On October 9, 2012, the New York Times ran a front-page story about a rural doctor who was prescribing attention deficit hyperactivity disorder (ADHD) drugs to children who were doing poorly in school but did not have the illness. He assigned them the diagnosis of ADHD so that he could prescribe medicine that would presumably help them concentrate better. He said that if we were not going to make the school system better serve the needs of these children, the medical profession would have to enhance children so they could make better use of the resources at their disposal. Notably, he was not prescribing the drugs to students already getting As and Bs, only to those having academic difficulties.
A young mother spoke of her dilemma in giving these drugs to her elementary school children, especially since the children did not want them. But, she said, when she showed her children the difference in their grades without the drugs and with the drugs (the difference between failing and passing), they reluctantly agreed to take them.
This story introduces a fascinating and scary prospect. What if school districts find that all students will do better if given enhancement drugs? May we someday see school districts drug-testing their students to make sure they're taking their drugs—even given potential side effects that include growth suppression in some children—the way they test them now to make sure that they are not?
The truth is, we've been enhancing human beings for a long time, so long that we sometimes forget that what we are doing is enhancing. Every tool we use bestows an ability to do something that a human cannot do with flesh, blood, and bone alone. Everything from a hammer driving a nail to a jetliner moving across the ocean are enhancements. Eyeglasses and hearing aids augment our senses. Immunizations and vaccinations boost our ability to withstand disease. Vitamin supplements, hormone replacement therapy, and artificial hips and knees are all enhancements. Recently, a widely publicized surgery was performed in which a cancerous esophagus was removed from a patient and replaced by a plastic esophagus. It was then primed with stem cells taken from the patient's body, creating a coating of live tissue over the plastic frame. (In the Terminator movies, this is the technology that created terminators: adhering live tissue to metal and composite skeletons.)
But to return to the issue of competitively medicated non-ADHD children, this situation appears perilously close to involuntary enhancement. From the standpoint of the mother mentioned in the article, the choice to use these drugs stemmed from her concern for her children's success and welfare. This concern was real and founded in love. It was a form of “defensive consumption,” which is acquiring things you might not necessarily want in order to keep up with others. An example would be purchasing a heavy sports utility vehicle to protect your children in case of a collision with another large car. Enduring the side effects of anticholesterol drugs in the hope of warding off a possible heart attack is another example. Or sending your offspring to a private liberal arts college instead of a state university and paying a premium of $10,000 to $30,000 a year to better ensure they graduate from college on time and with individual attention. It does not guarantee your children will rise in the economic scheme of things; it's more of an insurance policy against possible failure. It is identical in form and intent to the mother's decision to convince her children to take drugs that seem to enhance their school performance. Whatever the promise of human enhancement, it also will produce burdens.
Most of the enhancements discussed involve making us smarter, faster, and better, to give us a competitive edge over other human beings. If you take a drug believing it will make you smarter, what's the point? Does it mean you'll get a job or get into a school that you would not have otherwise, at the expense of another candidate? If we look at examples of such drug use, whether it is scientists taking Ritalin to enhance concentration (something 20 percent of all working scientists do, with or without prescription) or baseball players taking steroids, the aim is to obtain a competitive edge. In recent scandals, students at elite high schools took performance-enhancing drugs to help them compete on examinations to gain admission to elite colleges. We've seen an arms race in every competitive sport between athletes who take illegal performance-enhancing drugs and those who try to detect them. Under these circumstances, future human enhancements seem to be directed principally toward raising the stakes in a winner-take-all game.
These visions of enhancements are worth thinking about. Increasingly, the distribution of rewards in all areas of social life is shifting toward a model in which small differences in performance give rise to huge differences in reward. We have long known this to be the case in professional sports, best-selling authorship, movie stardom, and Nobel prizes. But it is now permeating education, law, finance, news reporting, music, art, agriculture, and politics. In a world with many contestants but only a few large winners, the pressure to obtain any competitive edge is enormous.
As I was writing this essay in early October, the portfolio of accusations against cyclist Lance Armstrong was made public: he had engaged in blood doping and systematically used performance-enhancing drugs, his massage therapist had been enlisted to smuggle them, and Armstrong had insisted that all his team members use performance-enhancing drugs, too. These accusations reflect the tremendous pressure to enhance in competitive situations even where the risk of discovery is very great and, perhaps, inevitable. Some strong supporters of enhancing drugs have suggested that all barriers to enhancement be dropped in professional sports, and there is some force to this argument. One can also imagine two different Tour de France competitions: one organic and one enhanced. Such a distinction might proceed along the lines of amateur and professional sports, although these distinctions tend to vanish at the highest level, where many members of national Olympic teams are highly paid professional athletes, in spite of the façade of amateurism maintained by the International Olympic Committee.
When we talk about drugs that enhance, we almost always mean drugs that enhance performance in competitive situations. No pharmaceutical company seems interested in developing drugs that induce compassion, radically reduce the desire for material things, or make one not want to be famous or rich. These, perhaps, would be worthwhile enhancements.
Keep in mind that our current human enhancements are not handed out for free. They are sold to high bidders, like almost everything else. Even with relatively ordinary human enhancements such as cosmetics, the better they are, the more they cost, and none are free. The same goes for sporting goods. One whole-body swimsuit has tiny fish-scale patterning on its surface. It's so tight that it can take half an hour to get into it. It costs hundreds of dollars, and may last only one or two competitions. But in a contest between two very powerful, very fast swimmers of similar ability, the athlete who can afford the swimsuit is more likely to win. Human enhancements are not humanistic: they are not the joint property of all humankind, they are not a birthright, and they are not evenly distributed. They have the potential to radically alter the world by helping to characterize every human interaction as a contest with a winner and a loser.
We've long known that the distribution of good things in the world is not equitable. Investigators over the last century have discovered something known variously as Zipf's Law, Pareto's Law, and Lotka's Law. It's also called the 80/20 Rule, which comes from sociologist Vilfredo Pareto's discovery that in almost every known society, 20 percent of the people get 80 percent of the good things: money, power, and attention. There are only a few bestsellers, there are only a few great sports champions, a few websites that get most of the attention, a few people who have most of the money, a few cities have most of the people, and so on. Human enhancements, as currently described and conceived, have nothing to do with the equitable redistribution of scarce goods. Rather, they have everything to do with the sharpening of the competitive edge of those people who want to be among the few winners instead of one of the many losers.
Enhancing human life expectancy—adding more decades of life—would also change many things. Financial advisors, using actuarial tables to plan retirement scenarios for people in their twenties, are now urging savings plans that will last until the individual reaches at least the age of one hundred. But consider that the retirement age of sixty-six for full Social Security benefits is only a year more than the retirement age when the program was established eighty years ago, even though most American men then lived into their early seventies, not their later eighties. Projections of Social Security running into financial difficulty and even going broke by the middle of the twenty-first century are largely a function not just of the increasing number of people, but also the extra years they are expected to live. There is already pressure (under the Simpson-Bowles plan and from the House of Representatives) to increase the retirement age sharply, precisely because of the enhanced longevity available to those who can afford the medical care that can extend their lives. If this aggressive trend of extending human life persists, it will be necessary for people to work much longer. If you're going to live to be one hundred and twenty, you might have to work until you're ninety-five or even one hundred to get full Social Security benefits. This might not be problematic for people with enjoyable desk jobs, but for a carpenter, roofer, auto mechanic, or plumber, further enhancements of physical strength will be required to make it to the retirement finish line. Indeed, enhancement breeds enhancement.
In every equation where things are divided and portioned out—education, money, environmental quality, vacation homes with clear views of the beach, sports cars, seven-course meals, or Blazers tickets—there are two numbers to consider. The numerator is the quantity of good things to be divided, and the denominator is the number of portions needed for everyone's needs and desires to be satisfied. At a global level, the denominator is the total population. While there are some faintly encouraging signs of birth rates leveling off, it is not possible for everyone on earth today to enjoy the same standard of living as experienced by many Americans: there are too many people and not enough good things. If we cannot produce enough good things for all people no matter how hard we try, one strategy to meeting human needs would be a deliberate decision to keep the denominator as small as possible as the numerator gets bigger.
One country has tried to impose a reduction in its population denominator. China's controversial one-child policy, enforced in urban areas since 1979, is an important part of the country's strategy for economic improvement and modernization. People don't just want to live longer; they want to live well. If they are enhanced and more capable than they are now, many fewer of them are needed to do the things done now. It seems inevitable that the dreams of human enhancement and longevity cannot be realized without strict attention to the size of the world's population. We know how many people the earth can support. Perhaps we should think more about how many people it should support? What may be good for the individual may not be so good for society. Each individual person might wish to live longer and enjoy more of the good things of life, but in a world already facing shortages of food, fuel, arable land, and freshwater, having everyone live decades longer will be extremely expensive to the groups that pay the bill.
These chemical, genetic, and mechanical enhancements I've discussed still reside in a world in which a person has a firewall of privacy and selfhood: we are inside our skins and the world is outside. We hold a hammer in our hand, but our hand is not a hammer. This firewall would disappear if we consider another aspect of enhancement: the insertion of computers into the neural structure of the brain. Such enhancements have already been accomplished with quadriplegic patients. Some have electrodes implanted in their brains that allow them to move the cursor on a computer screen by thinking about it. There is great interest in extending this technology as well as the hope of huge payoffs. Instead of Terminator, think of The Matrix, in which the hero quickly acquires vast bodies of knowledge, including fantastic skills in martial arts, by being directly connected to a computer and downloading this knowledge into his nervous system and memory. That's the dream.
For me, the prospect of linking humans to computers directly and breaching the firewall of selfhood and privacy is equally certain to lead (on a very short road) not only to human enhancement but also to mind control and human enslavement. The philosopher Immanuel Kant once wrote that the essence of freedom is not living without external restraint, but freedom from “internal coercion.” The prospect of adding to brain capacity and uploading material to the brain also contains the possibility of subtracting brain capacity and downloading material (surveillance inside your head). Every human invention has a double-edged blade of pros and cons, and for me, this particular enhancement seems an object of great potential peril in the next century or so.
When do humans become so enhanced that they're no longer human? Certain commercial potatoes are so genetically modified for disease resistance that they have to be classified by the Department of Agriculture as pesticides. They are still potatoes, but they are also something else. It's conceivable that the struggle over organic and genetically modified foods may be repeated in a debate over organic and genetically modified humans. Presumably, this would happen differently in the European Union than in the United States. In Europe, vendors of GMO foods must demonstrate there is nothing harmful about their products before they can be marketed. In the United States, GMO foods can be marketed if there is no evidence of them having caused harm. In China, neither of these concerns is in play, and one might expect, given China's national pride, its forceful devotion to population control, and its dreams of power and wealth, that enhancements toward genetically modified humans would move very far, very fast there.
It's far too easy to imagine a dystopian extreme, a world in which we are divided not merely into organic and enhanced human groups, but also into those who have access to enhancements and those who do not. What we would have among the upper end of the income and power spectrums are smart, strong, beautiful, healthy, and long-lived humans, thanks to the very expensive and intensive enhancements they can afford. They will become perilously close to being gods when compared to the rest of us.
The management and control of human enhancement is a problem that greets each age with the utmost subjective urgency. Around 360 B.C.E., Plato argued in his dialogue Phaedrus that allowing orators to purchase prepared speeches from paid speechwriters would put these extremely dangerous “weapons” into the hands of those who could not have invented them and who were unprepared to use them wisely and well. Then in 1139, Pope Innocent II called a Council to ban the use of armor-piercing crossbows. They were too dangerous to the social order because they would allow a commoner to slay an armored knight.
And in his 1750 essay A Discourse on the Sciences and Arts, Jean-Jacques Rousseau asks whether the “restoration of the arts and sciences” would serve to “refine moral practices.” We might translate this for our present purposes by asking whether the advancement of technologies, especially those of human enhancement, will make people better. This was the dream of eugenics: a way to make people better by making better people, to breed a moral race. Rousseau feared that far from enhancing moral life, technological enhancements would lead to corruption, inequality, and evil. Buried deep in this passionate treatise is the simple statement that any tool—even a sword or a pen—may be used for good or for ill, and does not have a moral compass within it.
No matter the age, we always face the same question: Are we to be the wise masters of our tools or their abashed and foolish servants? It is time again for all of us together to face that question.
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