Forecasting the future is a dangerous activity. Still, even if forcasting is difficult, it is important to try to anticipate what is to come in the not-so-distant future, if only to trigger the requisite public debate about the ethics of what is perhaps likely to come. So, in the service of keeping the ethics ahead of the biomedical science, here are my top 10 picks for exciting, likely, troubling, and attention-grabbing issues for the next 10 years. I look forward to the addendums and emendations that are sure to come!
1. GMOs save crops struggling with climate change and beset by plant pests that find climate change advantageous
Anti-GMO sentiment will flip as the world utterly fails to achieve control over climate change. With temperatures rising, droughts increasing, and the climate becoming more turbulent, genetically engineered plants are increasingly the Band-Aid to maintain food supply, expand growing seasons, and battle pests. The “value” of genetic engineering becomes self-evident as farmers and fishermen struggle to maintain yields and famine threatens many parts of the world.
2. IVF clinics do vast bulk of their business making healthier babies for the fertile
A drop in the number of people seeking infertility treatment pushes clinics to offer more services to fertile persons that could help achieve “healthier” offspring. Investors own and control clinics, and they market “better” babies aggressively around the world. Richer families seeking an edge in a highly competitive world increasingly turn to these services, ignoring the protests of some who see the emphasis on “health” as code for eugenics.
3. Efforts at protecting patient privacy are abandoned as benefits from full big data meta-studies take off
More and more benefits in terms of earlier diagnoses, preventive measures, and lifestyle enhancements flow from the use of big data. Increasingly interlinked, big data takes in healthcare information around the world. Privacy is not a priority for a generation that has grown up expecting none. The older generation of civil libertarians who see privacy as vital begins to die off. Laws protecting privacy have proven utterly ineffective, especially as hacking remains widespread and bribing data managers to provide access becomes more common. Laws and legislation affirming privacy begin to be abandoned.
4. First transgender birth occurs thanks to transplanted reproductive organs
The entire female reproductive system—uterus, ovary, fallopian tubes—is now transplantable. Those involved in transitioning their gender will pay money to undergo what is essentially experimental surgery but is not in clinical trials given the commercialization of IVF working with transplant programs. Donor organs are hard to obtain, but the first baby has been born via reproductive system transplantation.
5. Gene editing begins to replace gene therapy as therapeutic modality of choice in embryos, fetuses, newborns, and young children
The safety of gene editing along with greater precision has fueled interest in eliminating—and not just treating—genetic diseases and risk factors. Embryo editing is becoming routine for many conditions, some of which are oriented toward enhancement and improvement. Gene therapies are still in use, but genetic medicine and counseling are shifting toward prevention. Some governments are taking an interest in encouraging gene editing to control the high cost of healthcare and disability services.
6. Synthetic biology revolutionalizes vaccine development
Needles and jabs are gone. Genetically edited viruses can be inhaled, opening a new route for vaccinations and helping us fend off most viral and bacterial infections. These can also be used in animals to reduce reliance on antibiotics. The same technology is beginning to be used to help clean out blood vessels clogged with fatty deposits.
7. Artificial blood is introduced, prompting blood banks to shut down and encouraging medics to stock up
The dream of artificial blood, permitting universal donation, is achieved using synthetic biology, cloning, and better bioincubation. This means safer but more expensive transfusions as viral and bacterial risks fall to zero. Blood matching is rapidly disappearing, as is the need for blood drives and blood collections. In the field, transfusion is becoming routine for a variety of needs including traumatic accidents, gunshot wounds, and injuries caused by combat and terrorism. Poorer nations are desperate to acquire the technology (as they have never been able to achieve safe, adequate blood supplies), but the price is prohibitive. The Gates, Zuckerberg, and Bezos Foundations are under enormous pressure to subsidize cost.
8. Life forms are created from scratch
The mystery of “life” has yielded to biological reductionism. Synthetic biologists are creating functioning microbes from DNA and artificial cell parts. The line between organic and inorganic is found to reside in particular genetic messages. Our understanding of how life might have evolved on earth or elsewhere is greatly enhanced.
9. Hospitals close some units as home-based care and residential care rapidly grow
Increasingly, elderly persons desire care for terminal and chronic conditions at home. Telemedicine, better implantables, and robot-assisted chronic care make this option more attractive and lower in cost than institutional care. The explosion in Alzheimer’s disease and other neurological impairments overwhelms the capacity of hospitals and nursing homes, leading to some closure of units in hospitals and nursing homes. Tax breaks and other incentives have led to the beginning of a shift to more residential/home care.
10. First artificial womb is used to deliver preemie infant at 18 weeks
Scientists and biomedical researchers, having studied artificial wombs in sheep, pigs, and primates, have begun to deploy them at a few academic medical centers for fetuses born before 23 weeks with underdeveloped lungs. The experiments require a reexamination of the concept of “viability,” stoking the ongoing battles over abortion in the United States and elsewhere. Some nations and states could pass laws mandating the use of this new, experimental technology.
Arthur L. Caplan, PhD ([email protected]), is the Drs. William F. and Virginia Connolly Mitty Professor of Bioethics and founding head of the Division of Medical Ethics at NYU Robert I. Grossman School of Medicine.