Joint replacements routinely restore mobility, but what if they could provide superhuman speed? Laser eye surgery returns peoples’ vision to 20/20, but what if it could let them see for miles? Gene editing will soon help people avoid disease, but what if it could make them smarter or better looking?
These examples are all part of a rapidly advancing area of scientific developments known as human enhancement. Today human enhancement, in some respects already a mundane and universally accepted part of medicine, is now poised to spark transformative change—a kind of change that calls for reflection on choices that arise with its technologies, both on the individual level and for society as a whole.
Scientists and many of those who closely follow science know this. The question is, does everyone else?
The implications surrounding human enhancement call for open discussion, and the first step in such a discussion is awareness. How do people feel about various forms of human enhancement, and are they even aware of how quickly advances in this area are coming? And at the individual level, are they personally interested in being enhanced?
In collaboration with the World Economic Forum Global Future Council on Human Enhancement (GFC-HE), AARP, the world’s largest membership organization representing 37 million Americans age 50 and over, sought some answers via a unique survey on public perceptions of human enhancement technologies. What we discovered proved informative and telling.
In late August and early September of 2017, AARP Research surveyed over 2,000 American adults (age 18 and older) using the AmeriSpeak panel-based research platform from NORC at the University of Chicago. Data were weighted by age, gender, race, ethnicity, employment status and income to be nationally representative of the entire U.S. population. The study explored various types of human enhancements: interventions with respect to vision, joints, cognition and gene editing.
Of course, to reflect on implications related to enhancement, discuss them and make choices, people must first be aware of the underlying technology. As it turned out, the AARP study revealed a general lack of awareness concerning human enhancement technologies as defined by the GFC-HE. Approximately 76 percent of Americans have heard either nothing at all (40 percent) or not very much (36 percent) about human enhancement technologies. Fewer than one in 10 participants said they have already used human enhancement technologies such as organ transplants, pacemakers, prosthetics or joint replacements.
ACCEPTANCE DEPENDS ON APPLICATIONS
The study examined if and under what conditions it would be appropriate to apply human enhancement technologies along a continuum of use: therapeutic use to restore ability, prevention when there is a known risk or relevant family history, enhancement beyond the ability one would normally have, and enhancement greatly beyond normal. Perhaps not surprisingly, support for human enhancement depended somewhat on the type, and particularly the degree, of enhancement. Restoration of normal function, as opposed to enhancement beyond normal ability, was consistently more acceptable to the study groups. Receiving near universal support were enhancement to restore vision (96 percent) and joint replacement to restore mobility (95 percent). On the other hand, agreement with the appropriateness of enhancement to improve vision greatly beyond normal human capabilities dropped to 44 percent; similarly, joint replacement to improve mobility and performance to levels greatly beyond normal human capabilities dropped to 33 percent.
The results revealed a similar pattern for public acceptance of cognitive enhancement, even when the questionnaire provided examples with two different levels of invasiveness: medications and implants. The use of medications to restore cognitive abilities for those with dementia received strong support in the survey, with 95 percent agreeing that it is appropriate to use drugs for such purposes compared to a still-strong 88 percent agreeing with employing implantable devices to achieve the same ends. However, agreement dropped significantly—35 percent for medications and 31 percent for implantable devices—for cognitive enhancements that go greatly beyond normal human capabilities.
Gene editing is among the most controversial of the human enhancement technologies to emerge. While 60 percent of Americans felt that gene editing would improve quality of life, two thirds of the participants were worried the technology would negatively affect society. Nevertheless, gene editing received very strong support—83 percent—for its use in curing disease or suppressing genes that cause disease. However, support for non-therapeutic interventions dropped incrementally from there depending on use, with the purposes of making people stronger or more intelligent (46 percent) and determining human characteristics (32 percent) receiving the least support.
We took a closer look at those who believed it would be appropriate to use human enhancement technologies to allow an individual to have vision, joint function or cognition beyond or greatly beyond normal. We found that attitudes concerning these superhuman enhancements are consistent across the demographics of age, race/ethnicity, education and income. However, men were significantly more interested in such enhancements; for example, 72 percent of American males thought these technologies should be available for vision enhancements compared to only 55 percent of women.
PERSONAL INTEREST IS STRONG
Despite concerns in principal over the appropriateness of certain applications, the survey showed there is potentially a significant market for human enhancement technologies that improve one’s abilities beyond normal, even when a person doesn’t need corrective treatment. A total of 43 percent of the U.S. adult population were very interested (16 percent) or somewhat interested (27 percent) in a medication that improved their cognitive abilities beyond normal. Interest in self enhancement dropped to 34 percent if the cognitive improvements were delivered by implantable device. Over one-third of Americans would be interested in improving their vision beyond normal.
BROADER SOCIAL CONCERNS
Underscoring the need for public discourse on human enhancement perhaps like no other aspect of the survey is what it uncovered regarding Americans’ societal concerns. While most Americans agree that enhancement would improve an individual's quality of life, two-thirds are worried about negative effects to society. The list of fears runs long—among them, the potential societal divide based on income, abuse of technology against the poor and loss of uniqueness and diversity, to name a few. Fears of unequal access based on income, in fact, seemed to be confirmed just recently, when Spark Therapeutics announced it will charge a staggering $850,000 for a groundbreaking gene therapy to treat blindness.
Reflecting the range of fears, a majority of Americans said that individuals who have undergone enhancement should be monitored for possible health side effects and that widespread use of specific technologies should be regulated by medical experts. Thus, one of the most challenging tasks scientists face today is defining guidelines for human enhancing technologies that both benefit individuals and society and are consistent with broad social needs and norms.
THE STUDY AS A STARTING POINT
Today, none of us is a stranger to transformative and rapid technological change.Yet changes precipitated by human enhancement may be more profound than others we’ve encountered in recent years because they may redefine what it means to be a human. It is, therefore, time to engage the general public in the conversation so we can all understand and shape the use of the technologies and harness their potential in ways of our choosing.
The AARP survey represents a start to this work, offering a glimpse into levels of public understanding, attitudes and demand for a range of human enhancement technologies. As science advances, these attitudes may change, but for now they can serve both as a baseline of understanding and a spark for an important conversation.