The other day I was listening to one of my favorite podcasts. The topic of this particular episode was investing in healthcare. The guest was a venture capitalist. He focused on providing funding to start-up biotech and health delivery firms that were on the cutting edge of medicine. There were many interesting topics discussed. The guest was inciteful, intelligent, with a deep understanding of medicine and healthcare. As a healthcare professional I was very impressed by his knowledge despite the fact he was a former musician and had no formal training in medicine or research.
One of the topics covered was genetic mutation and correction though gene editing. The guest told a story about the conception of his daughter. His wife carries a particular gene that predisposes her to certain types of cancer. Based on the odds the guest described it appeared that the gene’s inheritance pattern was autosomal dominant. Since they were aware of the mutation, they put in motion a plan to prevent their daughter from inheriting the gene. Ova were harvested from his wife. Their genetic sequences were analyzed. An ovum without the genetic mutation was selected. Through in-vitro fertilization (IVF) his daughter was conceived sans potential cancer-causing mutation.
Prior to telling the story the host of the podcast asked an interesting question about gene editing. It was an existential question. This is not verbatim. He asked, “So it starts with curing diseases, but eventually the technology will become so good that you could decide that you want everyone to have blue eyes, where is the end?”
As I continued to listen to the podcast I was further enticed by the power of the technology. Most discussion surrounding healthcare are focused on healthcare delivery and different systems used accomplish this goal. This was completely different. This was about complete annihilation of disease. Let’s consider a disease like cystic fibrosis. This is a devastating genetic disease. A few years ago, most patients did not live beyond their early twenties. Many died at a much younger age. In this disease the lungs fill up with mucous and debris due to a faulty protein that is charged with clearing it from the airways. About 5 years ago Vertex Pharmaceuticals created a medication to treat this disease that expanded the life expectancy and improved the quality of life for these patients. The disease is due to an autosomal dominant genetic mutation much like the on described by the guest. Its penetrance and expression are very high. This treatment is inferior to the alternatives discussed in this podcast. If IVF therapy is advancing to the degree in which the genes of an ovum can be analyzed and an ovum without the cystic fibrosis gene selected to be fertilized, then cystic fibrosis can be eradicated. All that is required is the knowledge of the gene prior to conception. Likely, within the next century, even if you did not have knowledge of the gene, scientists will be able to edit your genes post conception eliminating the defect.
I am not a proponent of the existence of cystic fibrosis. It is a terrible disease that has led to suffering. However, I do have brown eyes. I am sometimes envious of those with blue eyes. My wife has brown eyes. They are dark and beautiful. Her eyes I do not find imperfection with, but I sometimes consider mine to be substandard. Is there something about blue eyes that signal genetic superiority? I will save that question for another discussion. This brings us to the host’s question. Why not have humans with just blue eyes if we have the technology to do so? The simple answer is, if everyone had them, there would be nothing special about them. But that answer does not satisfy the need to accept my brown eyes.
To break the question down further one must ask, why do we pursue the eradication of disease, or better, the eradication of frailty and suffering? I think there are two parts. First, we do not want to see the ones we love suffer. Second, we do not want to be without them. So, why do we feel the way we feel about our loved ones? It’s not because they are perfect. It is because they are vulnerable. They are imperfect. Grossly so. Also, there is a chance they could be gone, at any moment, which makes their existence scarce, finite. Hence, our existence together has value because it is limited.
It is clear to me that if left unencumbered, human ingenuity has no limits. There is a chance that nuclear war, the destruction of the planet via pollution, a virus far more virulent than COVID-19, or a meteor crashing into our planet will end our species. That would be an end to our time in history. However, it is quite possible we will continue as a species for many centuries or many more millennia here on earth. So, if human ingenuity is infinite, and we are in pursuit of the eradication of frailty and suffering, then logic would dictate these states will eventually come to an end.
Friedrich Nietzsche is quoted “To live is to suffer, to survive is to find some meaning in the suffering.” Nietzche, as many of you know, was a famous German philosopher. Philosophy is the study of reality and existence. Philosophy is a theoretical science, much like theoretical physics. Theories are conceived, mental models and maps are developed in the hopes of using them to explain the workings of our universe. Much like Einstein’s E= MC2 that changed the field of physics forever, medicine, and human ingenuity could use an equation to ensure survival of the human race outside of an extinction event. If we start with Nietzche’s quote we can identify the components of the equation as (suffering/meaning/survival). However, we do not know the optimal proportion or arrangement of each component to find an equilibrium. The simplest starting point would be the linear interpretation of the quote (suffering/meaning = survival).
What is the purpose of suffering anyways? Now I am a religious man. I believe in God. I believe my soul was redeemed when by Jesus when he died on the cross. I believe there was great intention in those events, and their purpose was not just for the salvation of my soul. The story of Jesus’ crucifixion on Calvary changed the history of the human race for the better, forever, whether you believe the truth of it or not. The progress of western civilization is due to that story being told thousands of times, generation after generation. One of the themes of that story is that there is suffering in this world, and it’s each individual’s responsibility to do something about it. Small or large makes no difference, pick up your cross and bear it as “I” did for you.
The purpose of that story is to better understand the intention of suffering. Whether or not you believe God created the Universe and conceived your soul or the universe occurred through random chance, darkness was born with it, or our knowledge of it was born. So, there must be intention in it. The intention is to give us purpose, drive, love, and urgency to life. Knowledge did not exist until the moment we were conscious of our own death.
It is conceivable that we will overcome physical death. Science will advance to the point that will give humans longer and longer lifespans. But will that bring value to our species? Will it bring harmony, happiness, and love? As human ingenuity has advanced, and life expectancies have expanded some would say mental and physical anguish has worsened. The prevalence of diseases like cancer and dementia have increased. People suffering with depression and anxiety continue to climb with each generation. Science continues to develop solutions to these problems, but what’s next? Could it be more compounding of disease and burden? Less satisfaction with life and more mental anguish? The question that arises is; Should we die? In today’s world, death is inevitable. We go to great lengths to avoid it. Mother nature goes to great lengths to deliver it. We beat it back but eventually succumb. Death is a frightful event because uncertainty lies beyond that event horizon. However, what is most feared is lost potential.
How could we study such a phenomenon? The best place to start would be to talk to those that have suffered greatly. Those that have suffered and no longer suffering, and those that continue to suffer. Do they have happiness? Do they have fulfillment? Compared to those that have suffered little, or much suffering is alleviated without personal cost. Are they fulfilled or happy? Which group has meaning? Which has a stronger desire to survive. Then investigate our great innovations big and small to understand life before and after their conception. Could an equation be found that will provide balance for a species. I mentioned this to someone in a conversation the other day and they thought it was ridiculous. So, maybe its out there. I’m sure physicists thought E= MC2 was ridiculous before Einstein proved it.
“You were so busy figuring out if you could, that you never figured out if you should.”
- Dr. Malcolm
,“Now I am become death, the destroyer of worlds.” (quote after the detonation of the first atomic bomb)
- Dr. Robert Oppenheimer