to be available only to the better off. That by itself looks like an injustice, but it also could lead to other injustices. And that's what I call the compound injustice problem. If there's an unfair distribution of biomedical enhancements, then that unfair distribution may spawn other injustices. For example, unacceptable political inequalities. And this wouldn't be surprising because many of us take it for granted, and I think it's reasonable to do so, that inequalities in wealth can also can often spawn political inequalities. Well, the kind of inequalities that would be introduced by differential access, limited access on the part of some people to biomedical enhancements might be unjust in itself, but it might also spawn other injustices, including political inequalities. Then the third item is a little harder to understand. I think it's what I call the radical compound injustice problem. And that's the worry that the unfair distribution of biomedical enhancements might cumulatively, perhaps over many generations, result in something like a new caste system. And the most extreme version of this worry that I know of is in Francis Fukuyama's book. And he thinks that there's a serious risk that eventually the cumulative effect of one group Having access to powerful biomedical enhancements and others not might be a system where, as he puts it, some people are born with saddles on their back and others are born with spurs. It's a pretty graphic image. Some people have suggested that this might even be cashed out in biological terms, that the eventual result of one group of human beings enhancing themselves and doing this over generations, especially if they use genetic modification, might result in a new speciation. That is, you'd have the unenhanced Homo sapiens, or whatever the successor to Homo sapiens is, without biomedical enhancement. And then you have another group that was so different that it would make sense to call it a different species. Now, I'm not going to focus on this radical compound injustice problem tonight in the lecture, but if anyone would like to raise it later, I'm happy to discuss it now. I think that whenever you're thinking about enhancement issues, there's a tendency to sort of be in medias race to already before you realize it, have made some assumptions in the way you frame the issues. And those assumptions, those framing assumptions tend to really push you in one direction or the other. Maybe favorable attitude toward biomedical enhancement may be an unfavorable one, but it's important to try to back up and unearth the assumptions that are already shaping your response to the issues. And my sense from reading the biomedical enhancement literature, which is voluminous, is that there are two framing assumptions that are quite pervasive. And I think it turns out they're both false, or at least they're both unjustified. And they're so clearly unjustified once you reflect on them, that I think we should make every effort to set them aside and not let those framing assumptions influence the way we approach the issues. So my goal tonight, as with last night, is not to try to make a case either for or against enhancement generally or for or against particular enhancements, but rather to try to help us think about the issues in a better way so. So that eventually we can come to some reasonable conclusions. Here are the two false or unjustified framing assumptions that I think are pervasive in the debate and that really seriously distort it. And I'll explain both why they're unjustified and how they distort the debate. The first is what I call the personal goods zero sum assumption. It's the assumption that for the most part, if not exclusively, the benefit of an enhancement is to the one who's enhanced. That's what I mean by saying it's a personal good and the second aspect of this first framing assumption is that biomedical enhancements are or tend to be primarily zero sum. That is, it's not just that the benefit of the enhancement accrues to the one who has it, but a person having an enhancement actually disadvantages others who don't have it. So what I gain from an enhancement, somebody else loses. That's the zero sum idea. So that's the first framing assumption. Second framing assumption is related to it, but I think it's worth distinguishing. It's the assumption that in the large, the production and distribution of biomedical enhancements will be governed by market forces, to use language Robert Nosek used a long time ago, that there'll be a kind of genetic supermarket or a biomedical enhancement supermarket more broadly, that it's going to be a matter of people making personal choices for themselves, perhaps for their children or their potential children to use or not use these biomedical technologies. Now, if you think of biomedical enhancements in that way, if you think both those assumptions are correct, then you're going to have a certain take on the problems of unfairness. If you reject those assumptions, you may have quite a different take on the unfairness issues. Now here's why I think people tend to assume that by and large, biomedical enhancements are going to be market goods. And the contrast here is with publicly provided goods by government subsidy or direct government provision. I think many people, when they look at the prospects of biomedical enhancement, can't help but think about the horrible experience with the eugenics movements of the late 19th and early to mid 20th centuries. They should think of that. They should be worried about that. And part of what bothers us most about the eugenics movement was that often the power of the state was used to coerce people, in some cases to sterilize people or kill people in the name of preventing harm to the human gene pool or improving the human gene pool. In fact, in my home state of North Carolina between 1920 and 1972, about 8,000 citizens of the state were forcibly sterilized in the name of eugenics at the behest of a eugenic board in the state of North Carolina. I've actually interviewed two of the last survivors of eugenics sterilization program throughout the United States. There were about 65,000 people who were compulsorily sterilized in the name of eugenics during that period. And not just in the United States, but in Denmark and Sweden and Norway and Canada, a number of other places as well. So many people assume that we learned enough from the eugenics movement and its horrors, that at least in reasonably liberal democratic constitutional democracies, where there's an entrenched set of rights, including reproductive rights, that we're just not going to have government involvement with biomedical enhancements. Except perhaps the government might somehow regulate this market in biomedical enhancements as personal goods. Safety regulation, for example, maybe conditions for informed consent, testing for efficacy before products are put on the market, that sort of thing. But the government won't have a role in encouraging the use of biomedical enhancements or subsidizing access to them and that sort of thing. Now here's why I think both of these assumptions, the personal good assumptions in the market provision assumption, are flawed. I think they both fail to take seriously the possibility that some biomedical enhancements. In fact, I think the biomedical enhancements that we're likely to be most interested in will increase social well being in several ways. Oops. Some of them won't be personal goods and they won't be0Sum. For example, any biomedical enhancements that's likely to increase productivity, broadly described, I think fits this description because increased productivity creates the possibility of large scale increases in well being. I say the possibility because it's clearly a mistake to think that whenever you get an increase in human productivity, you automatically get an increase in well being. But I think it's correct to say historically that the largest increases in human well being that can be quantified at least, and that's maybe an important qualification, have followed increases in human productivity. I mentioned the agrarian revolution earlier, that's one example. So that's one reason why I think we need to get beyond the idea that the value of an enhancement is just its value to the person who gets the enhancement. It's what it does for them, as it were, directly. There may be other effects if lots of people have enhancements, and this makes possible new forms of cooperation that are more productive and increases the size of the social pie. Now, increasing the size of the social pie is not necessarily a great thing. It all depends on how the pie gets sliced up then. And so issues about distributive justice arise again, even if we think that there's, there's a potential for not just overall betterment, but for equitable overall betterment that's created by the diffusion of biomedical enhancement technologies that increase human productivity. Now, many biomedical enhancements, I think, are likely to have what economists call network effects. And the easiest illustration of what a network effect is is one that takes the term network literally. That is, think of your computer. Your computer is valuable to you probably for a number of different reasons. It would probably be valuable to you if nobody else had a computer. But the fact that other people, lots of other people, have computers makes your computer more valuable to you. So a good exhibits network effects if it's like that, if the value of one individual having it tends to increase as more individuals get it. And I think that in general, cognitive enhancements tend to have network effects because they enable people to engage in interactions that they couldn't engage in before and that they couldn't engage in if they were the only one that had the cognitive enhancement. Well, this may be in a later slide, I'm not sure. But also, not just computers, but think about literacy, okay? I mean, if you're the only literate person in the world, great. And you congratulate yourself you can do something other people can't do. But it's really quite nice that there are lots of other literate people. They can write novels for you, they can write textbooks, you can exchange information with them through the medium of writing. So I don't think most of us think that every time a new person learns to read in the world that this diminishes us, right? I don't think we think of this as being a zero sum kind of good. I think it would be wildly irrational for us to think of it that way. So there are at least a couple of different ways we can think about biomedical enhancements, or at least some of them, as increasing social welfare, and help us break out of this assumption that they're just personal goods of a zero sum sort. As I said, if the biomedical enhancements contribute to greater productivity, then you can get a larger pie, more surplus wealth in the society and gains in productivity within the right context, especially if there are some scope for the operation of competitive markets can tend to lower prices. And that can have a good effect, actually, in terms of distributive justice, because it can make goods available to people who otherwise wouldn't have been able to afford them. I mean, if you think about it, even people in a society like the UK who are pretty much at the bottom of the socioeconomic ladder, are every day in their lives enjoying goods which were not available to kings and emperors in former times. And this surely has something to do with increases in productivity that lower the cost, make the production of new kinds of goods possible, and can, through appropriate circumstances, lower the prices of them. There are also direct benefits that individuals get. I don't want to make it sound as if the benefit of you're getting enhancement is just somehow to other people through their enjoying the network effects. If you have it, having it, there are direct benefits. And I think this is again especially true of cognitive enhancement drugs. There's some encouraging evidence that the cognitive enhancement drugs that we have now that we've studied, and this is all very recent, so the studies are not exhaustive, but the drugs that I was referring to earlier, like Aricept and Provigil and Ritalin, these drugs that were first developed to treat cognitive disorders but turn out to have some beneficial effect in improving normal cognition or cognition in normal people. There's sort of a nice feature of these, so far as we know at this point, and that is you tend to get the biggest boost in cognitive performance at the lowest end of the normal distribution of the cognitive traits. And in question, that is the people who need it most tend to get the most out of it. And from the standpoint of distributive justice, that's a good thing, that's not a bad thing. Now, we don't know whether cognitive enhancements, generally pharmaceutical or otherwise, are going to all have that characteristic. If they did, that would really ease the problem of distributive justice enormously, because then we might be able to view cognitive enhancements as a tool for reducing some of the morally arbitrary inequalities that now result at least play a role in producing what some of us think of as social injustices. Also, there's a lot of evidence that people who are at the lower end of the normal distribution of intelligence tend to have more problems than people who aren't. Now I notice I said people who aren't. I'm not saying that the smarter you are, the happier you are. I think most of us know that's not true. It's not a steady kind of progression. But people who tend to be pretty far down in the normal distribution of iq, which I'm suspicious about as an indicator for, as if there were sort of one thing called intelligence. But at least it measures part of what we think of as intelligent. People who are at the lower end of the normal distribution tend to have a lot more problems than people who are further up. And so we have to at least consider the possibility that if we were able to give those people a boost, that their lives would go better for them. It also might mean that they would tend to be more productive because the problems they now have wouldn't interfere with their being productive. And that might be good for the rest of us, but just for their own sake, it might be really wonderful. Thing. Now, I mentioned this after dinner, I think last night in the discussion, but I don't think I mentioned it in the lecture yesterday. Often the kind of enhancement that attracts the most attention, especially in the press, is performance enhancing drugs in sport. And there's a huge buzz about this. Lots of controversy about this, lots of talking heads, lots of interviews and things. And in the United States, laws are passed, you know, prohibiting use of performance and handicrugs in sport and their, you.
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Know.
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B
Blood tests and urinalysis tests and that kind of thing. I actually have heard so much about that debate that I'm just sick of it. And I'm not really going to talk about it, except to say that I think that it's a bad paradigm for thinking about biomedical enhancement generally. I don't think that life is like a game. I don't think that every aspect or even most aspects of our existence are zero sum competitions. And I think that it would be a mistake to assume that what we learn from reflecting on the sports case is going to tell us a lot about enhancements generally. You think about it, in sport there's a rule governed practice, a particular kind of highly conventional activity that's going on. It's essentially competitive. And the question of whether people should be able to use enhancement drugs in that context, obviously the answer to that has to draw on the nature of that practice, that peculiar kind of practice. A lot will depend on what you think sort of the essence of the sport is if you think it makes sense to talk about that, what the point of it is, what gives it its value, et cetera. And I just am unconvinced that that's directly relevant to other cases. Now if you wanted a different paradigm, and, and I'm suspicious that there's any one paradigm that work to cover all of the issues of biomedical enhancement. For all the types of biomedical enhancement, all the modes of biomedical enhancement, you might think about what epidemiologists call herd immunity. Do you know what herd immunity is? Odd term. If you have a young child in the United States, in most states, you're required to have the child vaccinated for some childhood infectious diseases. Now, some parents are worried that these vaccinations might have some hidden liabilities. In fact, there was sort of a mass hysteria that vaccinations were causing autism. Turns out there's virtually no evidence for this. But some parents really panic. They don't want their children to get autism vaccinated. Well, they might reason as follows. Look, my child doesn't really need to get vaccinated, because if other people's children are getting vaccinated, then my child will benefit from the phenomenon of herd immunity. That is, if enough people are vaccinated, the incidence of the disease will be so low in the general population that my child's not likely to get exposed to the disease, so there's very little risk. But of course, if enough parents reason in this way, you won't have enough people being vaccinated to get the herd immunity effect and you could all lose. Well, let's not think about the case where people don't get the vaccination. Think about the case where enough people get the vaccination. What this means is that some people are going to benefit who don't get the vaccination. It's like network effects. It's a positive externality, I guess would be a better way to say it. Your child gets vaccinated enough other children to get vaccinated. And if you ask, well, what's the benefit of the vaccination program, it's not just to the people that got vaccinated, it's to other people as well. So I think that's. Actually, I'm suspicious of any one paradigm or metaphor, but I think that's more accurate for some cases of biomedical enhancement than the sport metaphor. So here are some biomedical enhancements that don't fit the personal good zero sum assumption. Cognitive enhancements because of network effects, because they can avoid harms to some individuals, especially people who are at the lower end of the normal distribution. And also, let's not forget cognitive enhancements. For a lot of us, including the traditional ones like literacy education, there are things that are just valuable for us. Just having them is valuable, or at the very least, they enable us to engage in activities that are intrinsically valuable to us independently of their economic effects or whether they make money for you or whatever. Think about your computer. You may use your computer to make a living, and you may use your literacy and numeracy skills to make a living. So they probably have great instrumental value for. But they also just enable you to engage in activities that you find intrinsically valuable. And for many people, it looks like they take more pleasure out of activities that are somewhat more cognitively demanding. So if some cognitive enhancements can open the door to more complex, interesting kinds of activities, either ones that you do solo or ones that you do cooperatively with others, then that's another important benefit that we shouldn't lose sight of. And again, looking at traditional cognitive enhancement that we already have, like literacy and numeracy and that kind of thing can help us think about how more of these might be on the way in the form of biomedical enhancements. And then think about immune system enhancements. Okay. Right now we don't really enhance the immune system to fight disease. We trigger the immune response that we're already capable of through vaccinations. But it may be possible to actually improve the capacity of the immune system. And that would certainly be, would count as an enhancement. It's an augmentation of existing normal capacity. And it might have huge benefits both for the individual who then is more resistant to. But also, as with regular vaccination, there could be huge productivity effects. There is a lot of data on the increase in productivity you get when you have a population that's vaccinated against diseases which impair their functioning, which mean more days away from work, which make them unable to work as effectively. And also we should consider affective or motivational enhancements for a number of reasons. I mean, it may be that there are some ways of ramping up our emotional responses or our, what moral philosophers call our moral sentiments, like sympathy or empathy, which will facilitate cooperation that wasn't available to us before. There have been some interesting studies on oxytocin. If you raise the oxytocin levels in people's brains, they tend to be more trusting and they tend to do better working cooperatively to solve problems in games that require cooperation. There's a fellow at the Uhiro center for Practical Ethics at Oxford named Tom Douglas. He's a physician and a bioethicist, and he's doing some very interesting work on the possibilities for moral enhancements, that is biomedical interventions that would make us perform better morally. And if anybody wants to talk about that in discussion, I'd be happy to share some of his thoughts about that with you. I mentioned earlier that one advantage of biomedical enhancements might be slowing down some of the problems that occur with aging. Last night I mentioned that we shouldn't be surprised that we have a lot of problems as we get older, because the way natural selection works, it doesn't winnow out bad traits that we have in our post reproductive life, because having those traits doesn't reduce our fitness. Because we're not in the fitness game anymore. We're not in the game of passing on our genes. And so if problems develop in the organism just from wear and tear or from the nature of the way cells replace themselves, there's no reason to believe that given enough time, given any amount of time, that evolution is going to solve those problems. So we may need biomedical enhancements to solve those problems. And this is not a speculative worry. I mean, we've already increased life expectancy a lot. And the result is that because we haven't seriously addressed these problems that people have in their post reproductive years, the frailty they had, the degeneration of their nervous systems and their muscles and their joints, it's a kind of ticking time bomb, right? There are more and more people living longer and longer, more frail, more in need of social support. It's more costly to support them. The quality of their life is not good. And to avoid a catastrophe of having such a huge frail older population at a time when fertility rates are going down, right where there are few new people being produced, to avoid that, we may need biomedical enhancements. Now, I've already explained why I think the personal good zero sum assumption is unjustified. It just doesn't take into account the full range of benefits that can arise from biomedical enhancements. Things like network effects, positive externalities, increased productivity, increasing the size of the social pie, et cetera. Well, if the personal goods zero sum assumption falls prey to those objections, then this also has an effect on the other assumption, the market goods assumption. Because where biomedical enhancements promise broad social benefits, especially gains in productivity, governments may well become quite interested in promoting them. They may not be willing to view them simply as market goods for individual personal consumption. You think about it, some of the earlier enhancements, the non biomedical ones that I mentioned, like literacy and numeracy and immunization, governments have taken an interest in these. And those of us who are somewhat cynical think that governments haven't so much taken an interest in them because they're really concerned about us as individuals or think that we have rights to these things, but because governments think that it makes for a stronger economy or a stronger nation. If you think about the history of the welfare state in Europe, starting with Bismarck, Germany, there's a whole new set of entitlements that we now associate with the welfare state, like unemployment insurance and sickness insurance and extension of free public education. And the justification that's given for this at the time is not that individuals have a right to this, a moral right to it, it's that this will make for a stronger economy, a stronger Germany, a Germany that can compete better with Britain and other countries. Well, I see no reason to think that the government mentality has been enhanced beyond that. I think that's pretty much the way governments tend to think now. So there may be a role for the state and Notice that to give a public justification for the state being involved in the development of biomedical enhancements and their distribution and use, you don't have to appeal to those crazy old eugenic ideas. You don't have to appeal to the idea of a master race or some perfectionist ideal. Or to the idea that there's a genetic time bomb ticking away. The eugenicists had this prediction of a catastrophe. In fact, one of the more enlightened eugenicists, a man named Herman Muller, who won the Nobel Prize for his work on fruit fly genetics, 1920, I think, said, in a few generations, unless we do something, we're all going to be imbeciles. And one of his colleagues said, and invalids as well. There was the idea that the gene pool was deteriorating at an exponential rate. And unless there was some radical change in human reproductive activity, that that was going to be the end of humanity. And what they were worried about was that they thought that modern medicine and the welfare state. And the proliferation of charitable institutions to take care of the weak and the vulnerable in the 19th century was acting as a buffer against natural selection. And that there was an increasing accumulation of bad genes in the human gene pool. And that unless something was done, the bad genes would overwhelm the good genes. That'd be the end of civilization, the end of humanity eventually. So my point is that for the state to take an interest and to make a public plea for why it ought to be taking an interest and taking a hand in the development and distribution of biomedical enhancements, the state wouldn't need to say anything like that. It wouldn't need to appeal to the discredited eugenic ideology. It would simply have to appeal to the same kind of justification that it uses for public education, for public health programs like immunization. That's all it would have to do. And it would make perfectly good sense. It wouldn't be a spurious justification. Now, if you think that's a serious possibility, if you think that the state will be interested, at least in some of them, were valuable biomedical enhancements. Because they'll think of it as making the country more competitive economically, et cetera, and also reducing the cost of unproductive citizens and citizens who are at the lower end of the intelligence distribution, who tend to have more problems and more costly, et cetera, then I think you get a sort of sea change in how you think about the inequality issues, the unfairness issues. Because for biomedical enhancements that are likely to increase social welfare if they're widely diffused, if lots of People have access to them. Then if the state gets interested and promotes their development and diffusion, that's actually going to constrain inequalities to some extent, right? I mean, think about public education. If the state takes seriously the idea that everybody ought to have free access to. To at least, say, a basic education, that action by the state limits inequalities in education to some extent, right? It compresses the range of inequalities. There's still room for inequalities in education because there are great differences once you get above the primary education level. And if the distribution of wealth is allowed to determine what education you get beyond basic education, then you can have a lot of inequality. But notice, you'll have less inequality. The range of inequalities will be more compressed than it would be if the state didn't take an interest in providing everybody with basic education. Similarly with health care and similarly, I think, with biomedical enhancements that have some of the same properties as basic education and immunization and public health measures generally. Now, here are some advantages of this new way of framing the issues about unfairness. Advantages of getting rid of the two distorting, framing assumptions. The personal goods in the market, good provision assumption. If you focus on the positive sums, social welfare, increasing effects of enhancements. First thing, it puts biomedical enhancements in historical perspective. It sort of demystifies them. And I think people often tend to think that because they're biomedical, they're radically different. I'm not convinced they are. There are some differences, But I don't think we should start out assuming that the problems that biomedical enhancement raises, including the problems about fairness, are novel in human moral experience. I think that's a mistake. But also, this way of framing the issue directs our attention to the promise and the perils of state involvement in the development and dissemination of biomedical enhancements. Remember, I said before that if you just had this idea that biomedical enhancements are going to be personal goods offered on the market with no government involvement in developing and subsidizing and disseminating them, then you'll think, well, the only role for the government is sort of regulating the market in some way. And you'll focus on certain potential problems with that. But you really may miss the elephant in the living room. The elephant might be that the states, some states at least, may be very interested in encouraging these biomedical enhancements and channeling resources to their development and encouraging or mandating their use. And that raises a whole set of other ethical issues. We ought to be on guard for those we ought to be thinking about them proactively and we'll simply miss them. If we stick with these two early, earlier framing assumptions, we'll be lulled into thinking, well, you know, we had a go with eugenics. Don't worry about the state. Everybody's smart enough to realize the state's, you know, not going to be involved because we're not going to have another eugenics. We don't have to have another eugenics for the state to have a perfectly good, respectable looking justification for being intimately involved with some of these enhancements. And also, this new framing allows us to look at biomedical enhancement through what I'll call the lens of the ethics of development. So I want to explore that idea briefly. How are we doing on time?
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Another 15 or so?
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Okay, I'll try to keep it. I think I can do it.
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15.
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B
It's interesting. There are people on the left as well as the right end of the political spectrum who have a lot of hostility toward biomedical enhancement. And people on the left who tend to be, you know, identify themselves quite reasonably as liberals on a whole range of issues, are often pretty negative toward the idea of biomedical enhancements. I think because they're really worried about unfairness in access to biomedical enhancements. They're extremely worried about that. And sometimes they seem so worried that the message that you get from them is, well, let's just don't go there at all. Let's don't develop these things because it's almost certain that if we do develop them, they'll be distributed very unequally and that'll be unjust, and it may also contribute to other injustices, may have a kind of magnifying effect. But if you think of biomedical enhancements not as some rare, exotic, special thing, but as just a. The latest version of something that's been going on for a long time, namely enhancement and more broadly, innovation, development of new technologies, then I think the first thing you realize is that whatever you want to say, you don't want to say that the mere fact that these things won't be available to everybody means they shouldn't be available at all. If you think about it, if that were your rule that you can't have any new benefits for anybody until everybody has them, you would have a pretty peculiar view about development in the world. It would mean that countries who are sort of in the middle of the development indexes, maybe like Brazil, shouldn't be allowed to move up any further in terms of improving their standard of living until the worst off countries were allowed to Move up to wherever Brazil is. That seems crazy to me. And I don't think that most of us would say nobody should be allowed to be literate until everybody's literate. So I don't see any particular reason to think that we should say something like that in the case of biomedical enhancements. And thinking about biomedical enhancements in the context of how we try to think ethically about development, I think helps us avoid that kind of simple knee jerk reaction. And also I think that the mere fact that there's inequality isn't necessarily bad in itself. The most sustained attempt I've seen by a philosopher to show that equality in itself is good, inequality is bad is by Larry Temkin. And it's what I personally would call a glorious failure. It's a great service. The book's a great service, because at least some of us say, you know, boy, he did the best you could do with that idea, and the best is none too good. I'm not going to try to refute his gigantic, closely reasoned book tonight, but at least I'm going to appeal to your intuition that in many cases we think inequalities are okay. In fact, inequalities can be quite beneficial. I'm quite happy that there are lots of people that are smarter than I am. I have an appointment in the institute for genome science and policy at Duke. And you know, there are some of the smartest people I have ever encountered. There are lots of young genome scientists. They're absolutely brilliant and. And I don't feel badly that they're a lot smarter than I am. I'm really happy that there are a lot of people that are smarter than I am. I think it's great because, for one thing, I think I'm benefiting from it. So I don't think in any other area of human life, and certainly not when we think about development, that most of us would say, oh, the mere fact of inequality is bad. And we certainly wouldn't say this first thing, that we shouldn't allow anybody to get something until everybody gets it. But there's also another side to looking at these issues from the standpoint of the ethics of development. And I think this is improvement in the way we've begun to think about development just in the last 15 or 20 years. And that is we can't assume that we'll have this nice result, that there will be an innovation, say a biomedical enhancement, and it'll be available only some people at first, and then somehow either everybody will get it pretty quickly. It'll diffuse really rapidly or the benefits of some having it to the ones who don't have it will be so great. The trickle down. I don't know if you know this phrase trickle down from the Reagan administration rhetoric. This was a great. I think Thatcher used the term too. Sure. But we can't have a facile assumption that there's somehow it's automatic to the process of development or innovation that either that valuable things will diffuse rapidly or that they don't have to diffuse rapidly to take care of our worries about justice. Because there'll be a trickle down, the people who don't have them will benefit. Sometimes they will. I've mentioned cases where it looks like that's true, but you can't make a general assumption that this will happen. I think these are lessons that are just obvious lessons if you've been thinking about the ethics of development. And I think they're applicable to the case of biomedical enhancements as one interesting kind of innovation that can play a role in the development process. So many enhancements will not be zero. Some will have the potential for improving well being. And that means that focusing on luxury or vanity enhancements gives a distorted picture of the cost benefit schedule. Regarding enhancements, I use cost benefit here very broadly. I think as with any technology, we have to think about what are the pros and what are the cons. Doesn't mean that we can neatly quantify them and do cost benefit analysis in the rigid sense. But we need to think about the pros and the cons. And when we do, it's important to really think about the different benefits as well as the cost that we could get from having these things. And what I'm afraid of is that some people who, especially people who are worried about the unfairness issue paradoxically sometimes try to denigrate biomedical enhancements by thinking of them as vanity goods or luxury goods. I think Michael Sandel is a good example of this. I think President Bush's Council on Bioethics reports are a good example of this. And if you just think of these goods as being luxuries or vanities, then you're not going to think of them in terms of development. Because to think of them in terms of development, you're thinking of them more as things that contribute to human capital in some way, to human productive resources. And thinking of biomedical enhancements as if they were just sort of vanity goods or luxuries would be like thinking of cell phones as simply things to gossip with or as status symbols. There's a lot of Growing evidence about the dissemination of cell phone technology. It's been much more rapid than anybody ever predicted. And there's evidence that some of the poorest people in the world are beginning to use cell phones to organize economic and political activity and to do things they've never been able to do before. And so, you know, I think we have to keep that in mind and ask which biomedical enhancements are likely to be more like cell phones, or could be made to be more like cell phones, could be treated in such a way that they diffused pretty widely. Now, here's a more subtle point. The property of being zero sum or being positive sum isn't a kind of natural property of goods. Whether the effects of somebody having a particular good, like a biomedical enhancement, tends to be zero sum or positive sum depends on the social context. And in many cases it's a mixed bag. There are some zero sum aspects and some positive sum aspects. And more importantly, in some cases, we may be able to influence the context, the variables that make up the context, in such a way that we can accent one aspect of the good rather than the other. Now, if a beneficial new technology, whether it's a biomedical enhancement or not, is available only to a minority initially that already enjoys greater resources, and if this inequality persists for a long time, and if social arrangements allow this inequality, inequality and access to the technology, biomedical technology, if social arrangements allow that inequality to translate into injustices in other important spheres of life, like political processes, for example, then we have a really serious problem. But notice that this is a conditional worry. The two factors may in some cases be subject to our control. So we shouldn't assume that it's inevitable that inequalities in access to biomedical enhancements will create these problems. And more generally, I think we should at least entertain the idea that the problem with some biomedical enhancements, as with lots of other innovations, is not that some have them and some don't, it's that they don't diffuse quickly enough. It's kind of understandable that at the beginning, only some people are going to have access to the innovation. And I don't think we should realistically assume that we're only going to provide it to some if everybody can get it. At the same time, what we have to worry about is something that's really valuable and that doesn't diffuse rapidly. Now, how quickly a technology diffuses depends on a lot of factors. Cost is one of them. But again, think about cell phones. They diffuse rapidly because they're not very costly, and the cost comes down Just like the cost of personal computers has come down enormously last 20 years. One reason that innovations don't diffuse rapidly is a result of the intellectual property rights system that we have, the patent system in particular, because the patent system allows people who invent things to charge monopoly prices for them. What a patent confers is a time limited monopoly, usually 20 years. So one obvious practical response. If you're worried about unfairness in the distribution of biomedical enhancements, but you also think that biomedical enhancements may be very valuable, you don't think we can just say no to them, would be to think about how we can accelerate the diffusion of them. Say just a little bit about that and then stop. But before I do, let me just say one thing that may occur to some of you, and that is it's really a good thing that innovations aren't available to everybody at once for a couple of reasons. One is they may turn out not to be such a good thing. They may turn out to be a waste of money. And in a way, it's nice for the rich people to make that mistake rather than the rest of us. But also they may be risky. And if you have an innovation that looks great and you say, gee, I'm really concerned about distributive justice, nobody should get this until everybody does. Everybody's going to get it, and then it turns out that it causes some serious problem. Not good. I like to think of rich people as risk pioneers, as people who will voluntarily, even without coercion, assume risks in the development of new biomedical technologies so that those of us who aren't rich can benefit from them. When they become safe and more effective, they'll get the first generation of the thing that costs a hell of a lot of money and may be risky. You and I can sit back and get a second or third generation, but safer. Well, I don't want to be frivolous, but I think that it is a consideration. Okay.
- [56:45]
E
Well.
- [56:48]
B
In a paper that I published with international relations theorist, institutional analyst person Robert Cohan, and an international lawyer, Tony Cole, who's at Warwick University, we consider this general problem about justice in the diffusion of innovations. That's the way we think of it. That is, we're worried about not just biomedical enhancements, but a more general problem that our society is very innovative. That's good. We sometimes produce innovations that are potentially valuable for everybody, or almost everybody. But partly because of the intellectual property system that we have, patent system in particular, there are obstacles to the rapid diffusion of these valuable technologies. Now, of course, it Wouldn't make sense to say, oh, if the intellectual property system is an obstacle, let's just get rid of it. Because the rationale for having intellectual property rights is to stimulate innovation. It confers a time limited monopoly on the innovation you produce. And that's supposed to be an incentive to get people to invest in the risky business of trying to develop new things. And I think we need something like that. We need some kind of intellectual property rights system. Whether we need exactly the one we have, that's quite a different question. So the issue is not, oh well, diffusion gets slowed up by monopoly pricing. Monopoly pricing is a result of the patent system. Problem solved, get rid of the patent system. Can't be that. But it may be possible to tweak the intellectual property rights system in ways that will reduce this problem. Having something that's potentially valuable for a lot of people and maybe really valuable for some of the worst off people in the world, but they can't afford to get it. And so it doesn't diffuse rapidly. There's a philosopher named Thomas Poga at Yale University who has been going around the world making a proposal for something called the Health Impact Fund or Patent II system, which is his attempt to tweak the existing intellectual property rights system in a way that would ameliorate a particular aspect of this problem of slow diffusion of beneficial innovations. He's worried about what are called essential medicines in the case of anti HIV AIDS medications is the poster child for the essential medicines problem. There are millions of people around the world, especially in sub Saharan Africa, who could benefit greatly from these medicines, but they haven't been affordable to them. And it's partly because of the monopoly pricing that the patent system facilitates on the part of the drug companies that make these drugs. And so he has a proposal for how to try to incentivize the drug companies to act in ways that will lead to more rapid diffusion of this technological innovation. And Cohan and Cole and I have a different method and we can talk about that. But let me just conclude by saying, I think there are a couple of lessons here. One is don't think of biomedical enhancement just as personal goods to be delivered through the market. Another is think of them as, as things that can augment human capital or human productivity. And then that enables you to think of them in the broader context of the ethics of development. Once you do that, you realize that certain kinds of knee jerk reactions like, you know, if not everybody can have it, nobody should have it, that that's completely the wrong reaction. And Then you can start to think concretely. You can get beyond just the sort of, oh, gee, they might be really great, oh, gee, they might worsen in general justice. You know, what shall we do? You can begin to look at some particular policy proposals that might ameliorate at least some of the problems that are really worrying you when you quite rightly worry about the problem of unfairness. Thank you.
- [60:58]
A
Good. We have around 20, 25 minutes for questions. The rules are that you please state your name and wait until you have the microphone. And also please keep the questions short and to the point. Those of you who fail to abide by the rules will be candidates for moral enhancement. Right over here.
- [61:26]
F
My name is Matt Pines. I'm in the philosophy and public policy Master's program. And I have a question about you. Kind of. It was in the bottom one of the slides, the notion of moral enhancement that Alex just referenced. And a lot of what you've been talking here is the issue of inequality and access to these things. But I worry about the sense in which, given the capacity, you mentioned oxytocin, it might be strongly socially beneficial for. For people to be more cooperative. And it might be in the government's interest to make citizens a lot more willing to cooperate. But it seems the. Seems to be there's lots of objections to do with autonomy and the notion of that. I'm not sure I want to be genetically engineered to have higher average levels of oxytocin or my progeny to have.
- [62:15]
B
I agree. That's why I said, you know, if you think that the state will be interested in some biomedical enhancements, you better start worrying about these things. And you won't worry about them. If you just think, well, the state's going to be at most regulating the market. You know, we've been there, done that with eugenics. It's just going to be personal goods offered on the market. So I think that's exactly the kind of question to ask. And look, cooperation is a good example because, I mean, what is cooperation? It's not as if we're going to find a cooperation gene or even, you know, some set of cooperation genes. You think about it. What do we want when we say we want people to be more cooperative? Something very value laid. We don't want them to be cooperative with genocidal maniacs. We don't want them to gladly get on board with the next mass killing. You want them to cooperate with the right people for the right reasons in the right way. That's a very complex moral virtue. And I think the first lesson is it's almost certain that you're not going to find some distinct genotype such that if you introduce that into a human being, meaning you're going to get that result. That seems to me to be almost unimaginable. That could happen. But to the extent that you could make either pharmaceutical changes or genetic changes that would influence cooperativeness, you're going to have all these problems about who's controlling what's done with this increased propensity to be cooperative. How's that going to be channeled? Is it going to be toward the kind of cooperation that we think would be good, or is it going to be channeled toward making more docile citizens that will go along with some dreadful government? Those are just the kinds of issues that you have to think about.
- [63:57]
A
Over there.
- [63:59]
E
Luke Bovitz.
- [64:03]
G
Yeah, Luke Bovitz, I'm actually curious about. I mean, it seems like, you know, in the things that we do, there's sort of two different kinds of things. I mean, sometimes the value comes about because of what we attain, and sometimes the value comes about because of the.
- [64:22]
B
Doing right of it, because of the process.
- [64:24]
G
Now, it seems to me that if we're thinking about these diseases, right? Then the value comes about because of what we attach, namely, we overcome those diseases, right?
- [64:35]
B
It's just the outcome.
- [64:36]
G
That's one kind of thing. But then when I think about your numeracy and your literacy cases, then I think we're in a different realm, really. And that's where I'm wondering about the enhancement business. And I was thinking about the following analogy. I mean, suppose that, you know, you like doing crossword puzzles, right? And now I say, oh, you like doing crossword puzzles. Why don't I give you an encyclopedia media that'll help you out. You say, oh, yeah, that's great. You know, now I look things up and it's exciting and all of that. And then I give you a really good crossword puzzle book. And if it's really good, then the fun is kind of gone, right? You say, no, that's not the kind of thing that I want to do.
- [65:14]
B
I get you.
- [65:15]
G
I get so. So, of course, I mean, the point of this is that, you know what we want? I mean, we like tools to do things better, even if it's the process that we value. But these tools have to be the kind of things that kind of challenge our cognitive abilities, that engage them in particular ways. Now, numeracy and literacy does that. But I'm really worried that, you know, these Enhancements are doing that in any way. Okay, they're kind of like the crossword puzzle.
- [65:41]
B
Okay, let me address that because this comes up a lot. A lot of people have the concern that you do. It comes up in the sports context. People say, well, you know, what we want is somebody to struggle hard to develop their natural talents and then show us how good they are on the field and stuff. Well, as it turns out, the way performance enhancement drugs work in sport, they don't obviate effort. In fact, the main drugs that are used, what they do is they enable you to train even harder and for your body to repair itself between training sessions. Barry Bonds, who's sort of the poster child for sports enhancement drugs in the United States, a baseball player, is reportedly the person who imposes on himself the most draconian training schedule of anybody in professional baseball. And I think that it's. As a generalization, it's accurate to say that typically what happens with performance enhancing drugs in sports is that people use this to raise themselves up to a platform from which they can exert greater efforts. So it's not that they take a pill and they don't have to train, and so they've missed whatever the value of the process of struggle is. But let's set that aside. Think about something like, well, I mean, think about literacy, okay? We have ways of people learning to become literate, and there's always questions about whether it's being done most efficiently. And there are new reading programs that come out and stuff like that. But what if, in fact, you could give somebody a pill and make them literate? I think this would be a fantastic thing. Okay? 80% of the women in Afghanistan are illiterate and 60% of the men are. And throughout South Asia, there's fantastic illiteracy. China's done extremely well on literacy, but at great social cost. The opportunity costs have been great. Resources could have been devoted to other things. I think it would be fantastic if we could introduce something into the water supply that would make the population of Earth literate overnight. And it's not that you say, oh, gee, all that struggle wouldn't have been great if you had to sit there learning to read. I mean, I don't think anybody would say that. Partly because then once people are equipped with literacy, they can go on, they can strive, they can pursue excellence in various ways. Or think about something like a GPS unit, a global positioning device. It's true that if everybody has a global positioning device, you're going to have fewer people who have the traditional orienteering skills, they won't have them. And that's a loss. But I think it's a loss that's probably worth it to most of us. So I don't think enhancements generally are going to create a shortage of opportunities for striving. What they will do is they'll just open up new ranges of human activity in which new striving can occur at higher levels. Think about this. Suppose you're a musician, and lots of musicians take Adderall because it makes their heart beat more regular and steadies their hands. And the musicians I know who take Adderall don't take it so that they can then slack off on practicing difficult pieces. They say that now they can attempt to master even more difficult pieces than they could master before. So I guess I have a little more faith in the idea that we're not going to be facing a shortage of opportunities for striving in human existence. And I also have more faith in the human propensity to look for new challenges. And I think of biomedical enhancements often as raising us up to a new platform from which we can strive even further for excellence.
- [69:49]
A
Okay, the gentleman over here.
- [69:58]
E
Thank you. I don't know if my question falls into the Malthusian or it simply shows I understood nothing, but aren't we assuming a lot when we thinking that natural selection is some kind of vehicle with a side effect on an utopian point, a star somewhere in the heaven with the bottom line, it's our survival. Because all the signs for the human race in modern history suggesting that we have reached the used by deaths such as the atom bomb, and when we failed to blow each other, up came hiv, then homosexuality en masse, which I'm talking out of morality, but out of it is reproduction status, biological status. Now all of these signs are there telling us that we are heading for extinction. Can a biological enhancement raise quantitatively raise to the level of these challenges? I'm talking about quantitatively, not qualitatively. Thank you.
- [71:17]
B
Yeah, I think it's a great question. Last night I argued that. I think in a way that you'd be sympathetic to that. One of the reasons we should at least consider as a serious possibility genetic enhancements of human beings is because from everything we know about evolution, biological and cultural evolution gives us no reason to think that we're going to survive. In fact, biological evolution gives us reason to think we're not going to survive. All we know is that species go extinct. So it's not as if we can stick with the status quo and assume that everything's going to be all right. We've already created lots of problems for ourselves. Nuclear energy one example, global warming another. So we might in fact need biomedical enhancements of particular human capacities, not to improve us compared to the status quo, but just to sustain the status quo, to prevent things from getting a lot worse, even to prevent us from going extinct. That's a possibility we have to consider.
- [72:25]
A
Gentleman over here in the front. Oh, sorry, I was this, this gentleman first. Yeah, there we go.
- [72:35]
C
Wolf Gardner, currently teaching at the LSE from Germany. I buy most of your arguments, but maybe it's a bit over optimistic. One thing, for example, is the issue of inequality. What we actually see over the last 30, 40 years in industrialized countries is the gap between the poor and the rich is widening inequalities on the increase almost everywhere.
- [73:01]
B
Yes.
- [73:01]
C
And what you would have to show, and I think this is very difficult to show, is that enhancement would reverse this tendency.
- [73:08]
B
I don't. Well, I don't know.
- [73:09]
C
I mean, I buy the argument that, you know, by, through enhancement people get better education and by having more skills and so on, they would earn higher salaries and so on and so forth. But if the smarter get smarter through enhancement and the not so smart get a little bit smarter, also the difference between those two groups will stay constant.
- [73:31]
B
Yeah, that's right. Well, that's, that's an empirical question. I mean, I said that the evidence we have right now about cognitive enhancement drugs, the ones we know blue bit about, is that it doesn't work like that. That is, it's not that the drug gives a 5% increase in capacity to everybody, including the highest, so everybody just maintains the same relative position. In fact, it compresses the range of inequality because it works best for the people lowering it. Now, it would be great if that were true about enhancements generally. I see no reason to think it will be true about them. I don't think it's necessary to show that biomedical enhancements are going to reverse this trend. And I agree all the data is that there's more inequality now than we have any record of as far as we've been able to measure inequalities in the past. And I'm worried about that. Not because I think inequality per se is bad, but because I think that if inequalities become great enough, they're almost likely to have effects of domination and they're likely to distort political processes, undermine the kind of political equality that's needed for democratic functions. So I agree with all of that, I just think that there's no reason to pick on biomedical enhancements as being especially pernicious with regard to the problem inequality. And depending on how they actually work, it might turn out that they can be useful to some extent. I wouldn't predict that they have to, that they would reverse the problem, the tendency toward greater inequality. But again, I'm not advocating biomedical enhancements in any of them. I'm just trying to find a better way of thinking about them that's not based on justified assumptions that narrow our ranges of thinking about the options. But yeah, I mean, the staggering growth in inequality is quite amazing. Now, some people are not as worried about this because they think, well, there is tremendously more inequality now, but the lower level is higher than it's ever been. And it's certainly true that in measurable indicators of human welfare, more people are better off now than they've ever been in the past. That's compatible with a lot of inequality. And the problem is that a lot of these measurements of welfare don't take into account the political effects of extreme inequalities.
- [75:57]
C
I have another remark, if I may. This is an issue.
- [76:07]
A
I would like to prohibit both of you from making two remarks.
- [76:09]
C
Sorry, could I just add something which you really avoid? This is the following. I mean, I understand that enhancement will have the effect that people get older and they will get older in good health, but I think there is an implication for the pension system. So would you advocate that the retirement age should be increased? I can tell you from Germany that the Social Democrats have actually made this proposal very recently and they had large defeats in recent years, elections. It's a very unpopular issue.
- [76:43]
B
Old people vote and they don't want to have it.
- [76:46]
C
So would you recommend that you term in hr?
- [76:48]
B
Well, I don't know if I would recommend that, but I think you make an important point in that, is that if we do have a continued increase in how long we live and it's accompanied by, you know, sustaining vigor longer, then we'll have to rethink some things. It might turn out that people will want to work longer. Maybe they'll go into a different. They'll have several careers, right? And they will have worked for up to what we now consider normal retirement. Then they'll do something else that's productive and they'll be generating resources that will help pay for the very end of life. What we have now is people getting out of the mainstream economy and retiring, but then having many years where they have very expensive ailments and so if you eliminate some of those ailments and compress them toward the very end of life, so you have a short period of decline, that it may ease this problem a lot. But it's hard to predict because we don't know what people are going to do. I mean, there's been a huge increase in life expectancy since 1900, say, but it's occurred fairly gradually and it's mainly been a result of reducing childhood work. It's not been a result of extending life at the other end. So we don't have a lot of track record of historical evidence about what would happen if all of a sudden you had a large number of people living a lot longer and being vigorous and competing for jobs. Whether the economy could absorb them if they wanted to keep, you know, that's a question. But again, there might be new economic opportunities as a result of biomedical enhancements. So just thinking about the current job market might not be a very good guide.
- [78:37]
A
Gentlemen, here I'm really going to ask you to keep it to one question. Thinking of the worst, right?
- [78:43]
D
I'm going to say that you were overlooking the fact that biological organisms are economic organisms. And you've got a very faulty paradigm about what's going on now. You're looking at bioenhancement as an add on, a bolt on. But every bolt on is going to have a cost and the economic organism will be suffering if you ask it to do this or that. For instance, in the aging paradigm you have, you're looking at increasing repair on the arterial system and the brain, so on. All of those things have a biological cost. If you're looking at cancer, it's happening largely by genetic error. If you want to improve on that, you've got to pay energetically. And with time to stop the error happening largely, your organism will grow slower, you become a dwarf, probably you might.
- [79:38]
E
In fact.
- [79:41]
D
Some of the illegitimate recombinations that produce these hybrid oncogenes. You could remove one of those sites that looks like another one in the wrong place and reduce that frequency. But the point is, are very fundamentally basic to the way ordinary cells act. You can't go in ahead of a cancer and say we shut that one off. This is not how it works. Basically, if you were doing xenobiology, if you're doing xenobiology and starting afresh, you could organize by the divine creator that you want to be, but you actually starting with a system which has been created, evolved, whatever word you want in a completely different way. And by bolting on things, you're actually asking to do something which would be very reluctant to do. It'll probably resist very thoroughly, I think.
- [80:32]
B
Okay. A quick and probably unsatisfying reply to a complex and comment. As I tried to say last night, I don't think it's a matter of bolting things on. I don't think that the human organism is like, do you have the Mr. Potato Head? Do you know what that is? Is that a toy that your children use or Legos? We're not like Legos. You can't just sort of stick something on in any place. Right. And last night when I was talking about genetic modification of human beings, I was emphasizing that that's a kind of intervention that occurs very early in the ontogenic process. Right. Early with the embryo, and that that process has evolved and there's a sequence of things that go on. And if we ever make interventions of that sort, it has to only be on the basis of a lot of knowledge of the causal connections. It's not. It shouldn't be just like sort of bolting something on. As you say, you have to understand the current design of the organism, no matter how faulty. It doesn't matter whether it's faulty. That's not the point. You have to understand the current design of it to be able to make certain kinds of changes. And I'm not assuming that we'll learn to do those things. All I was saying, particularly last night, was that if we do get to the point where we have the knowledge to do these things, it looks like we'll be able to overcome some of the constraints under which unassisted, regular old evolution operates. Some of the constraints. We can't start with a new slate unless we're really literally willing to start out with a radically new basic design. But all the cautionary heuristics I gave yesterday for genetic alterations of human beings for the sake of enhancement were designed to take into account just the point that you're making, which I think is important. Well, I think they're in the right direction. But again, remember, I'm not just talking about genetic modifications. The things I talked about today, especially the cognitive enhancements, have not been nearly so radical as that. They've been mainly pharmaceutical kinds of enhancements or perhaps some neural tissue implants or computer brain interface technologies. And these things all carry risk, and we're not ready for any of them at present. But I don't think we can rule them out a priori. And I think to see whether we should invest in seeing whether we can develop them we need to have the right framing of the issue and appreciate both the benefits and the cost.
- [82:48]
A
Richard Bradley over here, he's sitting right over there.
- [82:54]
B
Yep, you're next. You've been very patient. So very quickly. So you, I mean, I take your point about not automatically framing things in sort of zero sum terms, but there are enhancements that do have negative external. And I'm sort of wondering whether you're willing in those kind of cases to talk in terms of limiting access to them and what kind of conditions. So, I mean, the example that I had was the one that Wilf has already raised. Longevity is an important area where I agree. I mean, I think that there are going to be some that will have negative externalities and some may even be zero sum in some context. And the question is, is can you change the parameters of the context to reduce that effect? If you can, then that's helpful. But even if you identified some particular biomedical enhancement on the horizon that you thought was going to have some serious negative externalities, there's serious questions about whether you could stop it from coming. Right. There's a sort of a problem with the prohibition strategy because if it's something that's really valuable, people are going to want it. And where there's demand, supply tends to appear. And if you try to have prohibitory regulations in one country, then you can be certain the technology will go to another country. And this means that the problem of regulation has to be addressed at the global level. This is extremely difficult. I think in general, prohibition strategies are. They may look morally attractive and they might even work in some cases, but they're very hard to pull off for something like this. And I don't think we should be naive about that. We should be concerned about distributive justice, but in general we should try for policy responses that don't require prohibition, but that instead speed diffusion or counteract the negative externalities when we can. I mean, you know, I think there are probably going to be some innovations, biomedical enhancements or otherwise, that it would be much better off if we never had them at all. But it's hard if they're viewed as valuable, especially if in our culture there are marketing pressures and people see the profits from having them. It's going to be very hard to prohibit them, especially in countries where there's an ideology of individual freedom, consumer choice and all that. I won't mention any in particular, but good.
- [85:24]
A
I've seen there are more questions, but.
- [85:27]
B
Please, this fellow has been so patient.
- [85:29]
A
Okay, 1, 10, 10 over here in The Blue Scholar.
- [85:35]
H
It's a short one. Well, I also, by the main argument, but I also wonder, I mean, what's the primary purpose of biomedical enhancement? Is it the increase of productivity, or is there another claim, there stronger claim about the distribution, the just distribution of natural goods? Because if it's the claim that we have to care about the increase of productivity, you can enhance already intelligent people, you increase the productivity, and then of course, you have something like, you know, the Global Institute for Justice in Innovation, and you make sure that the innovations are diffused. But if it's the claim that, you know, by using biomedical enhancements, you actually achieve some sort of justice in the distribution of natural goods, then things might change a bit.
- [86:35]
B
Yeah, I mean, well, I don't think you could make a generalization that biomedical enhancements are going to reduce existing unjust inequalities, but I think that some of them might have some impact in that direction. And so we shouldn't just assume that they're going to exacerbate existing inequalities. Whether they'll exacerbate them or lessen them is going to depend on what the facts turn out to be. And we don't have much in the way of facts. We for something, we have a little bit of evidence about these few existing cognitive enhancement drugs or drugs that are used for cognitive enhancement. And that seems to be encouraging from the standpoint of inequality. But it would be a huge mistake to generalize from that. We don't know. And it might turn out that in some cases we'll have reason to believe that a certain biomedical enhancement would tend to have better effects in terms of equality. And of course, then the question would be, could we somehow manage a public policy that would encourage those which would channel resources toward the ones that are likely to improve, or at least not worsen the situation with respect to injustice, and if not, stop in their tracks. The ones who would increase inequalities at.
- [87:47]
G
Least.
- [87:50]
B
Restrict the flow of resources to them to some extent, lessen the negative impacts that it might have. That's a tall order, but I think we have to start thinking in those terms. And one thing would be again, to sort of mainstream the biomedical enhancement thing and think about innovations generally, including essential medicine, things like that, and try to set up a sort of monitoring and surveillance system that would draw on knowledge we have about the diffusion of technologies in the past and try to be on the lookout for either positive tendencies or negative tendencies of new innovations, and then see if we could do something to encourage the things that are going the right direction, speed up their diffusion and impose whatever constraints we're able to. I'm skeptical about this on the ones that look like they're going the wrong way, but as it is now, it's kind of free for all. In retrospect, we look back and we say, gee, cell phones turned out to be better than we thought they were going to be. So a lot of people thought they were going to be sort of luxuries for the rich. And it looks like they have some sort of democratizing effects and they're enabling economic activity for very poor people. And that's good. But it would be nice if we could study cases like that and the contrary kinds of cases and develop some reliable predictions about which features of emerging technologies are likely to either exacerbate justice problems or make them worse. One feature we know about already, and that's what's called piggybacks. There's a group at MIT that's developed a new kind of laboratory in a chip that they say can be added to an ordinary cell phone for $1 cost. And this will enable anybody who has such a modified cell phone to test the atmosphere, to test water, to test blood samples, and the results will be wirelessly sent automatically to public health data collection integration centers. And for people working in very poorly resourced medical clinical in rural villages and things like this, this would be absolutely fantastic. And they designed it to be easily added on to an existing technology that's already been very successful in diffusing at low cost. So, you know, more thinking like that.
- [90:20]
A
Thank you so much.