CT551--Week 10--Lecture notes

Technology and Human Life

This week's theme is medical and biological technologies. We've touched on some of these already; the stress this week is the need to evaluate them dispassionately and not react to new ideas out of reflex. Just because an idea is new does not mean it is necessarily a bad idea. Or a good one, either.

Yet many people do react reflexively. This is very clear in the history of hand washing in medicine. This is very simple medical technology. It is hard to conceive that anyone could ever have objected to it. But when in the late 1840s Ignatz Philip Semmelweiss observed the tremendous difference in the death rates at two maternity clinics--one staffed by physicians and medical students who would come to the mother direct from dissecting cadavers, with their hands covered with intensely septic corpse juice (no refrigerators then), and one staffed by midwives--and tried to convince the doctors to wash their hands in antiseptic, he had a hard job. Eventually the doctors gave in and tried it for six months, their death rate dropped, and they said, "There, Ignatz old boy, satisfied?" and went back to business as usual. This supposedly contributed to Semmelweiss's later insanity.

You can find the story in many places, including (at great and outraged length) in Ben Hecht's A Guide for the Bedevilled, Scribner's, 1944). On the Net, try this site.

To most people, "medical and biological technologies" means solely medical, but there are a great many biological technologies that are also important to our society--for two instances, agriculture and fermentation (not just beer and wine, but also bread and soy sauce, among others). And both bio and med tech have a long history of development, with even the earliest stages of development representing very impressive advances. Think of the discovery that crops could be grown, that sanitation had benefits, that herbs could be used to treat various illnesses (this tech isn't even uniquely human--anthropologists have noticed chimpanzees eating exceedingly nasty-tasting [the anthropologist tried them] leaves that contained compounds that could kill intestinal worms [as revealed by lab tests]).

Today, in medicine, we're looking at much more advanced procedures such as kidney dialysis and organ transplants, which unlike antibiotics and vaccines benefit few people, are expensive, and can be seen as inappropriate in certain circumstances. Should we use them? When should we use them? When should we not use them? In Chapter 7, Medical and Biological Technologies, Volti offers four criteria (from Bryan Jennett) for judging whether technological intervention is appropriate:

Is the intervention: To translate, we should not treat if the treatment is unlikely to do any good, if it is likely to do more harm than good, if the good it does is too little, or if the resources used (including money) could be put to better use elsewhere. The last item here may seem cold, callous, unfeeling, and too darned rational, but I do think that if by letting one grandfather (even my own) go, I can save a thousand children, then I have an ethical obligation to do so. It is a sad truth that medical resources are not unlimited. Please note the numbers given on page 126.

So far the most effective medical technologies have been the simplest and cheapest. Simple sanitation (clean drinking water, handwashing) has saved far more lives than vaccines, antibiotics, bypass operations, and so on. New technologies could conceivably change that. In Chapter 8, Genetic Technologies, Volti discusses stem cells, cloning, and genetic engineering. All raise ethical issues, but stem cells raise the possibility that many handicaps will become curable conditions and genetic engineering raises the possibility that we will one day (maybe even soon) be able to change one's genes to remove vulnerabilities to disease, high blood pressure, cancer, and so on. Should we? Or do we do better to identify behaviors (such as high-fat diets, smoking, drinking, couch-potatoing) that activate those vulnerabilities--and then to change the behaviors? And should we even dream of using genetic engineering to upgrade the human brain (more memory, more thinking ability) and body (stronger, faster, extra arms, etc.)? Some futurists suggest that such things may be coming. If they are, how will they affect the classroom of the future?

Something that perhaps is not emphasized enough is the business of "halfway technologies." Volti mentions the term in Ch. 7, meaning technologies that keep patients alive without curing their problems. The term can also be used to refer to technologies that are not yet in their final and most useful form, such as genetic engineering or cloning. In their present form, they are alarming; if we permit them to develop, they may reach a point where the alarming features diminish or vanish and they provide huge benefits; if we ban them, we never reach the benefits stage. Right now, cloning (as with that famous sheep, Dolly) is all about whole creatures, and many people react to it very much with alarm. Yet I (as a biologist) can see the techniques developing to the point where we might be able to clone single organs, perhaps even inside the body. Stem cell research in particular may lead in that direction, giving rise to a field already called regenerative medicine.

The Jennett criteria do not really address the morality or ethics of medical treatments (although such considerations may be subsumed under "Unwise"). In the Teich book, Chapter 16, Stem Cell Research: The Great Moral Divide, Christopher Thomas Scott discusses stem cell research in this light. The debate has its roots in the initial need to destroy embryos in order to obtain stem cells (note that researchers have found other ways to produce stem cells). Some people feel that such destruction of embryos--especially ones that were not destined to grow up (from abortions, or surplus in fertility clinics)--is justifiable if it leads to reduced suffering or even cures for medical patients. Others insist that an embryo is a human being and destroying it is murder; not all of these people are anti-abortion. There are a conflict of values, a conflict of definitions of what a human being is, a conflict over just how far we dare to go in pursuit of admittedly desirable ends.

The conflict extends to whether we should try to improve the human design by tinkering with genes, either to remove vulnerabilities to disease or to improve various features (or to add new features). This, say critics, is meddling with nature, playing god, pushing beyond "natural" limits, altering "human nature" itself, and it should not be allowed. Others, however, are quite excited at the prospect; extreme proponents include the transhumanists. Less extreme proponents note that some people have clearly advantageous genes, such as the one found in one family of Limone, Italy, that in effect makes them immune to high cholesterol. In time, perhaps, we could give everyone this gene. Should we?

The transhumanists (see Issue 21 in Taking Sides) are very optimistic about the potential for improving the human body and even mind. Observers such as Maxwell Mehlman see the technology as developing in this direction and say there will be a need to keep it from creating new class divisions. There may therefore be a need for government actually to subsidize the technology for everyone. Others, such as McNamee and Edwards, are very worried by the prospect. Should work toward "transhumanist" technology be forbidden? Or just put on hold while we think out the implications? Scott discusses the 2002 four-year moratorium on embryonic stem cell research. The aim was "to force scientists and supporters to write guidelines and rules to regulate hESC research." There is a risk in such a move that it may be repeated, amounting to the same thing as a ban. Another risk is that it may delay genuine benefits. On the other hand, as things worked out, it forced researchers to look for alternative ways to produce stem cells. A major step occurred in 2007, when researchers announced that they had been able to convert mouse skin cells into stem cells with all the potential to become other kinds of cells seen in embryonic stem cells.

In Teich, Ch. 19, Implications of Advances in Neuroscience, Henry T. Greely discusses how neuroscience may help us forecast behavior and disease, which is useful if the forecasts are reliable; if they are not, they can destroy lives.  Contexts include criminal justice (think of the movie "Minority Report"), education, business, and even parenting.  Improved lie-detectors would impact the courts, as would a method of forcing witnesses and suspects to tell the truth, but so far these and other applications of neuroscience are speculative.

Some of the objections to both genetics and neuroscience seem to center on the idea that the more we know, the less room is left for fate or free will.  We seem locked into a particular destiny. But genes rarely force a particular outcome; identical twins do not always develop the same diseases or display the same tendencies to crime or nobility. Neuroscience too seems to leave lots of "wiggle room."

Questions for Discussion

1. Why did people object to Semmelweiss's idea that handwashing was a Good Thing? Which, if any, of Volti's four criteria (from Bryan Jennett) for judging whether technological intervention is appropriate (necessity, safety, kindness, wisdom) were in play?

Is there a lesson here for the present?

2. Halfway technologies--"halfway" in the sense that they have yet to reach their full usefulness--can seem much more alarming than useful (consider cloning and stem cells). Should their use be delayed until they are fully developed? Do you think that if their use is delayed, they will ever be fully developed? (All right, all right! Yes, this is an easy one!)

3. In time, genetic engineering, cloning, and stem cells will mature as medical technologies. Neuroscience will also advance.  Eventually, many current medical technologies will no longer be needed, for they will be revealed as halfway technologies (in the sense of time-buying technologies). What current medical technologies are we talking about here? What problems do you see in shifting to the new "genetic fix" technologies?