New and emerging biomedical technologies – particularly those involving genome editing and human reproduction – have the power to cure illness and alleviate suffering. They also may exacerbate inequities, whether by socioeconomic status, gender, race, place, or some combination thereof. How best to harness and direct that power toward the public good?
A varied mix of market forces and other regulatory mechanisms is not enough. The social sciences and humanities have a crucial role to play – collaborating with scientists before, during, and after research; anticipating, interpreting, and mediating its application and social effects; and offering nuanced perspectives and evidence-based insights to inform regulatory and governance structures.
Some of those perspectives and insights were on offer on November 14, 2019, as CASBS hosted a public discussion on “Today’s Technologies, Tomorrow’s Humans.” It featured a panel of two 2019-20 CASBS fellows – sociologist Rene Almeling and law and bioethics expert Alta Charo. They were joined by guest moderator Debra Satz, a 2017-18 CASBS fellow who now serves as the dean of the School of Humanities and Sciences as well as the Marta Sutton Weeks Professor of Ethics in Society, both at Stanford.
The event was the Center’s first in a series of three public symposia for the 2019-20 academic year. CASBS sponsored the event as part of the Ethics, Society, and Technology Hub at Stanford. The hub, a new presidential initiative, aims to stimulate, coordinate, and amplify projects and initiatives across institutes and centers on campus. CASBS co-coordinates the hub with Stanford’s Center for Ethics in Society, and Satz is a key hub player.
In fact, it was the first-ever hub-related event. In her introductory remarks, CASBS director Margaret Levi acknowledged the hub as a key step in the ethics-related “cultural revolution” occurring at Stanford.
Satz, the moderator, sketched a few of the many ways that biological technologies are extending and improving human life – but also potentially “upending” the very idea of what it means to be human, as we engage aspects of altering ourselves, and also approach the prospect of altering our descendants, and their descendants. It sets up all kinds of issues related to risk, equity of access, implications for the future of work, and more. She teed-up discussion focused on older and current reproduction technologies as a way to get at the issues and perhaps learn something from them.
That’s in Rene Almeling’s wheelhouse. Almeling, author of the forthcoming GUYnecology: The Missing Science of How Men’s Health Matters for Reproduction, is an authority on the social and cultural aspects of the interactions between science, institutions, and human bodies. She acknowledged, as others do, that reproductive innovations, dating back decades, have been developed in the context of “intersecting inequalities” – racial, economic, and of gender. But she pointed out two other inequalities of sorts.
First, biomedical technologies focus too much on the individual body level. But what about the structural and environmental contributors to diseases – polluted air, water, access to healthcare? Efforts to alleviate disease at broader levels will “improve the health of all bodies and reduce the need for expensive and invasive biomedical interventions after the damage has already been done,” she said.
Second, individual bodies, said Almeling, “are raced and classed and gendered and imbued with sexuality.” So why for decades has the process of developing biomedical knowledge and technologies gone forth with mostly white male bodies accepted as the “standard” body? The assumption through most of 20th century medical history is that results would simply “generalize to the rest of us.” That began to change in the 1990s, said Almeling, but we’re still in catch-up mode. But as a result there remains a knowledge gap regarding biomedicine and human health outcomes, with implications for what kinds of technologies have been and will be developed.
From her perch engaging law and policy related to medical genetics, ethics, reproductive technologies, and the environment, Alta Charo basically concurred on the inequality theme. She noted that while the CRISPR gene editing tool provides us an incredible opportunity to rethink how we might want to develop a new technology in a way that’s relevant to more people’s lives, some of the biggest improvements in public health likely won’t come through gene editing of eggs and sperm. For example, simpler technologies, like those involved in gene editing crops, building “living skins” for homes, or growing real meat in labs, have an enormous capacity to enhance lives while doing less harm to the environment.
Besides, she said, there’s plenty of cognitive dissonance involved when, for example, many people feel threatened by the idea of genetically engineering mosquitos to fight the Zika virus, for example, while at the same time they don’t seem to exhibit much concern about millions of tons of pesticides that are released into the air we breathe.
Charo called for an evidence-based bioethics to address a potential “genetic caste system” of have and have nots, but her concerns, while real, are not overblown.
“We’re doing a great job of enhancing ourselves with low-tech technologies already.” Besides, she said to the audience, if you think we’re going to change or species overnight, just look straight ahead.
“You’re looking at three height-challenged women…I’d want tall kids, but approximately 700 genes have an influence on height…so the concept of enhancement is far more complicated and less realistic than we think.”
Almeling, Charo, and Satz then engaged in interactive discussion on topics surrounding tech advances ranging from the role of the market and different incentive systems, the role of public opinion and its mutual feedback loop with the scientific enterprise, and the possibilities for and speed of shifts in cultural norms.
On the latter, notably, Charo noted that “there are…cultural norms that are very sticky that will probably take a long time to sift no matter how many technological innovations you throw into the mix.”
Her case in point: The Jetsons. That’s right. View the video of the event on this page or on the CASBS YouTube channel to see how she connected the two.