Over thirty years ago 20th Century Fox took the moviegoing public (and Raquel Welch) on a "Fantastic Voyage." In this cinematic barn-stormer, a diplomat lay near death from a blood clot, until, through miraculous technologies, scientists shrank a 30-foot-long clot-busting metal ship to the size of a pin's head.
Audiences shuddered and gasped as the miniature ship sailed through the bloodstream, encountering white blood cells that seemed as large as the Brobdingagian giants confronted by Gulliver on his travels. The ship's crew narrowly avoided destruction and its heroes were restored to normal size. It was a fantastic first step toward human dreams of shrinking medicine to microscopic size. Today at the cinema we are entertained by even more dramatic stories of kids shrunk to the size of ants and microscopic machines sent to infect the world. But is it just fiction?
In 2000, the barrier between man and machine is as thin as a strand from the double helix. As computer equipment, surgical tools and communications pipelines shrink ever smaller, the next step in engineering is to merge biological and mechanical molecules and compounds into really, really small machines. This will happen in many different ways, and it raises many new issues.
First, we are beginning to see life forms reduced to molecular codes. This means that in our lifetime, viruses and components of our own DNA are going to become a lot more portable. Today, the last samples of smallpox virus are locked away in a vault in Atlanta at the Centers for Disease Control and Prevention. Tomorrow, getting smallpox may be as simple as forwarding an e-mail attachment with the smallpox DNA code to a $5,000 DNA synthesizer. The portability of DNA also means that where you once thought of your DNA as a part of your body, tomorrow the DNA from any of your cells might be used to make a cloned embryo or to make a big sack of cloned tissue for transplantation.
Is it ethical to move life around this way, playing mix-and-match with bits from different animals and species? Should we create entirely new kinds of life from the molecule up? Would it be wrong to build a bacterial life form that depended on a machine for survival, such as battery-acid-powered carpet-stain-removal bacteria? Or is that no more problematic than executing billions of little yeast molecules to make a barrel of beer or a loaf of bread?
Second, enhanced DNA and computers are more and more becoming parts of our bodies. Millions watch as Captain Picard and the crew of the Starship Enterprise battle a genetically engineered race called The Borg, who are the ugliest possible combination of DNA with computers (with the exception, of course, of new Borg sex symbol, Seven of Nine).
The Borg aren't real, but human-machine integration isn't just fiction anymore. Teams at MIT, Xerox and elsewhere are racing to connect you very closely to your cell phone and television. Within a few years, pacemakers and other medical devices will begin corresponding electronically with hospitals, physicians and even insurance companies about the patients whom they "inhabit." Many aspects of our behavior will be monitored more closely, and we may even get insurance discounts if we agree to "show" what healthy people we are!
Ethical issues in merging with computers go beyond the "weird" factor into a whole new kind of problem: what happens if human beings are made from non-human parts? Is a baby made from cloned DNA, gestated in a bubble and connected to a cellular phone still human? The answer matters because it is no longer obvious what it means to call something or someone "normal" or a "person," even in the world of medicine. That means it is getting harder and harder to figure out which advances in medicine are worth public research money and which ought to be mothballed.
Most interestingly, we are approaching the world of Fantastic Voyage. Experts in this new field of nanotechnology promise a world in which very small machines literally circulate within us, pursuing bad bacteria and viruses and dissolving cholesterol and lipids. It sounds great, if a little bit spooky, but it is still a long way away.
So should we spend taxpayers money on clot-breaking machines to extend the average life span, or work to build other artificial devices much smaller - and more effective - than the artificial heart of the 1970s? It is a difficult decision but one that only our generation can make.
Saving Social Security takes on a whole new meaning in a world that works hard to keep people alive well into their 100s, but connected to dozens of expensive little machines. As we prioritize about hunger, our status as a global power and the future of medicine, many of the most troubling decisions will be very, very small.
