Who Will Enjoy Benefits of "Life Enhancement"

Soon there may be a new reason to see the doctor: not just because you're sick or want to stay well, but to be enhanced.The term "enhancement" is showing up more and more frequently in discussions of medicine and health.Enhancement includes all that science and technology can do to allow human beings to live longer, grow taller, think better, be saner and fight disease more effectively. New developments along these lines are so promising that there is some talk of human beings evolving to a new stage, enjoying unprecedented health, ability and lifespans.But a dark question clouds this bright picture. Which human beings? The enormous wealth gap in the world is inseparable from the "health gap": wealthier people are already more protected against disease and live longer. With enhancements, that gap could widen dramatically.In a sense, of course, any medical advance is a sort of enhancement. Vaccines are among the oldest enhancements, and more of those are on the way. And the line between treatment and enhancement can be fuzzy. Growth hormones are enhancements when they are used not to treat dwarfism but to boost the stature of normal children or increase vitality in old people. Prozac is an enhancement when it is used not to relieve chronic depression, but to make a patient feel (as one psychiatrist put it) "better than well." Plastic surgery is an enhancement when it is used not to correct some deformity in a child, but to fulfill an adult's idea of beauty and youthful appearance.Market conditions will no doubt stimulate work on enhancements. In particular, the growing numbers of older people guarantee a strong demand for anything that will enable human beings to live longer -- and be stronger, smarter and sexier while they're at it.Enhancement is already big business at places like the Palm Springs Life Extension Institute, which offers hormone treatments as well as exercise and diet instruction, and at Nashville's Institute for Aesthetic and Reconstructive Surgery, which specializes in reshaping human faces and bodies. It is big business for all the companies that manufacture and sell testosterone, melatonin, human growth hormone, Prozac, and any number of other potions -- prescription, over-the-counter, doubtful and illicit -- reputed to stretch the years and improve performance.But as the enhancement industries expand, so do the worries about safety and equity.Safety worries have to do with is called the "benefit-risk ratio." Look into any treatment which is supposedly beneficial, and you are likely to find reports of undesirable effects. Testosterone seems to make older men more energetic and muscular, but may increase the risk of prostate cancer. Human growth hormone has produced spectacular results in the aged -- boosting resistance to disease, improving muscle-to-fat ratio and skin tone -- but it carries a risk of diabetes and enlarged internal organs. Prozac, a wonder drug for some has been accused of making people suicidal and violent.With so many uncertainties there will be intense pressure on regulatory agencies -- as well as lots of quacks hustling dubious treatments, and a thriving black market.Most safety issues will probably be resolved over time, but as these worries ebb, concern over equity issues will probably increase. All these treatments cost money, and some cost huge amounts -- and it hardly seems likely that publicly-funded medical providers will be able to supply enhancements to everyone.The best case scenario, then, the development of astonishing breakthroughs, could can easily become the worst-case scenario -- inequalities beyond anything the world has yet seen.It's a dismal -- yet very real -- prospect, and one that public policy-makers have scarcely begun to consider. Some scientific leaders believe it's time to begin. Not long ago an editorial in the respected British publication Nature urged that some organization -- like UNESCO -- look at scenarios of likely future developments, anticipating the time when feats "that are currently regarded as out of bounds have become both practicable and, to some, eminently desirable."

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