17:22
TED2011

Harvey Fineberg: Are we ready for neo-evolution?

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Medical ethicist Harvey Fineberg shows us three paths forward for the ever-evolving human species: to stop evolving completely, to evolve naturally -- or to control the next steps of human evolution, using genetic modification, to make ourselves smarter, faster, better. Neo-evolution is within our grasp. What will we do with it?

- Health policy expert
Harvey Fineberg studies medical decisionmaking -- from how we roll out new medical technology, to how we cope with new illnesses and threatened epidemics. Full bio

How would you like to be better than you are?
00:15
Suppose I said
00:19
that, with just a few changes in your genes,
00:21
you could get a better memory --
00:23
more precise,
00:25
more accurate and quicker.
00:27
Or maybe you'd like to be more fit, stronger,
00:30
with more stamina.
00:33
Would you like to be more attractive and self-confident?
00:35
How about living longer with good health?
00:39
Or perhaps you're one of those
00:42
who's always yearned for more creativity.
00:44
Which one would you like the most?
00:47
Which would you like, if you could have just one?
00:51
(Audience Member: Creativity.)
00:53
Creativity.
00:55
How many people would choose creativity?
00:57
Raise your hands. Let me see.
00:59
A few. Probably about as many as there are creative people here.
01:01
(Laughter) That's very good.
01:04
How many would opt for memory?
01:06
Quite a few more.
01:09
How about fitness?
01:11
A few less.
01:13
What about longevity?
01:15
Ah, the majority. That makes me feel very good as a doctor.
01:17
If you could have any one of these,
01:21
it would be a very different world.
01:24
Is it just imaginary?
01:26
Or, is it, perhaps, possible?
01:28
Evolution has been a perennial topic
01:31
here at the TED Conference,
01:34
but I want to give you today
01:37
one doctor's take on the subject.
01:39
The great 20th-century geneticist,
01:41
T.G. Dobzhansky,
01:43
who was also a communicant
01:45
in the Russian Orthodox Church,
01:47
once wrote an essay that he titled
01:49
"Nothing in Biology Makes Sense
01:52
Except in the Light of Evolution."
01:55
Now if you are one of those
01:58
who does not accept the evidence for biological evolution,
02:00
this would be a very good time to turn off your hearing aid,
02:03
take out your personal communications device --
02:06
I give you permission --
02:08
and perhaps take another look at Kathryn Schultz's book on being wrong,
02:10
because nothing in the rest of this talk
02:13
is going to make any sense whatsoever to you.
02:15
(Laughter)
02:18
But if you do accept
02:20
biological evolution,
02:22
consider this:
02:25
is it just about the past,
02:27
or is it about the future?
02:29
Does it apply to others,
02:31
or does it apply to us?
02:33
This is another look at the tree of life.
02:36
In this picture,
02:39
I've put a bush with a center branching out in all directions,
02:41
because if you look at the edges
02:44
of the tree of life,
02:46
every existing species
02:48
at the tips of those branches
02:50
has succeeded in evolutionary terms:
02:52
it has survived;
02:54
it has demonstrated a fitness
02:56
to its environment.
02:58
The human part of this branch,
03:00
way out on one end,
03:03
is, of course, the one that we are most interested in.
03:06
We branch off of a common ancestor
03:10
to modern chimpanzees
03:12
about six or eight million years ago.
03:14
In the interval,
03:17
there have been perhaps 20 or 25
03:19
different species of hominids.
03:21
Some have come and gone.
03:24
We have been here for about 130,000 years.
03:27
It may seem like we're quite remote
03:31
from other parts of this tree of life,
03:33
but actually, for the most part,
03:36
the basic machinery of our cells
03:39
is pretty much the same.
03:42
Do you realize that we can take advantage
03:44
and commandeer the machinery of a common bacterium
03:47
to produce the protein of human insulin
03:50
used to treat diabetics?
03:53
This is not like human insulin;
03:55
this is the same protein
03:57
that is chemically indistinguishable
03:59
from what comes out of your pancreas.
04:01
And speaking of bacteria,
04:06
do you realize that each of us carries in our gut
04:08
more bacteria
04:11
than there are cells in the rest of our body?
04:13
Maybe 10 times more.
04:15
I mean think of it,
04:17
when Antonio Damasio asks about your self-image,
04:19
do you think about the bacteria?
04:22
Our gut is a wonderfully hospitable environment
04:26
for those bacteria.
04:28
It's warm, it's dark, it's moist,
04:30
it's very cozy.
04:32
And you're going to provide all the nutrition that they could possibly want
04:34
with no effort on their part.
04:36
It's really like an Easy Street for bacteria,
04:38
with the occasional interruption
04:41
of the unintended forced rush to the exit.
04:44
But otherwise,
04:46
you are a wonderful environment for those bacteria,
04:49
just as they are essential to your life.
04:52
They help in the digestion of essential nutrients,
04:55
and they protect you against certain diseases.
04:58
But what will come in the future?
05:02
Are we at some kind of evolutionary equipoise
05:04
as a species?
05:07
Or, are we destined
05:09
to become something different --
05:11
something, perhaps, even better adapted
05:13
to the environment?
05:16
Now let's take a step back in time
05:18
to the Big Bang, 14 billion years ago --
05:21
the Earth, the solar system,
05:24
about four and a half billion years --
05:26
the first signs of proto-life,
05:29
maybe three to four billion years ago on Earth --
05:31
the first multi-celled organisms,
05:33
perhaps as much
05:36
as 800 or a billion years ago --
05:38
and then the human species,
05:41
finally emerging
05:43
in the last 130,000 years.
05:45
In this vast unfinished symphony of the universe,
05:48
life on Earth is like a brief measure;
05:51
the animal kingdom,
05:54
like a single measure;
05:56
and human life,
05:59
a small grace note.
06:01
That was us.
06:03
That also constitutes the entertainment portion of this talk,
06:06
so I hope you enjoyed it.
06:08
(Laughter)
06:10
Now when I was a freshman in college,
06:12
I took my first biology class.
06:15
I was fascinated
06:17
by the elegance and beauty of biology.
06:19
I became enamored of the power of evolution,
06:22
and I realized something very fundamental:
06:25
in most of the existence of life
06:27
in single-celled organisms,
06:29
each cell simply divides,
06:31
and all of the genetic energy of that cell
06:33
is carried on in both daughter cells.
06:36
But at the time multi-celled organisms come online,
06:39
things start to change.
06:43
Sexual reproduction enters the picture.
06:45
And very importantly,
06:48
with the introduction of sexual reproduction
06:50
that passes on the genome,
06:53
the rest of the body
06:55
becomes expendable.
06:57
In fact, you could say
06:59
that the inevitability of the death of our bodies
07:02
enters in evolutionary time
07:05
at the same moment
07:07
as sexual reproduction.
07:09
Now I have to confess,
07:11
when I was a college undergraduate,
07:13
I thought, okay, sex/death, sex/death, death for sex --
07:15
it seemed pretty reasonable at the time,
07:19
but with each passing year,
07:22
I've come to have increasing doubts.
07:24
I've come to understand the sentiments of George Burns,
07:26
who was performing still in Las Vegas
07:29
well into his 90s.
07:31
And one night, there's a knock at his hotel room door.
07:33
He answers the door.
07:35
Standing before him is a gorgeous, scantily clad showgirl.
07:37
She looks at him and says,
07:40
"I'm here for super sex."
07:42
"That's fine," says George, "I'll take the soup."
07:45
(Laughter)
07:48
I came to realize,
07:52
as a physician,
07:54
that I was working toward a goal
07:56
which was different from the goal of evolution --
07:59
not necessarily contradictory, just different.
08:02
I was trying to preserve the body.
08:05
I wanted to keep us healthy.
08:07
I wanted to restore health from disease.
08:09
I wanted us to live long and healthy lives.
08:12
Evolution is all about passing on the genome
08:15
to the next generation,
08:18
adapting and surviving
08:20
through generation after generation.
08:23
From an evolutionary point of view,
08:25
you and I are like the booster rockets
08:28
designed to send the genetic payload
08:30
into the next level of orbit
08:32
and then drop off into the sea.
08:34
I think we would all understand the sentiment that Woody Allen expressed
08:37
when he said, "I don't want to achieve immortality through my work.
08:40
I want to achieve it through not dying."
08:44
(Laughter)
08:46
Evolution does not necessarily
08:49
favor the longest-lived.
08:52
It doesn't necessarily favor the biggest
08:54
or the strongest or the fastest,
08:56
and not even the smartest.
08:58
Evolution favors
09:00
those creatures best adapted
09:02
to their environment.
09:05
That is the sole test
09:07
of survival and success.
09:09
At the bottom of the ocean,
09:11
bacteria that are thermophilic
09:13
and can survive at the steam vent heat
09:15
that would otherwise produce, if fish were there,
09:18
sous-vide cooked fish,
09:21
nevertheless, have managed
09:23
to make that a hospitable environment for them.
09:25
So what does this mean,
09:30
as we look back at what has happened in evolution,
09:33
and as we think about the place again
09:36
of humans in evolution,
09:39
and particularly as we look ahead
09:42
to the next phase,
09:45
I would say
09:47
that there are a number of possibilities.
09:49
The first is that we will not evolve.
09:52
We have reached
09:57
a kind of equipoise.
09:59
And the reasoning behind that would be,
10:01
first, we have, through medicine,
10:03
managed to preserve a lot of genes
10:06
that would otherwise be selected out
10:08
and be removed from the population.
10:10
And secondly, we as a species
10:12
have so configured our environment
10:14
that we have managed to make it adapt to us
10:17
as well as we adapt to it.
10:20
And by the way, we immigrate and circulate
10:23
and intermix so much
10:25
that you can't any longer
10:27
have the isolation that is necessary
10:29
for evolution to take place.
10:31
A second possibility
10:34
is that there will be evolution of the traditional kind,
10:36
natural, imposed by the forces of nature.
10:39
And the argument here would be
10:44
that the wheels of evolution grind slowly,
10:46
but they are inexorable.
10:49
And as far as isolation goes,
10:51
when we as a species
10:53
do colonize distant planets,
10:55
there will be the isolation and the environmental changes
10:57
that could produce evolution
11:00
in the natural way.
11:03
But there's a third possibility,
11:05
an enticing, intriguing and frightening possibility.
11:07
I call it neo-evolution --
11:10
the new evolution
11:12
that is not simply natural,
11:14
but guided and chosen
11:16
by us as individuals
11:19
in the choices that we will make.
11:22
Now how could this come about?
11:24
How could it be possible that we would do this?
11:27
Consider, first, the reality
11:30
that people today, in some cultures,
11:33
are making choices about their offspring.
11:36
They're, in some cultures,
11:39
choosing to have more males than females.
11:41
It's not necessarily good for the society,
11:44
but it's what the individual and the family are choosing.
11:46
Think also,
11:50
if it were possible ever
11:52
for you to choose, not simply to choose the sex of your child,
11:56
but for you in your body
11:59
to make the genetic adjustments
12:02
that would cure or prevent diseases.
12:05
What if you could make the genetic changes
12:07
to eliminate diabetes or Alzheimer's
12:10
or reduce the risk of cancer
12:13
or eliminate stroke?
12:15
Wouldn't you want
12:17
to make those changes
12:19
in your genes?
12:21
If we look ahead,
12:23
these kind of changes
12:25
are going to be increasingly possible.
12:27
The Human Genome Project
12:32
started in 1990,
12:34
and it took 13 years.
12:36
It cost 2.7 billion dollars.
12:38
The year after it was finished in 2004,
12:43
you could do the same job
12:46
for 20 million dollars in three to four months.
12:48
Today, you can have a complete sequence
12:51
of the three billion base pairs in the human genome
12:54
at a cost of about 20,000 dollars
12:56
and in the space of about a week.
12:59
It won't be very long
13:01
before the reality will be
13:03
the 1,000-dollar human genome,
13:05
and it will be increasingly available for everyone.
13:07
Just a week ago,
13:11
the National Academy of Engineering
13:13
awarded its Draper Prize
13:15
to Francis Arnold and Willem Stemmer,
13:17
two scientists who independently developed techniques
13:19
to encourage the natural process of evolution to work faster
13:23
and to lead to desirable proteins
13:27
in a more efficient way --
13:29
what Frances Arnold calls "directed evolution."
13:31
A couple of years ago, the Lasker Prize
13:35
was awarded to the scientist Shinya Yamanaka
13:38
for his research
13:41
in which he took an adult skin cell,
13:43
a fibroblast,
13:45
and by manipulating just four genes,
13:47
he induced that cell
13:50
to revert to a pluripotential stem cell --
13:52
a cell potentially capable
13:56
of becoming any cell in your body.
13:59
These changes are coming.
14:02
The same technology
14:04
that has produced the human insulin in bacteria
14:06
can make viruses
14:08
that will not only protect you against themselves,
14:10
but induce immunity against other viruses.
14:13
Believe it or not,
14:15
there's an experimental trial going on
14:17
with vaccine against influenza
14:19
that has been grown in the cells of a tobacco plant.
14:22
Can you imagine something good coming out of tobacco?
14:26
These are all reality today,
14:30
and [in] the future, will be evermore possible.
14:33
Imagine then
14:36
just two other little changes.
14:38
You can change the cells in your body,
14:41
but what if you could change the cells in your offspring?
14:43
What if you could change the sperm and the ova,
14:47
or change the newly fertilized egg,
14:49
and give your offspring a better chance
14:52
at a healthier life --
14:54
eliminate the diabetes, eliminate the hemophilia,
14:56
reduce the risk of cancer?
14:58
Who doesn't want healthier children?
15:00
And then, that same analytic technology,
15:03
that same engine of science
15:06
that can produce
15:08
the changes to prevent disease,
15:10
will also enable us
15:12
to adopt super-attributes,
15:15
hyper-capacities --
15:17
that better memory.
15:19
Why not have the quick wit
15:21
of a Ken Jennings,
15:23
especially if you can augment it
15:25
with the next generation of the Watson machine?
15:27
Why not have the quick twitch muscle
15:30
that will enable you to run faster and longer?
15:33
Why not live longer?
15:36
These will be irresistible.
15:40
And when we are at a position
15:42
where we can pass it on to the next generation,
15:45
and we can adopt the attributes we want,
15:47
we will have converted
15:50
old-style evolution
15:53
into neo-evolution.
15:55
We'll take a process
15:57
that normally might require 100,000 years,
15:59
and we can compress it down to a thousand years --
16:01
and maybe even in the next 100 years.
16:04
These are choices
16:07
that your grandchildren,
16:09
or their grandchildren,
16:11
are going to have before them.
16:13
Will we use these choices
16:16
to make a society that is better,
16:19
that is more successful, that is kinder?
16:22
Or, will we selectively choose different attributes
16:25
that we want for some of us
16:28
and not for others of us?
16:30
Will we make a society
16:32
that is more boring and more uniform,
16:35
or more robust and more versatile?
16:38
These are the kinds of questions
16:41
that we will have to face.
16:43
And most profoundly of all,
16:45
will we ever be able to develop the wisdom,
16:47
and to inherit the wisdom,
16:50
that we'll need to make these choices wisely?
16:52
For better or worse,
16:55
and sooner than you may think,
16:57
these choices will be up to us.
16:59
Thank you.
17:02
(Applause)
17:04

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About the Speaker:

Harvey Fineberg - Health policy expert
Harvey Fineberg studies medical decisionmaking -- from how we roll out new medical technology, to how we cope with new illnesses and threatened epidemics.

Why you should listen

As president of the Institute of Medicine, Harvey Fineberg thinks deeply about new medicine, both its broad possibilities and the moral and philosophical questions that each new treatment brings. How do we decide which treatment to use in a tricky case -- both individually and as a community? Is it fair that the richest hospitals get the best healthcare? Who should bear the risk (and gain the reward) of trying the newest treatments?

Fineberg helped found and served as president of the Society for Medical Decision Making and also served as consultant to the World Health Organization. He was provost of Harvard from 1997 to 2001, following thirteen years as Dean of the Harvard School of Public Health. He has devoted most of his academic career to the fields of health policy and medical decision making. His past research has focused on the process of policy development and implementation, assessment of medical technology, evaluation and use of vaccines, and dissemination of medical innovations.

More profile about the speaker
Harvey Fineberg | Speaker | TED.com