I recently attended a meeting in which a public intellectual spoke with boundless enthusiasm about the wonderful future medical technology will inevitably deliver to human beings.
His lecture went something like this: “Since the dawn of civilization, we humans have sought to transcend the limits of our condition. While we’ve long worked at this enterprise of empowerment, the arrival of the scientific method has radically accelerated the pace of change. With more and more educated minds working together to apply ever more sophisticated technology, perennial maladies such as disease and perhaps even death will someday be conquered. With artificial uteruses, women will no longer have to experience the discomfort and inconvenience of pregnancy. By understanding and counteracting the processes of aging, people will be able to enjoy the pleasures and capacities of youth in perpetuity. And beyond eliminating suffering, we can look forward to developing limitless ways to enhance our experience of life. We might, for instance, alter our genetic code to give ourselves wings for soaring the skies and gills with which to explore the wonders of the ocean.”
Listening to this charismatic futurist expound his philosophy, I was impressed by the logic of his arguments and even caught up in his enthusiasm for what the future might hold. But I also felt something was missing.
The case of thalidomide came to my mind. Viewed as a scientific triumph over age-old ills such as insomnia and morning sickness, the medicine thalidomide was dispensed to thousands of pregnant women to relieve their symptoms. By the time its teratogenicity was detected and its use banned, more than 10,000 children, mostly in Europe, had been born with birth defects such as severe malformation of their limbs. Thalidomide’s story is only one of many times in the history of medicine that unexpected and devastating consequences have resulted from promising technologies.
Indeed, my own current experience of medical practice regularly reveals the wisdom of William Osler’s advice to “remember how much you do not know.” For example, I once took care of a patient who had been prescribed a commonly used antibiotic for a mild urinary tract infection. Days later, she was in a hospital ICU, hanging on for dear life after she experienced an extremely rare and severe type of drug reaction. So medical history and my own experience as a practitioner suggest that the futurist’s grand vision should be tempered by humility and caution. Such humility should flow from a greater awareness of our epistemic and moral fallibility.
Remembering our historical situation should drive home the reality that even with our recent advances in knowledge, we still have a great deal to learn. It is estimated that life on began about 4 billion years ago and that it was not until roughly 100,000 years ago that Homo Sapiens evolved into existence. Human beings are thus the product of natural selection and other evolutionary forces operating over a vast period of time to create a staggering degree of complexity. When we gravitate toward food and medicines that are more “natural” rather than recently created, perhaps we intuit that that it is safer to consume that which has stood the test of time. Maybe we sense, notwithstanding the cocksure confidence of some futurists, that life and the human body are immensely complex systems and that manipulating them may yield unforeseeable, unintended consequences. This is the insight of resonant stories such as Doctor Faustus, Frankenstein, and Jurassic Park.
Humans’ moral fallibility should be another cause for caution in our quest to master and manipulate the world to our liking. Technological innovations may someday overcome diseases such as dementia, cancer, and schizophrenia. But much of the suffering in our world comes from moral deficiencies, not technological limitations. War, crime, child abuse, sex trafficking, the subjugation of women and minorities, abject poverty, corrupt governance, terrorist attacks: Are these problems amenable to technological solutions? While technical innovations can be applied to fight these evils, they can also be used to exacerbate them. The history of the 20th century testifies to this reality. Filled at its dawn with hope and optimism, the century would soon bear witness to the worst wars, genocides, and famines in human history, only to be followed by the threat of worldwide nuclear annihilation. Perhaps it is no accident that one of the 20th century’s towering myths, J.R.R. Tolkien’s Lord of the Rings, spoke to the great perils of power.
The reality of human fallibility does not mean we should resist our natural desire to learn about the world and improve our lot. As a physician, I daily try to apply the latest knowledge and best technology to ease the ills of those entrusted to my care. I am grateful for the scientists and engineers who make my work possible. Being humble about our epistemic and moral capacities will enable us to most effectively and ethically use our growing knowledge and power.
James Marroquin is an internal medicine physician who blogs at his self-titled site, James Marroquin.
