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Second-guessing the Future
Medical Developments

This article looks at the ways in which our predictions of medical developments in the future are constrained by our present anxieties and fears. Another article in this issue looks at the ethics of medicine.

At the turn of a new century many journalists are busy making predictions about future developments in science. Forecasts or speculations about future inventions or possible discoveries are fascinating to read. However, for a non-specialist reader they seem to be as fantastic as an imaginary world created by science fiction writers.

For example, Jules Verne, a French science fiction writer living in the 19th century, was able to anticipate and describe a trip to the moon in perfect detail. His contemporaries were fascinated by his ideas but found it hard to believe that it would actually happen. Jules Verne was perfectly right. People did travel to the moon. The problem is that he got all the details wrong. So maybe this is a good hint for the readers of all those speculations and predictions - the anticipated developments will soon become reality but it is often impossible to imagine the exact details or solutions employed to implement them. With hindsight we also know that it is very difficult to predict the actual time scale on which future developments might become feasible.

Cloning is a very interesting example. Especially in the view of the recent heated debate in the British Parliament on the question of the legality of the cloning of human embryos. A procedure which ten years ago seemed to be entirely out of the question is now becoming perfectly feasible and legal. Consider this entry on cloning in "The Cambridge Encyclopaedia" edited by David Crystal in 1990 (David Crystal, ed. 1990. The Cambridge Encyclopaedia. C.U.P.):

"This is a very difficult procedure which has so far been achieved mainly in amphibia. There is a considerable potential application in animal rearing, but its application to humans is extremely unlikely (except in some very rare instances of in vitro fertilization)."

The key question that should have been asked in this case is not whether cloning was possible but rather why anyone should want to take advantage of the technical possibilities of it. The truth is that however hard we try to speculate about the future, there is only a very slim chance of getting it right. It is not due to the lack of scientific data but to the fact that all predicted and forecast scenarios are projections of our contemporary anxieties and fears. Our imagination seems to be restricted by a straight-jacket of contemporary problems which we find impossible to solve.

Let us take another example from bioengineering. Will the advances in bioengineering allow the blind to see? Difficult to envisage but feasible. Scientists predict that soon by means of a video-link to the optic nerves the blind will be capable of learning to "see". The problem is that it is very difficult to predict what that "seeing" will involve. It will probably be a very different way of "seeing". Only with time and experience will the scientists be able to collect and compare data and, if necessary, learn. No doubt mistakes will be made. But this is often the price paid for success.

It is predicted that the biggest developments will probably occur in molecular medicine. Doctors have not dreamed yet of the thousands of small yet important jobs that can be done, with the developments in the field of so called nanotechnology, i.e. the science of creating molecular-size machines that manipulate matter one atom at a time. Nanobots working in the patient's arteries could chip plaque, fight bacteria or viruses and repair blood vessels. Many of us may still think that it is too far-fetched. A little imaginary trip into the past may convince those who doubt.

The year is 1895. A German physicist, Wilhelm Roentgen, discovers X-rays. They become very useful in medicine, since different parts of the body absorb X-rays to a different extent.

However, many years have to pass before taking an X-ray becomes a matter of routine. Firstly, X-ray machines were not only awkward but also dangerous to the patients and operators alike, as very little was known about radiation risks. It is still used today. But nowadays doctors have many more useful tools that enable them to make a correct diagnosis: from little cameras travelling through the patient's intestinal tracts to the ancient skill of iridology.

Nevertheless, the most unknown territory as regards new developments in medicine remains genetics. Here speculations flourish. Some dark scenarios describe a future world threatened by human robots-clones with chips in their brains controlled by their evil masters.

Again it is very difficult to respond rationally to these predictions. The first reason being that an average person knows very little about genetics. So the first step would be to try to learn as much as possible. The second reason is that future projections really hark back to past anxieties and fears. Thus we must try and answer such fundamental questions as: who makes the decisions about money spent on experiments in the field of medicine or who decides what the new directions in medical research should be. So, in conclusion, maybe it is worth considering the following questions:

  • towards what ends should science look?
  • should science be ethical? Who should decide what to base these ethics on?
  • if you could make decisions concerning your unborn child’s health/appearance/mental ability, would you? Should you?
  • what is science for?
  • what is your definition of ‘science’?
  • should we trust science?
  • is science political?
  • how ‘valuable’ are new developments in medicine? Whom should they serve?

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