Wednesday, May 06, 2009

Talk on Enhancement and the "Status Quo" Bias

Yesterday I drove down to Bowmanville, Ontario to give a 90 minute talk to approximately 50 students at Clarington Central Secondary School. They were Grade 12 students taking courses in politics and philosophy. My talk addressed the issues of enhancement, aging and the "status quo" bias.

I want to thank Trish for inviting me down and thanks also to all the students that raised lots of good questions at the end of my talk. I really enjoyed the exchange, and it was interesting to see what the attitudes of the younger generation are to these issues. Below I summarize some of the main points from the talk, and my response to some of the questions raised.

Last week President Obama announced that the largest investment in scientific research and innovation in American history will be made. This raises many interesting questions concerning the role of science in helping us create a more fair and humane world. And here I will limit my discussion to novel advances being made in the biomedical sciences and the great benefits they could provide us with this century.

I started things off with a discussion of the PEPCK-Cmus Mice and showed the class this brief video. These are transgenetic mice that researchers at Case Western Reserve University created back in 2007. The results were published in the Journal of Biological Chemistry (see here) . These genetically enhanced mice can run twice as far as a normal mouse, they live longer and can remain fertile longer than regular mice. They can also eat twice as much as a normal mouse but only weigh half as much.

These "enhanced" mice have had their metabolism re-patterned. If (and it is a big *if*) re-patterning the human energy metabolism were to confer the same magnitude of enhancements on humans, then some people could live to a 140 years of age, a woman could still have a baby at age 80, and you could over-eat and still be healthy.

So the question I wanted the class to focus on was this: Is it ethical to biologically “enhance” humans (to improve upon evolution)? [I noted that this question was loaded, and would explain why later)

Suppose this was (relatively) safe to do in humans, [roughly equivalent to the risks associated with immunizations or playing sports], how many people think the idea of enhancing humans like this is a bad idea? How many think it would be great?

I was surprised by how many students said this would be great (over half the class). When I ask my fourth year University students this question most think it would be a bad idea. But in this class the advocates outnumbered the critics.

I then asked them to consider this. Imagine that a new “exercise machine” was created that could do the same thing for humans. It could really make you twice as strong, live longer, remain fertile for longer, etc. And let's suppose this was scientifically proven rather than just hype from the company selling the machine. How many people would like to work out on this machine? And how many would prefer to go to the gym and use the older machines that would be less optimal for their strength and health? Most thought you should use the better machine.

I then asked how many who opposed enhancing humans via genetic intervention or drugs were in favour of this same thing via exercise (there were quite a few). And I told them they were the people I would be trying to get to think critically about their position on these issues. Why are they in favour of enhancing humans via exercise and not via a drug, especially when (as my example presumed) the effects of enhancement were the same.

I asked for some initial answers. One student mentioned that people deserve these benefits if they work for it but not by popping a pill. I replied that this is a common reaction. But if we think about our attitudes towards health, we probably wouldn't want to endorse a principle of desert as the appropriate principle. In other words, do we really want to say that those who exercise less *deserve* diabetes, cancer and an earlier death? That's harsh. Furthermore, there are many reasons why people's lifestyles vary (how much time they have, how affluent and educated they are, whether they live in a climate or city conducive to outdoor activities, etc.). So the role of personal responsibility in this context is a tricky one.

OK, so my concern was why some people's intuitions change when the means of enhancing humans is altered. Those who favour enhancement via the exercise machine must explain why they don't support enhancement via drugs.

My explanation for this is that these people suffer from the cognitive bias known as the "status quo bias". This bias is a strong desire to keep things the same. There are plenty of examples from this in real life. Here is a simple example.

Suppose your best friend is dating a guy you know is a jerk. You ask her why she stays in the relationship. And she responds "Because he's the best boyfriend in the world!". To which you think "How can you say that when you have only had two previous boyfriends!!". When one considers all the possible boyfriends there are in the world, what are the odds that the really BEST boyfriend just happens to also be in your Grade 10 Chemistry class and live within a 1 mile radius of where you just happen to live? This applies in many aspects of our decisions- economic decisions, decisions about where to live, etc. We often place weight on the status quo for no other reason than it is what we are familiar with. And lots of people suffer from the "enhancement status quo". That is, they believe that pursuing external environmental enhancements (education, going to the gym, etc.) is inherently good, but altering our biology via drugs or genetic intervention is inherently bad.

What I find surprising is that people seem pretty confident that the human body's current energy metabolism just happens, at this stage in our evolutionary history, to be the best! That we shouldn't aspire to improve upon it like we have with the PEPCK-Cmus Mice.

So how do we combat this enhancement status quo bias? Here is a great paper on that topic. For this talk my suggestion was that if we reveal the real costs of the status quo, then people might realize that perhaps it is not that great to try to keep the status quo. Just like your friend might realize she should dump her boyfriend once she has all the relevant information about him at hand (e.g. that he cheats and lies to her), perhaps we would chose to "dump" our current energy metabolism in favour of one that makes us stronger and healthy for longer when we reflect on the harms of the status quo.

To bring this into focus I addressed the issues of aging and aging research. I won't re-visit all of these issues here as I have posted on them many times before. But I highlighted (1) what the costs of aging are, and (2) how close the science is to making the aspiration of retarding aging a reality.

At the end of all of that I returned to my initial question: Is it ethical to biologically “enhance” humans (to improve upon evolution)?

But that question is not the correct way to phrase things. The real question is: Is it ethical to “enhance” humans? The answer is clearly “yes”. We enhance ourselves through education, immunizations, clothing, eye glasses etc. No one champions that "status quo" of our vulnerability to measles and mumps, or our failing vision, tooth decay, or susceptibility to freeze to death without appropriate clothing, etc. Every day we utilize enhancements.

Once we realise that, we are likely to take the view that it would be unethical not to enhance humans! Limiting access to immunizations and education, for example, would be viewed as an injustice.

So the best means to achieve the goals of health, intelligence, etc. ought to be considered on their merits- their efficacy, safety, costs, etc. We shouldn’t pre-judge these issues by assuming we already know what the best way to achieve these goals are. Such arrogance neglects how little we really know about our biology.

[some extra points are added here...]
One of the greatest dangers to creating a better world is the status quo bias. The next time you defend a policy that is premised on an assumption like "the current rate of aging is the ideal" or "the current global temperature is the ideal" or "our current cognitive capacities are the ideal" ask yourself if you have fully considered all the costs and benefits of the status quo and potential alternatives. Odds are your "gut reaction" does not track these complex variables. Would you prefer public policies to be premised on "gut reactions" or a comprehensive assessment of the all the relevant, available data? I prefer the latter.

Unfortunately good intentions alone are not enough to create a better world. If they were we would have realized these ideals a long time ago. Humans have always possessed good intentions, but what we have lacked is the knowledge to know how realize these intentions. Hence why it is imperative that we cultivate a culture the celebrates scientific habits of mind and a respect for the great good that science can (and has) created.

After the talk some great questions were raised. I've tried my best to recall the points raised and briefly summarized the questions and my responses (with some addition points added) below.

Question (1): people have to die from something, so what good would slowing aging really accomplish? Also, wouldn't this cause overpopulation?

Response: It is true we all have to die of something, there is no "immortality" drug. However, our attitudes towards age-related risks of mortality should be the same we take towards every other possible cause of death. Namely, we want to *minimize* those risks. We wear seat belts, look both ways before crossing the street, etc. in an attempt to avoid death. And there are an almost infinite list of ways to die. No one says- let's just accept the current deaths from car accidents, adverse reactions to drugs, war, poverty, etc. by saying "well, people have to die of something!".

So why only bring this objection up with age-related risks? [in other words, consider this modified version of the question- "given people have to die of something, what good would stoping war, cancer or poverty really accomplish"]? Of all the possible risks to be complacent about the risks of aging should be last on our list. Why? Because aging is among the greatest risk factors and it is something we might be able to do something significant about. If we have to be complacent about some risks lets pick those that are very small and ones we can't change anyways .

On the second point, many people believe that the world is overpopulated. They also seem to think the evidence for this is the fact that some people live in poverty. Well, it is worth noting that there has never been a period in human history when some humans did not live in poverty. In fact, just 2 centuries ago everyone lived in poverty. So poverty existed when the world had less than 1 billion people. And poverty exists today when the population is over 6.5 billion. But the cause of poverty is much more complex than the # of people. Life is not a zero sum game (meaning more life for some need not come at the cost of less life for others).

But even if slowing aging caused problems associated with overpopulation, you have to weigh up the harms of that versus the harms of letting billions of people die prematurely from chronic disease. And my view is that the harms of the "aging status quo" present much more certain and greater harms than the potential negative consequences of age retardation.

Question (2) A question was raised concerning the moral hazards that might be involved with developing a drug that accomplishes these things. Won't this just perpetuate inactive lifestyles because people think they just need to pop a pill?

Response: good question. The reality is that such a pill, in conjunction with a healthy lifestyle, could help us reap the most optimal health consequences. So we would have to educate people about what the pill actually does. It would be a supplement, not a replacement to a healthy lifestyle. Of course there are dangers of people being misinformed. And that would have to be addressed.

Question (3) what about this leading to greater inequalities between the rich and poor? How do we ensure developing countries have access to an anti-aging intervention?

Response: All existing enhancements (education, immunizations, eye glasses, opportunities for exercise, etc.) are unequally accessible to people in the world. So this inequality problem is not unique to an enhancement that retarded aging. Is it better to have these enhancements, even if they are unequally available to all in the world, than to have never developed them in the first place? I think the answer is clearly "Yes" [if you think the answer is "No" then what you are saying is you really would prefer for everyone to revert to a life expectancy below 30 years, which is what the norm has been for humanity for 99.9%+ of our species' history).

Recognising that enhancements are unequally accessible doesn't mean we should not fight for greater access to them . Of course we should. And what is particularly important to campaign for is access to those interventions that are most cost-effective, that would reap the greatest benefits for the smallest cost. And I believe an anti-aging pill would be just such an intervention. So if we make age retardation a priority for global health, there is no reason all couldn't reap these benefits.

Unfortunately many people in the developed world fail to realize that less affluent countries also suffer from the chronic diseases of aging. Many seem to think all people outside the most developed countries die from HIV and malaria, when the truth is that most die from the same things that kill us- cancer, heart disease and stroke. The WHO estimates that in the decade between 2005 and 2015, 144 million people will die of chronic disease in lower middle income countries like China and India. So retarding aging would be a benefit to those in less affluent countries. Indeed, staying healthy and productive is much more vital in a poor society because workers cannot rely on health care and pensions to aid them in later life. So slowing aging is also a matter of development economics.

One last point to consider. A public health intervention like providing clean drinking water requires large-scale urban and rural planning, construction, enforcement of compliance, etc. These "post" R+D costs and challenges are unlikely to be such a problem with a drug that retards aging. So when thinking about what access to an anti-aging pill might be like consider something like the birth control pill rather than sanitation. The UN has the data here on World Contraceptive Use.

It is true that women in the developed world enjoy greater access to the birth control pill than women in developing regions (16% to just 6%), but things are more complex because there are many different ways of using birth control. So IUD's are used more widely in less developed regions, as is female sterilization. And access to the pill is complicated by issues like religion. Unless the Pope comes out in support of a ban on an anti-aging pill we should assume these obstacles would not arise with a pill that reduces the risks of morbidity and mortality in later life.

Question (4) But the danger with tampering with our genes is that we won't know all the consequences of this. Every day we are learning about new toxins in the food we eat that cause cancer. Epigenetics reveals how complex the interaction is between genes and environment. So how can you say it would be ethical to enhance humans by tampering with our genes when we don't know what the full consequences will be of this ahead of time.

Response: But everything we do on a day-to-day basis influences our genes- the food we eat, our lifestyle, etc. So there is no option of "leave our genes the way they are!". And most of the things we do now that influence our genes and biology are done in ignorance of the full consequences they will have on our health prospects.

The best we can do is go by the data we have, try to get new data, and make an informed decision. We know what the costs of the current rate of aging are. They result in death and disease for most people before age 85, that is a certainty for our species (though the rare individual may live a 100 years of disease-free life). So we will see unprecedented levels of chronic disease this century unless we do something about aging.

A decision to pursue age retardation has to be made on the basis of (a) the grounds for believing such an intervention can be efficacious (so it would have to be shown to work in other organisms (like mice), and a plus would be that it has a demonstrated therapeutic effect for treating human diseases in clinical trials); and (b) its safety (this is where the clinical trials for treatment prove useful again).

There are no guarantees. But that holds for everything we eat and consume. And if, among all the various things we currently do consume that are good, bad,indifferent and unknown (which are most things) for our health, we suddenly invoked the "status quo" bias and decided not to pursue an anti-aging intervention even though it had a proven track record of improving health in other organisms (including mammals) AND a proven track record for safety in clinical trials for humans, then we would be irrational. But these are important issues, and we need to wait for more of the data to come in before we can decide how best to proceed.