The shape of things to come

Is it progress if a cannibal eats with a fork?— —Stanislas J. Lac

In the current issue of Neurology, Anjan Chatterjee1 makes a compelling argument that neurologists need to enter the debate about the proper uses of the fruits of the biomedical revolution. In so doing, he has performed an important service to the neurological community. Chatterjee reminds us that advances in neuroscience carry with them the likelihood, intended or otherwise, of medical applications that go well beyond the traditional goals to prevent, diagnose, and treat disease.

Chatterjee focuses our attention on biomedical advances that are likely to provide new ways to modify behavior, improve performance, extend lifespan, and generally give the user a competitive edge over his or her fellow humans.2–5⇓⇓⇓ It addition to the traditional concept of relieving suffering, these advances will also improve the perceived quality of life, a concept that will have different interpretations depending on one’s point of view. One of my colleagues has noted, somewhat sarcastically, that in a free market economy the proximate goals of genetic engineering are as likely to focus on correcting male pattern baldness and increasing height as on curing disease. Individuals will go considerable distances to seek advantages, even trivial ones, both for themselves and their children. In the words of Bill McKibbon, 2 “people will do far-out things for less than pressing purposes.” The rampant use of cosmetic surgery, use of growth hormone for children within the range of normal height for age, and the apparently widespread use of performance-enhancing drugs by professional (and in some circles amateur) athletes, are but a few examples of this behavior.

Several authors have commented on the slippery slope encountered along the path from treating diseases to eliminating predispositions to actively enhancing functions. Depending upon …