Wondergenes: Genetic Enhancement and the Future of Society

5 Safety and Effectiveness

66 Wondergenes Safety and Effectiveness 5 As we saw in the previous chapter, genetic enhancement potentially could produce major changes in human abilities and characteristics . Yet some skeptics, we know, disagree. For them, all this talk about genetic enhancement is just hype. Enhancement simply won’t work, they say. It’ll be ineffective. A dud. The question is: How will we know if they are right? In fact, how will anyone know if genetic enhancement works? Well, how do we know that any biological intervention, like taking a drug or having surgery, is effective? For many medical interventions, the answer is easy. We identify a set of objectives (call them endpoints), administer a drug or procedure , and ascertain if the endpoints are met. Depending on the circumstances, these endpoints might be reducing a fever, preventing immediate death or prolonging survival, clearing a blocked artery, or lowering the amount of HIV in a person’s bloodstream. These endpoints can be measured by fairly objective methods: thermometer readings, blood flow, lab tests. We might also be able to identify clearly defined endpoints for 67 Safety and Effectiveness a number of genetic enhancements. Strength can be measured by how much weight people can lift, endurance by how far they can walk or run, visual acuity by the size of the letters they can read on an eye chart.Tests even exist for memory and intelligence, although IQ, the principal measure for assessing intelligence, is controversial , and in the case of memory, the endpoint, and therefore the appropriate tests, might differ depending on the goal, for example, increasing the amount of information someone can remember versus the duration of recall. Height at first seems easy: all you need is a tape measure. But as the experience with human growth hormone (HGH) described in the previous chapter demonstrates, a height enhancement might increase a person’s ultimate height or merely hasten when they attain their natural height.1 Would only one of these be considered evidence of effectiveness, or both? Other potential enhancement endpoints are less well-defined and more difficult to measure. How would we assess beauty or charisma, for example? In the case of beauty, we might employ the same technique as cosmetic surgeons: allowing patients to select a representation of their desired nose or breast shape and comparing it with the surgical outcome. For charisma, we would need some scale that captured the effect that the enhanced person had on others. Even if there were some way to measure the relative physical or mental changes produced by genetic enhancement, however, this might not reveal enough to enable a person to determine effectiveness . The goal of the enhancement arguably is not just to increase IQ or strength, but to enable the individual to get into Harvard or to win an Olympic weightlifting medal. Therefore, measuring short-term or immediate effects may not tell us whether or not the intervention achieves its long-term objectives. Instead, we will have to identify the appropriate long-term goal and evaluate the impact of the enhancement in terms of its achievement. At a minimum, this means there is likely to be a significant delay between being enhanced and obtaining the benefit, and therefore in discovering whether or not the enhancement actually works. Moreover, ultimate goals might vary from person to person. This would make it difficult to assess effectiveness because it might be difficult to combine results from different people to obtain an overall result. With- 68 Wondergenes out a large number of observations of the effects of an enhancement in many people, it is difficult to attain the statistical confidence to rule out that a result occurred purely by chance, rather than because of the intervention. Some people may still get into Harvard without being genetically enhanced. While these difficulties will plague future efforts to assess the effectiveness of genetic enhancements, they are not new. We have encountered them before in currently existing biomedical interventions . Take cosmetic surgery. When they remove the bandages, patients may be able to see if they ended up with the nose or breasts they wanted, and their self-image may improve abruptly. But they will still have to wait to find out if they become more popular or if their sex life improves, and the identification of these endpoints and the determination of whether or not they have...