Part 4 of the TED Radio Hour episode The Fountain Of Youth

About Harvey Fineberg's TED Talk

Medical ethicist Harvey Fineberg says "neo-evolution" is on the horizon. When it becomes easier to eliminate disease through gene therapy, will we change the trajectory of evolution?

About Harvey Fineberg

Harvey Fineberg is President of the Gordon and Betty Moore Foundation and the former president of the Institute of Medicine. He served for 13 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 policy development, assessment of medical technology, evaluation and use of vaccines, and dissemination of medical innovations.

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Transcript

GUY RAZ, HOST:

It's the TED Radio Hour from NPR. I'm Guy Raz. Our show today is about one of the things that humans have been searching for since the beginning of recorded history - the fountain of youth.

(SOUNDBITE OF TED TALK)

HARVEY FINEBERG: Suppose I said that with just a few changes in your genes, you could get a better memory - more precise, more accurate and quicker. Or maybe you'd like to be more fit, stronger, with more stamina. How about living longer with good health?

RAZ: This is Harvey Fineberg speaking on the TED stage. He's a physician and a medical ethicist and the former dean of Harvard's Medical School.

(SOUNDBITE OF TED TALK)

FINEBERG: Which would you like if you could have just one? How many would opt for memory? How about fitness? What about longevity? Oh, the majority - that makes me feel very good as a doctor. If you could have any one of these, it would be a very different world.

RAZ: All the hands went up when you asked that question.

FINEBERG: Yeah.

RAZ: Everybody wants to live longer.

FINEBERG: Most people do want to live longer.

RAZ: Yeah.

FINEBERG: But we want to live longer healthier. You know, we have a chronological age, and we have a psychological age. And we have a physical age, which is how many years compared to the average person are you in your state of health at a given age. We can't do anything about the chronological age. That's the passage of time.

RAZ: Yeah.

FINEBERG: We can do something about the psychological age and the physical age. How we live, what we eat, whether we exercise regularly - those are the choices that are within our power today.

(SOUNDBITE OF MUSIC)

RAZ: That's today, and many of us do make those choices. But Harvey Fineberg has researched an entirely new world of choices we might someday have, choices that might change how long we live and even how future humans evolve.

(SOUNDBITE OF TED TALK)

FINEBERG: Evolution does not necessarily favor the longest-lived or the strongest or the fastest and not even the smartest. Evolution favors those creatures best adapted to their environment. So as we think about the place again of humans in evolution, I would say that there are a number of possibilities. The first is that we will not evolve. The second possibility is that there will be evolution of the traditional kind - natural, imposed by the forces of nature.

But there's a third possibility, an enticing, intriguing and frightening possibility. I call it neo-evolution, the new evolution that is not simply natural but guided and chosen by us. What if you could make the genetic changes to eliminate diabetes or Alzheimer's or reduce the risk of cancer or eliminate stroke? Wouldn't you want to make those changes in your genes? If we look ahead, these kind of changes are going to be increasingly possible.

(SOUNDBITE OF MUSIC)

RAZ: Harvey Fineberg's idea is that the kinds of changes Cynthia Kenyon made in those tiny little C. elegans will one day be common in humans, that eventually, we'll be able to edit human genes - splice parts in, take things out - but not just in a gene that might help us live longer, but in all kinds of specific genes that make some of us more susceptible to certain diseases.

FINEBERG: Just a year ago, mice that were specially bred to have a gene defect that was analogous to muscular dystrophy were treated in embryo form, and the mice that grew up were much less likely to have the expression of muscular dystrophy. That suggests that this technology may become a way to treat human disease or to prevent human genetic disease.

RAZ: I mean, so could that also prevent the diseases of aging, like - where things like cancer or Alzheimer's might one day seem like diseases of the 19th century like scarlet fever or smallpox.

FINEBERG: We think of many diseases as natural phenomenon.

RAZ: Right.

FINEBERG: Infection is natural. But it's avoidable, whether it's a vaccine today or a gene edit in a hundred years from today.

RAZ: Wow.

FINEBERG: And imagine a world where you're walking on the street, and you just can't tell if someone is 80 or 180 years of age.

(SOUNDBITE OF MUSIC)

RAZ: I mean, that's - that's crazy.

FINEBERG: I don't think it's crazy. It's unlikely in the near-term.

RAZ: Right.

FINEBERG: But it's not inconceivable.

(SOUNDBITE OF TED TALK)

FINEBERG: Imagine, then, just two other little changes. You can change the cells in your body, but what if you could change the cells in your offspring? Eliminate the diabetes. Eliminate the hemophilia. Reduce the risk of cancer. Who doesn't want healthier children? And then that same analytic technology, that same engine of science that can produce the changes to prevent disease will also enable us to adopt super attributes. That better memory - why not have the quick wit? Why not have the quick-twitch muscle that will enable you to run faster and longer? Why not live longer? And when we are at a position where we can pass it on to the next generation and we can adopt the attributes we want, we will have converted old-style evolution into neo-evolution. We'll take a process that normally might require 100,000 years, and we can compress it down to 1,000 years and maybe even in the next 100 years.

(SOUNDBITE OF MUSIC)

RAZ: I mean, of course, this raises a ton of ethical questions, right?

FINEBERG: Absolutely.

RAZ: I mean, like, you're talking about a future where we create people who have certain genetic advantages.

FINEBERG: We can try to anticipate the ethical questions with technologies, but we're better, usually, at trying to deal with them when they are tangible and real. Any of these tools is going to be powerful enough that it would also be subject to misuse and inappropriate use, so it's very important, in my mind, that it be used under very strict control and legal and ethical conditions. But we won't be able to undo new knowledge. When we have that knowledge and we have problems that we're trying to fix, we will have tremendous desire to fix those problems.

(SOUNDBITE OF TED TALK)

FINEBERG: These are choices that your grandchildren or their grandchildren are going to have before them. Will we use these choices to make a society that is better, or will we selectively choose different attributes that we want for some of us and not for others of us? Will we make a society that is more boring and more uniform or more robust and more versatile? These are the kinds of questions that we will have to face. And most profoundly of all, will we ever be able to develop the wisdom and to inherit the wisdom that we'll need to make these choices wisely. For better or worse and sooner than you may think, these choices will be up to us. Thank you.

(APPLAUSE, SOUNDBITE OF MUSIC)

RAZ: Harvey Fineberg is a physician and a medical ethicist. He's also the former dean of the Harvard Medical School and now the president of the Gordon and Betty Moore Foundation in Palo Alto. Transcript provided by NPR, Copyright NPR.

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