What Should We Be Worried About?

OUR INCREASED MEDICAL KNOW-HOW

ESTHER DYSON

Board member & investor in health care, human capital, & aerospace startups; chairman, EDventure Holdings; former chairman, ICANN (Internet Corporation for Assigned Names & Numbers); author, Release 2.1: A Design for Living in the Digital Age

We should be worried about the consequences of our increasing knowledge of what causes disease and how that knowledge will affect human freedom.

It’s exciting that we can figure out what kind of diet and behavior will keep most people well, and it’s good to use that knowledge. But that raises the question of who bears the responsibility, if people don’t. Indeed, does society have the right to interfere beforehand precisely because society bears some of that responsibility, if only by assuming the burden of health-care costs? It calls to mind the medical irony of the cure being worse than the disease or the immune reaction worse than the pathogen.

In this case, the trigger is our increasing knowledge of how we make ourselves sick—or how we can keep ourselves healthy: proper diet, regular exercise, no smoking, limited drinking, sufficient sleep. It’s clear that a squeaky-clean lifestyle (and just for good measure, add avoidance of stress) is the key to good health for most people and to reducing medical costs for society as a whole.

In addition, our knowledge of genetics and specific markers for susceptibility to disease is growing. Certain people with genetic predispositions to certain conditions need to take additional measures to stay healthy. Over time, we will know more of these specific correlations and be able to identify—if we want—people with predisposition to certain diseases (and therefore increased responsibilities?).

The thing to worry about is how society handles this knowledge, both in general and for the specific people who carry extra burdens. We all know of artists and others who are at least somewhat crazy. Many of them avoid treatment for fear—justified or not—of losing their creative gifts. Other people simply want to be themselves rather than some medicated version. And while much medical knowledge may be true, not all of it is. Certainly it keeps changing. Many drugs and other treatments don’t do much; others cause collateral damage. How much is an extra month of life worth, if you’re diminished by the side effects of life prolongation?

In short, the notion of unpredictable health catastrophes is giving way to something closer to flood plains. People are rightly asking whether society should pay to protect people who live in predictably dangerous areas, refuse to wear helmets while riding motorcycles, and so on. But when somebody actually undergoes such a catastrophe, even a predictable one, attitudes change and the government offers disaster relief. Such rare occasions are becoming more common.

So the questions are: What duty do we have to live properly? What responsibility do we have for the consequences if we do not? How much can we blame on our parents, or society, or whomever—and even so, what responsibilty do we bear? Should society pay for prevention but not for remediation of avoidable outcomes? Should we force special responsibilities on people with particular vulnerabilities?

These questions aren’t new, but they will become more urgent as we get better at predicting or avoiding outcomes. There are no simple answers to define or to allocate responsibility. That’s why we should be worried.