Human Nature: Science, Technology, and Life.

The Future as We Don't Know It

I just got back from a talk by David Friedman at the Cato Institute. Fascinating guy, thinks a mile a minute. He must have spat out 100 provocative ideas in his half an hour or so. I can draw you a mental picture of him pretty quickly: bubbly, balding, not much over five feet tall, wears a backpack over his tweed jacket (did I mention the "recreational medievalism"?) and asked the audience whether anybody could give him a ride to Charlottesville tonight. There's still time--if you're going from D.C. to Charlottesville, try him at DDFr@DavidDFriedman.com.

Friedman touched on a range of topics covered in his new book, Future Imperfect. I haven't read the book yet, but he gave a pretty good sense of it. Here's the Cato summary (the podcast will be up later):

[Friedman] looks at a variety of technological revolutions that might happen over the next few decades, their implications, and how to deal with them. Topics range from encryption and surveillance through biotechnology and nanotechnology to life extension, mind drugs, virtual reality, and artificial intelligence. One theme of the book is that the future is radically uncertain. Technological changes already begun could lead to more or less privacy than we have ever known, freedom or slavery, effective immortality or the elimination of our species, and radical changes in life, marriage, law, medicine, work, and play. "If it can be done, it will be done," David Friedman has said. "So the interesting thing to me is not what should you stop but how do you adapt." We do not know which future will arrive, but it is unlikely to be much like the past.

In short, the book covers nearly everything Human Nature covers but with a libertarian bent. Which is sort of my bent, too, except that I'm less theoretically confident than Friedman is--or, to put it the other way, I'm more daunted by practical developments. Three years ago, for example, I wrote a series based on the idea that scientists would try to grow embryos beyond the conventional two-week limit, raising icky possibilities. The scenario made sense to me at the time, but in the three years since, it hasn't happened. A theorist would say, well, it'll happen eventually. I'm not so sure. My reaction is: Maybe I was just wrong.

So this is what I asked Friedman: Is there a contradiction between his technological optimism and his premise of radical uncertainty? When I say optimism, I don't mean a belief that technology will be good; I mean a belief that it will work. His talk was full of bold scenarios: conquering aging, developing artificial intelligence 100 times smarter than us in the next 30 years, and administering mind-control drugs that induce credulity. I agree that these scenarios are fascinating, and when I first came into this field, I took them very seriously. But everywhere I look, the news is telling me another story. The story is that in many fields, and in biology in particular, causality is turning out to be way more complex than we anticipated. The immediate manifestation of that complexity is that even our most conventional attempts to manipulate biology are producing unexpected and often decisive ill side effects.

Take the most obvious case: drugs. Friedman talked about three classes of mind drugs: those for pleasure, those for performance, and those for controlling other people. I've been to visionary or bioethics conferences where theorists have talked up these drugs and how cool or scary they'll become in the near future. But look at the news: Drugs are being restricted or pulled off the market because they're inducing ugly side effects. Not just drugs for the body, like Vioxx, but drugs for the mind, like Chantix. Steroids are boosting athletic performance but causing violence and circulatory trouble. Marijuana is being linked to heart attacks, brain shrinkage, and psychosis. I had high hopes for Bremelanotide, a new sexual-dysfunction drug, aka aphrodisiac. But last year its developer, Palatin Technologies, had to abandon that project due to "blood pressure increases" in some study participants. The company now touts the drug for "organ protection." It's turning out to be very hard to tinker with one function of the mind or body without affecting others.

Friedman's reply to all this was that we do better off "on net" by encouraging biotechnology than by limiting it, and that proposals to restrict it should be subject to the same skepticism that we might apply to the technology itself. That makes sense to me. Still, it's just a political answer. It doesn't address the underlying question of how soon--or even whether--biotechnology will achieve its promises.

I agree with Friedman that the future is radically uncertain. Too uncertain, in fact, to count on its arrival in the form that he envisions--or I do--anytime soon.

White-Collar Steroids

Are people in your office using performance-enhancing drugs?

I'm not talking about steroids. I'm talking about brain enhancers, such as Ritalin for concentration and Provigil for sleep reduction. Two months ago, I wrote about a Nature survey in which 20 percent of a self-selected sample of scientists, academics, and journalists admitted using such drugs "for non-medical reasons to improve my concentration, focus and memory." In absolute terms, it's hard to argue against these neuroenhancers. But in relative terms, freedom of enhancement can become coercive. If your officemates are outworking you by popping pills, can you afford not to join them?

We know this is a problem in sports. Has it become a problem in the white-collar workplace? Neil Munro examines this question in a recent issue of National Journal. The answer seems to be: We don't yet know, but signs point to trouble ahead.

Munro goes through what little we know. First, there's the non-random Nature poll. Then there's a survey at one college in which one of every six students admitted to taking prescription drugs as a study aid. Munro also cites the recent doubling of adult prescriptions for Adderall and Ritalin, implying that the increase is too big and fast to be purely therapeutic. But the really interesting comment comes from Zack Lynch, the executive director of the Neurotechnology Industry Organization:

If you're GE Capital and you have offices in 154 financial centers around the planet, and these [brain-drug] tools are available in Dubai, and your workers there are trading more effectively, 5 to 10 percent better—they'll have a neuro-competitive advantage over workers where these tools are not legalized.

Neuro-competitive advantage. There's the leverage point for pushing brain boosters into the workplace. The good news is, these pills might make you more productive. The bad news is, if you don't take them, some guy in Dubai will, and he'll eat your job. Lynch flatly tells Munro that if the United States restricts performance-enhancing office drugs, "companies will shift their work offshore."

I don't want to make this scenario sound like it'll be here tomorrow. The brain is notoriously finicky, so there are a lot of obstacles and side effects to work out. But the same is true of performance-enhancing drugs in sports, and that hasn't stopped them from becoming a coercive presence.

Munro points out that neuroenhancement is a big emerging market and that one firm has already been caught exploiting it:

Cephalon, a large biopharmaceutical company, agreed to pay a $425 million settlement to the federal government last year after the firm's sales force was accused of marketing its Provigil anti-sleep drug for purposes other than those for which it has been approved. Provigil was approved for treating narcolepsy, but it was used as a stimulant by some of the scientists who responded to the Nature poll.

Next time you're chatting with your colleagues around the water cooler, ask what they're taking with their water.

Wake Up and Smell the Craniotomy

Yesterday, Sen. Ted Kennedy got out of the hospital. He'd been there since last week, when he had surgery to remove a brain tumor. How long he'll live, nobody knows. The last report from his doctors was right after the operation: "Senator Kennedy was awake during the resection, and should therefore experience no permanent neurological effects from the surgery."

Awake during brain surgery? And this helped? How?

Awake craniotomy has been around for decades and is gradually becoming more common. Kennedy's surgery will certainly get more patients and doctors talking about it. Here's the initial problem: Your doctors need to cut out your tumor, but it's hard to tell where regular brain tissue stops and the tumor begins. Which parts can they cut out? Which parts can they cut through? Overall brain structure is similar from person to person, but details vary enormously.

If the operation were on your leg, the surgeons could check and map their route while you slept. That's where most of us would like to be during surgery: out cold. I don't know about you, but my feelings about going under the knife are pretty close to Woody Allen's feelings about death: It's not that I'm afraid of it; I just don't want to be there when it happens.

But when the surgery is on your brain, you need to be there, because the feedback that will tell your doctors where to cut or not to cut isn't strictly physical. It's mental. According to the Boston Globe, "Kennedy's tumor was located in a region of the brain involved with language and movement." How can doctors find out whether snipping the next bit of tissue in their path would mess with his verbal ability? By asking him questions. "Tiny electrodes are placed on the brain to introduce an electrical current," the Globe explains. If the electrified zone is verbally important, says a neurosurgeon, the charge "will stop their speech. You know then that's a region you usually try to stay away from or preserve while you're doing surgery."

Depending on the tumor and surgeon, the test may be as simple as counting to 10 or as complex as conversation. Here's one account from the San Francisco Chronicle a couple of years ago:

[Dr.] Perry starts flashing the pictures on the computer screen, and Hill hits them as if he's been studying. "Window, owl, elephant, football, scissors, hammer." Before Perry asks each question, [Dr.] Berger receives a cue to stimulate a tiny piece of brain with an electrical current ... Suddenly that line is crossed. Hill starts getting confused, his brain waves spiking on an EEG monitor. He calls a door a car. Then he starts calling every picture chicken.

And here's a British case reported by BBC News:

[Dr.] Marsh used an electrical pulse to find out where Adrian's tumor ended and where the region of the brain that controls speech began. The pulse temporarily slurred Adrian's speech, giving [Dr.] Marsh a clear idea of what tissue he needed to remove. Throughout the surgery, Adrian was asked to identify a series of pictures, such as a tripod, a compass and an accordion. ... Marsh decided to stop the surgery after Adrian started to become muddled.

This is the hardest thing to accept about brain surgery: What's being operated on isn't some body part you can think about or not think about it. What's being operated on is you. If the surgeon goofs, you don't wake up like Ronald Reagan in Kings Row, shouting at your missing legs, "Where's the rest of me?" The word me simply doesn't mean the same thing anymore. You may never know that there ever was a "rest of me."

This is why the surgeon in the British case warned his patient up front that

there was a risk in cutting so deep into the brain to remove as much of the growth as possible: the parts of the brain which govern speech, language or personality might be affected. "The difficulty is that you are operating very close to the regions of the brain that affect people's thoughts, feelings and speech. It could change their personalities forever," he said.

So take my advice: If you ever get a tumor next to the parts of your brain that think or speak, ask for the awake surgery. It'll be pretty weird trying to answer questions or hold a conversation while you're being zapped. But it's better to wake up and live the nightmare for a few minutes than to sleep and live it forever.