By Allan Maurer
CARY, NC—Regenerative medicine holds promise of repairing or replacing damaged organs. Stems cells offer incredible healing potential. Gene therapy and other medical marvels are on the horizon. But all are controversial. Last night at the 8th Annual Pappas Biosymposium, nationally known bioethics expert Art Caplan addressed the question, should we really try to live forever?
Caplan is chair of the Department of Medical Ethics and director of the Center for Bioethics at the University of Pennsylvania, author or editor of 23 books, and columnist on bioethics for MSNBC, among many other accomplishments. In his talk to more than 200 people at the symposium, he offered answers to arguments by critics that medical advances are somehow unnatural, too costly, or otherwise wrongheaded.
Caplan says the question of whether or not modern science and medicine should extend our lives and enhance our capabilities is going to be “the battleground of the next ten years and even of the 21st century.” He noted that while some may ask, what’s wrong with living forever, repairing damaged organs, or fixing genes, a lot of people and organizations from the left and right of the political spectrum oppose these advances.
Beginnings of bioethics field
Caplan traced the establishment of bioethics as a field back to another question posed by modern medicine years ago: how do we define death? Once, it meant the cessation of respiration and heartbeat, but modern instruments can keep a comatose person breathing and fed. The resulting discussions led to the new standard of brain death.
A second impetus, he noted, was the infamous Tuskegee study of untreated syphilis in 399 black men with syphilis and 201 without it. A 1972 Associated Press story about the study raised a public outcry. The men were misinformed about the nature of the study and never treated, even though antibiotics would have cured them.
That, Caplan notes, led to such things as “informed consent” regarding clinical trials and treatment regimes.
Today, bioethics questions affect nearly all the players in medicine, from researchers and startups to the global pharmaceutical companies.
Not easy to wrestle with these issues
A not untypical incident involved a very wealthy man with a daughter dying of cancer. The man did a literature search and discovered an experimental drug in development that he thought might help his child.
He approached the company developing the drug and asked the company to give it to his child. That posed, and poses, a number of problems. First, the company only had a limited quantity of the drug. “It was expensive to make,” said Caplan. “They would have had to give all on hand to the child.”
Since no clinical trial had been done, no safety or dosing data existed. Also, if the effective dose given to mice were upscale to the human level, “They would have had to give her pounds of it,” he said.
Giving the whole amount of the drug to the little girl also could endanger the company’s ability to do a clinical trial, thus preventing it from helping others. Caplan asked, are they any less worthy?
In the end, the company did not give the drug to the child and she died. “I don’t think this drug would have prevented that. But it shows that sometimes bioethics are not much fun. It is not easy to wrestle with these issues.”
Is long life natural?
Then, Caplan took on those who oppose many medical advances that promise not only longer life, but greater function and quality of life as we age.
“Is it really unnatural to seek a longer better life, as critics argue?” he asked. He pointed out that there is really nothing natural about a 70 or 75-year average lifespan. In ancient times, lifespans were closer to 35. To those who say advance the Biblical idea of three-score and ten, he asks, “What about all those earlier in the Bible who lived 800 years?”
Biologically, our inherent lifespan is more of an accident than anything else, Caplan said.
There’s nothing particularly natural about it. There are risks and costs. “Risk should always be taken into account,” Caplan said.
Some procedures are very costly and many critics fear that methods for extending and enhancing life will be available only to the rich. “We should establish access as public policy now,” Caplan said.
Critics also oppose advances that increase the quality of life as opposed to just saving lives, he noted, pointing to political opposition for government subsidies of such drugs as Viagra, Cialis, and Levitra.
Some critics even oppose enhancing vision via laser surgery to 20/10, and certainly cosmetic procedures. But, Caplan said, enhancing the quality of life is what makes life worth living.
On the Web: www.pappasventures.com
Caplan interviewed by MSNBC on the latest ethical controversies as discussed in his new book, “Smart Mice, Not So Smart People.”
www.msnbc.msn.com/id/15643279
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