(this is an unfinished post retrieved from nearly 2 years ago!) As I said on the panel at Westercon in July, unless we make some explicit attempts to build an alternative infrastructure, our first efforts at engineering ourselves are liable to be driven by the same mechanisms and subject to the same regulation as present day drug developments. The first efforts at bioengineering are occurring now, and they are attempts to repair genetic diseases where the disease is caused by a defect in a single gene that causes loss of function (it produces too little, or a non-functioning enzyme or other protein). The challenges are evident; some of gene therapies most successful trials have been stopped because young patients treated for SCID have developed leukemia because the vector carrying the defective gene into their DNA has inserted itself close to an oncogene (gene associated with cancer). So there are considerable technical challenges to be worked out. But as long as the intent remains therapeutic, biological therapies could fit more or less comfortably into the present framework that regulates and delivers health care, and will probably be carried along as that framework evolves. And as long as the intent remains therapeutic, the majority of us will remain comfortable with the idea. And as, perhaps, knowledge expands to multigene disorders, many of us will become beneficiaries.
Beyond the tidy bounds of therapy, things start to get fraught. For one, the most prevalent multigene disorder of all is that thing that most of us (outside Hollywood, at least) acknowledged (willingly or otherwise) as natural: aging. I don’t expect to see effective and accessible life-prolonging therapy in my lifetime, though I’d dearly like to be around in a 100 years to rescind this statement; even if it is achieved, I expect the cost will be prohibitive, and the treatment initially accessible to only the privileged. Which may spare the Earth another explosion of human population, if it is slow to disseminate, but will not spare humanity the resulting social disruption.
Anti-aging therapy straddles therapy and enhancement; it is, I expect, within most people’s acceptance-zone that we extend life, or if we cannot extend life, then extend healthy life. But then there’s outright enhancement. We’re already struggling with the distinctions, as, for instance, whether children who are exceptionally small but otherwise normal should be considered candidates for treatment because of the perceived and demonstrated social penalties of small stature.