Future life 0026067706

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EIGHTEEN OF THE WORLD'S

FOREMOST SCIENTISTS- INCLUDING SIX NOBEL PRIZE WINNERS-FORECAST MAN'S PHYSIOLOGICAL, PSYCHOLOGICAL, AND PHILOSOPHICAL DEVELOPMENT IN THE DECADES TO COME

Tomorrow. Someday. Words that some degree of response in the human psyche. Contemplation of the future is one of the oldest and most powerful of human common denominators. It is the essential stimulus for our dreams, our intentions, our motives, our cautions, our fears; it activates our curiosity, our determination; it keeps us guessing, interested, perhaps even sane. Visible from the brink of the second millennium are advances in science and technology so significant that they have effectively nar-

The

rarely

future.

fail

to provoke

rowed the

distinction

'present."

There

is

between

and dream— and

"future"

less time to

The tools of the future are at hand, in energy electronics, biology. How will they be used— and by whom? Will the future be Utopia less need.

or apocalypse?

Appropriately, in this collection of "talks," Michel Salomon has made the latter question the centerpiece for the thought-provoking views of some of the world's leading scientists on the subject of life in the 1990s and beyond.

Vaccines

will

conquer

allergies,

gonorrhea,

some cancers. be nuclear-powered hearts, new

tooth decay, and perhaps even

There

will

organs grown internally from genetic material, and drugs to increase memory function .... In Spain, neurologist Jose Delgado is mapping the brain, millimeter by millimeter, working to establish radio contact with every area. Success will mean exclusive treatment of a disease—without inhibiting organs and functions that the disease does not affect. Equally important to the quality of future life is psychogenesis. People can be trained, says Delgado, (Continued on back

flap)

BOSTON PUBLIC LIBRARY

Digitized by the Internet Archive in

2012

http://archive.org/details/futurelifeOOsalo

FUTURE

LIFE

MICHEL SALOMON

MACMILLAN PUBLISHING COMPANY

New

York

FUTURE Translated by

Guy

LIFE Daniels

—

.

English translation copyright ing Company.

No

All rights reserved.

©

1983 by Macmillan Publish-

part of this

book may be reproduced

or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any in-

formation storage and retrieval system, without permission in writing from the Publisher.

Macmillan Publishing Company 866 Third Avenue, New York, N.Y. 10022 Collier Macmillan Canada, Inc. Library of Congress Cataloging in Publication Data

Salomon, Michel. Future

life.

Translation of L'avenir de la vie. 1 Human biology Social aspects

— — 1950-

.

2. Civilization,

Interviews. 5.

4.

Forecasting.

Modern

Medical scientists I.

10

Biologists

Title.

QP34.5.S2513

ISBN

3.

—Interviews.

1983 0-02-606770-6

3034'83

83-11995

987654321

Printed in the United States of America

Originally published in France as L'Avenir de Editions Seghers, Paris, 1981.

la Vie,

copyright

to Alain Boulloche

Contents Acknowledgments

ix

Scientists in Search of the

A

Andre Cournand

Future

xi

Futurologist Considers His Past

1

Robert Good

Crusade Against Cancer

18

Roy Vagelos

Drugs

2000

35

Konrad Lorenz

for the Year

Animals, Man, and the Patriarch of Altenberg

Christian de Duve

Rene Dubos

A

Erwin Chargaff

Andre Lwoff

A

Bet on

52

Great Flemish Gentleman

Man

The Beginnings Passion and Reason

73

89 of a

New

Barbarism

102 120

Contents

vin

Gabriel G. .

N ah as

Floyd Bloom

Pleasure and Dependence

The Brain Connection

A

Henri Laborit Jacques Attali Elie

Shneour

Jonas Salk Jose

Delgado

S Hans Krebs v

Jean Bernard

161

Medicine Under Prosecution

177

Stoic of

Our Time

Colorfulness

Weimar's

Niko Tinbergen

A

150

Futurology of Happiness

The Deeds of Mother Nature

A

134

and Exactitude

Autumn

190 213

235

249

Science in a Wrecked World

262

Distinguished Professor of Medicine

280

Acknowledgments The author thanks the numerous people and institutions that helped him in this task: libraries, hospital services, universities, laboratories, and other institutions. Unable to cite them all, he would particularly like to mention here: the Salk Institute, Scripps and Biosystems in San Diego, California; Stanford Research Institute and its pharmaceutical department, inspired by Mr.

Von

Haunalter; the University of Berke-

Columbia University in New York and the in one Montreal; Universite Catholique de Louvain and U.L.B. in Brussels; Pharma-Information in Basel; Hoechst Pharmaceutical Laboratories in Frankfurt and Paris; Merck Sharp and Dohme in Rahway, New Jersey; and most especially the French laboratories of Roussel-Uclaf. The author also thanks his co-workers and friends at Prospective et Sante Publique who have encouraged him and helped him in his work, and he particularly thanks Odile Robert, who had the patience to reley, also in California; the

read the long French manuscript with the attention she always brings to

her work.

be]

—

Scientists in Search of the Future We

are living

in the expectation of the

second millennium, the com-

ing of the messiah or of the apocalypse, just as our forefathers lived

through fear and hope of the year 1000. Therefore, the present ticularly favorable

is

par-

not only to prophets, diviners, and fortune-tellers

whose predictions, via newspapers, radio, have become a common social phenomenon but also to "scientific" futurologists who try to detect, among today's burgeoning ideas, anticipations and prospects, some

—

facts

pregnant with the future.

—

Between the foreseeable or "futurible" a neologism coined by Bertrand de Jouvenel in a contraction of "future" and "possible" and a Utopian ideal, the margin is often very narrow. Between the borders of the likely possible and the untramelled imaginary, there is a vast noman's-land where few dare expose themselves. It is this field that together with some great minds of our time have chosen to explore. It is the field of health in the broadest sense: man's place in the eco-

—

I

—

system, in Yet, in

privileged

life.

my

opinion, reflecting on the future seems to be

ground

for those

they anthropologists,

whose

physicians,

research areas are traditional

[»]

life

biologists,

a

rather

sciences, be

or

bioengi-

— mi

Scientists in Search of the

neers, the last being simultaneously therapeutists

new

just created a

have

the servant of the

ter or

Ot course, Utopia

machine but

utopia has

is

become routine

and technicians who no longer the mas-

is

married to or integrated into

not the specific field of the

is

urban, or technical Utopias are a

whereby man

discipline

Future

more conducive

many

to fantasy. Yet,

reality in laboratories

it.

sciences. Social,

life

and hospitals

all

Over the world.

The miracle and amazement have already dissipated great conquests of health which,

for

some

of the

however, are recent. There are

anti-

which rendered harmless some of the most virulent infectious which have provided mental patients with

biotics,

diseases; psychotropic drugs,

more akin to and other vaccines; and more. The healing of all diseases, and the Faustian dream of eternal youth, belong to man's most deeply rooted myths, everywhere, throughout gentle and often effective medication, replacing practices

and

jail

torture than to medicine; polio

Can biomedical progress

time.

realize

it?

For the year 2000, scientists have forecast safe organ transplants and sex determination,

memory

and

centa,

—between 2000 and 2500

and

for shortly thereafter

correction, prolongation of virility, creation of life

an

artificial pla-

expectancy prolonged without major failings until the

age of 120 years. Are these

men

idle

dreamers? Are they

chants, or insane scientists like Dr. Frankenstein, Mr.

illusion

mer-

Hyde, and other

characters of horror novels? In order to maintain

men

some homogeneity

of various cultural

ipated,

I

started

from

obviously restricted

From

—

backgrounds

in

all

in these interviews, in

kinds of

life

which

sciences partic-

a set of questions. This 20-point questionnaire is

as follows:

contemporary version of the whole range of medicines and methods outlines tomorrow's medicine. What, in your view, seems to be a reasonable 1.

elixir

a miracle cure for cancer to a

of youth, a

projection? 2.

What

3.

Isn't

is

Utopia?

Utopia particularly dangerous in the realm of health?

Of the medications of the future, which seem to you to be the most likely and the most promising? 5. Do you see man of the twenty-first century as being less aggressive, more convivial? Or will changes in life brought about by demo4.

—

graphic explosion, greater density of urban living, greater scarcity of

6.

—

make him even more aggressive? Does genetic engineering promise a golden age or an apocalypse?

natural resources

Scientists in Search of the

in tine

living 120 years possible?

xiii

desirable?

7.

Is

8.

Could euthanasia tomorrow, under

be part of a 9.

new

Do you

Is

it

social

and

political

restraint;

morality?

think that free will and liberty will be alienated by

new

psychotropic drugs? 10.

Can we

take precautions, within a democratic society, against

excesses of this nature, 11.

Can mental

i.e.,

manipulation of the psyche?

illness benefit seriously

How?

from manipulations of the

psyche through either psychotropic drugs or electronic means? 12. In a world of contraceptive vaccines and test-tube babies, conception and sexuality be 13.

Can you

will

totally dissociated?

see a world where, thanks to prosthesis and grafts,

ing organs will be replaced like parts of an automobile?

What

fail-

ethical

considerations will be associated with the establishment of organ banks,

which 14.

will

be necessary?

Do you

think that, for demographic reasons or because of ex-

haustion of natural resources,

man

will establish habitats in space,

on

the sea, in large communities? 15.

Can you imagine

the day

when immunology

will palliate the fail-

ures of chemotherapy and surgery? 16. Isn't

computer-controlled public health care a prelude to an even

more police-like conception fer no possible escape?

of

tomorrow's society, one that would

of-

17. Will man be able to exercise biological control over his own body by the use of miniaturized devices made possible by microcomputers? Would it be desirable? 18. So many miracles are expected from the new biology that some, already, are speaking of this discipline as being able to respond adequately, not only to therapeutic problems, but also to food, energy, industrial and other needs in tomorrow's world. Do you believe this? 19. How do you see the role of the doctor and of "medical power" in

tomorrow's society? 20.

Can vou conceive

Some

of

my

sponded only its

purpose as

interviewees answered partially. Let

apocalyptic.

some It is

my

all

questions, while others re-

us say that this questionnaire has served

a set of guidelines.

reader will share the future:

of preventive medicine without coercion?

And

I

found

it

exciting

(I

hope

the

excitement) to compare various attitudes toward

are optimistic,

some

also interesting to note slight

two opinions, although they may be

gloomy and even differences between any

deliberately

close to each other.

Scientists in Search of the

xi\

A

Pharmacopoeia

for the

Future

Year 2000

Another document seemingly worth mentioning here

the table

is

I

have drawn up (and which has been abundantly used) of the "miracle drugs" of the year 2000, a list of which was submitted to my interviewees

m

Let

their

me

wisdom.

be

clear: this is definitely

not a work of science

search Into the drugs mentioned here

is

being carried out

fiction.

Re-

in laborato-

now, and some are already being experimented with on animals. Research on new molecules which are efficient and active on diseases vet to be overcome is indeed the focus of discussions in the scientific world in developed countries. A symposium held by the British Royal Society of Medicine estimates that it will take another 20 years or so to complete development and reach application of these new products. So it is today that the pharmacopoeia of the year 2000 is being elaborated. By making a summary of the works of Bender, Blum, Strack, Ebrig, and Von Haunalter of the Stanford Research Institute (S.R.I.), using a forecast on psychotropic drugs made by Evans and Kline, and integrating assumptions made by Gabor and some others, I have arrived ries

at this

list.

—

Underneath its aspect of science fiction, this table both optimistic and frightening, dealing as it does mainly with psychotropic drugs is definitely not a gratuitous amusement at the present time. It has been compared with futuristic studies, mainly carried out by American scientists,

some

of

them

of recurrent polls using the

—

method known

as

the Delphi Method.

Predictions Concerning the Discovery Dates of Medicines or Psychotropic Substances YEAR

SUBJECT

Aggressiveness, control of

most states Analysis, improvement of the capacity

2000 or

Allergies, control of

Antibacterials,

new

generations of

earlier

1990 for

1985 1985

Anxiety and tension, control of

1988

Asthma, control

1985-1990

Autoimmune

of

illnesses

1990

viral illnesses

Beauty, deeper consciousness of

1985-1990 2000 or sooner

Cancer, cure for

1990

Bacterial

and

Scientists in Search

/

the Future

XV

Caries (dental), prevention of

1990

Childhood, retarding adolescence by extending

it

2.000 or

sooner

Contraceptives, female (safe, convenient, and inexpensive); male

1990-2000

Depression, alleviation of

1990

Edemas, control

1990 2000 or sooner

of

Fear, creation of

2000 or sooner

Guilt, relief of feeling of

Hallucinations, creation of "jamais-vu"

and "d£ja-

vu"

2000 or sooner

Hypertension, prevention of

1990

permanent stimulator of Intoxicants, safe and with brief action Learning, medications to improve Maternal behavior, development or suppression of

1990-2000

2000 or sooner

Memory,

2000 or sooner

Intelligence,

Mental

increasing or decreasing of

illness, alleviation of

Mycoses, prevention of

1985-2000

1990 1990

Neurological troubles, control of Nutrition, metabolism,

1990-2000

1990

and physical growth, media2000 or sooner

tors of

1990-2000

Obesity, control of

CCDEMAS Psychobiological states, control of

1990-2000

Radiation, immunization against

1990

Relaxation and sleep, control of

1990-2000

Senescence, control of the process of

1990

Senility, control of

1990-2000

Sexual response, regulation of

2000 or sooner

Sociability, control of

2000 or sooner

Sleep, reduction of the need for

2000 or sooner

Spasm

1990 2000 or sooner

(of striated muscles), control of

Time perception, reduction Thromboses, control of

or extension of

Toxicomania, control of

199°

1990

Three Steps for the Future us leave pharmacology for other areas of prospective therapv. Here again, some of the scientists we have interviewed, such tfl Floyd

But

let

w

Scientists in Search of the

i

Future

Delgado (who have talked about some of their experimental work And very probable assumptions to serious science writers, such as Jerrold \1a\men, Alfred Rosenfeld, Stephen Rose, and Allen Utke) will give us a chance to look quickly at the often too-ambiguous

Bloom

or [os4

promises of tomorrow's medicine. The eighties first: they are today and tomorrow. Before the end of

and without even mentioning data processing and which are already part of our life today, we will be minicomputers, able to find on the "health care market" some astonishing prosthetic and controlling devices to regulate vital organs. There will be a completely implantable nuclear-powered heart that can survive its patient and be re-implanted in another individual (this has already been successfully tested on animals) and an artificial pancreas automatically dispensing insulin to diabetics. There will be an electrocardiogram belt or bracelet providing information as accurate as today's heavy electrocardiogram equipment. The patient with chronic cardiovascular ailments could wear it constantly except in the shower and, in case of emergency, the device would emit an alarm with a range of several miles that would warn the physician or a special-care unit. In the same way, the present decade,

—

—

a small electronic brain stimulator

would ease chronic headaches, enand even, in

able paralyzed persons to regain the use of their limbs

some

cases,

modify the behavior of aggressive mentally

Artificial skin will

decrease the death rate

among

ill

persons.

severely burnt peo-

new skin growth and preventing infection. In the immunology, "smart spheres," covered with antibodies, would

ple by accelerating field of

attack specific cancer-causing or infectious cells in the body, without

harming any others. Safe and

efficient

eliminate the most widespread of

methods

will

all

gonorrhea vaccines

range from the monthly

pill

for

men and women

contraceptive vaccine (successfully being tested

on cows

present), as well as to injections of antibodies that coat the

temporarily prevent fertilization. Surgical abortion ing

—

will

will

soon

venereal diseases. Contraceptive to the

in India at

ovum and

—always traumatiz-

be either reduced or eliminated thanks to abortion-inducing

drugs. Improvements in sperm-freezing techniques as well as in data-

processing methods in sperm banks will permit the increase of

num-

bers of donors and the selecting of sounder babies, perhaps with specific capabilities. It is

estimated that in the United States in 1979, 250,000

children were conceived through

artificial

insemination. Apparently,

sex determination can already be achieved with a 90 percent success rate.

For the nineties, the possibilities are even more surprising. They in-

— Scientists

m

Search of the Future

xvii

wombs

in which a fetus can be kept alive until it is ready blood with the characteristics of natural bkx)d; blood clot detection (blood clots being the cause of heart attacks or strokes);

elude

artificial

for birth; synthetic

vaccines against influenza, hepatitis, and tooth decay; bone transplants; prevention of

(and here

we hope

that

computers implanted

some

no one

in the

marrow

birth defects; plus eugenics techniques will

be misled). They also include tiny

human

brain (prosthesis for brain defi-

ciency or boosting physical or intellectual performance) and cloning of multi-cell

organisms by parthenogenesis.

To Care For Twenty The year 2000 day's minds. eration

will

witness potentialities even more baffling for

now — the span

only twenty years from

It is

—and

Billions

we

remain within the

limits

of

allowed for prospective

speculation and for possible futures. But here, perhaps,

it

wiser to avoid giving more importance to the year 2000 than deserves: tancies

it is

and

a plain

round

figure, a

to-

one gen-

would be it

actually

magic one, pregnant with expec-

anxieties of another millennium.

The year could

also well

by that time, human kind has not sunk into some apocalyptic disaster, be it nuclear or other. Then, if the Family of Man which, according to the demographers, should stabilize at some 15 to

be 2015 or 2030

if,

20 billions of individuals

—

is still

organized into societies, scientists are

forecasting other developments.

Hibernation

— through

body processes same way, cryogenic

intermittent slowing of the

should considerably extend

human

life.

In the

techniques should theoretically lead to some kind of nondeath, by

keeping cells of plants and animals in a state of suspended animation, and this for undetermined periods of time. Scientists in the Soviet Union have apparently succeeded in reviving a bacterium found in a 250-million-year-old potassium sample. In the United States, a monkey brain has reportedly been transplanted to another animal and kept alive for several days. The possibility7

disembodied brain by attaching it circulatory systems does not seem to be science fiction any

of keeping alive

to artificial

and healthy

a

longer.

The synthesis

of plant

and animal

cells,

creating

new

species out of

nothing, generating hybrid monsters called man-plant-animal chimeras

through

a fusion of cells resulting in

tentiality, It

is

even

if

another genesis

—

all

this

is

a

po-

frightening for us today.

not a fantasy any more to think of the possible regeneration

or

win

Scietititts in

parts of the

way

human

body: limb regeneration for instance, in the

lizards, lobsters,

th.it

Search of the Future

salamanders, and

worms

all

same

regenerate parts

of their

bodies. In the laboratory, scientists have regenerated the limbs

ot frogs

and induced partial regeneration in rats. this rapid overview of the future, is it impossible

—

\tter

rilegious

not sac-

if

— to imagine that man might, some day, in a laboratory, create

what is called Life, out of biochemical compounds of most simple to the most complex?

all cells,

from the

Once again, we are not dealing here with some sort of fanciful scisome futuristic witchcraft, created through the imaginative mind of some Isaac Asimov or Van Vogt. Experiments are being carried out in America, in Europe, in Japan, in India, in China, in Israel, and elsewhere, in well-known universities and laboratories. Some twenty or ence,

thirty years ago, the

gorical.

It is

sufficient to read again

when Boyer and technique of

in the

artificial

human

insulin or somato-

through genetic engineering would have appeared phantasma-

statine

time

production of

today the medical literature of the

Cohen were reporting their first results "chromosome cuttings" to understand that scienStanley

tists

themselves have only a limited capacity for forecasting, perceiv-

ing,

and receiving with grace the shocks

of the future,

even

in areas

that they are familiar with.

—

if we do not go into extreme forecasts where man plays the God even if we restrict our reflection to the next ten or twenty even if we limit our thought to the universe whose threshold

Even part of years,

—

we have acquired,

None

we

are,

however, confronted with

of our laws, religions, ethics,

for this

seem to be already huge ethical dilemma. or ideologies have made us ready

practically just crossed, to discoveries that

new

a

world. The challenge set us by these anticipations

is

not a

one (we will find a way out). It is rather something pertaining what is called bioethics: a new morality that we have to invent one whose premises we have not even glimpsed. scientific

—

to

The Unforseeable Let us return to today, future. for

Nothing

is

simple.

and

more sober and peaceful view of the Nothing is decided; no result is ever achieved to a

good; and the most disconcerting changes

may

lead us to drift to-

ward new horizons, promised lands or mirages, unexpected success, or a painful dead end. Not all of our interviewees have equally or even similarly participated in the psychodrama of Utopian anticipation. Some of them have partially rejected or severely condemned any scenario of

Scientists in Search of the Future

on the grounds

the future, tion

is

evinced

and middle-term prospective views,

all

at

of

any

them

cost

haw

great prudence, supported by their doubts, their uncertain-

a

and

their fears. In a recent report, "Sciences of Life

addressed their

and Society,"

to the president of the republic, three of France's

seem

most

influ-

echo the views of these scientists when they eminent interlocutor and "all our governing princes" against

ential scientists

warn

such an excessively long-term projec-

kind of cheap journalism with a bent for sensation

In their short-

tics,

that

xix

to

They write as follows: "... sciences by the end of this century? this question and to outline what seems and its end-uses in areas of social conto be this future in biology cern we would like to emphasize the following. First of all, it is quite a dangerous exercise for scientists to have to extrapolate the future of their science, to forecast its end-uses and possible effects on tomortoo simplistic a view of prospective science.

what can be expected from Before attempting to answer

—

—

row's

life

life:

they

know

only too well that they are certainly going to be

wrong. Indeed, the main feature of research is that it is unforeseeable, particularly in the life sciences, because of their variety and complexity. All fundamental research is two-fold. One element, directly grounded on already acquired knowledge, makes it possible to predict how the latter is likely to develop in the next five to ten years. The other element, resulting from an entirely new manner of envisaging problems or elaborating questions, remains without any prediction. At the end of the forties, no planned or concerted action could suggest to any biochemist that he should join forces with geneticists and physicists in order to constitute a molecular biology. At that time, nobody could anticipate that the chemistry of heredity that of dendrons.

firmed that

it

By

their

enormous

was indeed possible

to

would be understood before

plan for

research; possible to plan for a trip to the oi cancer.

It

is

Americans have condevelopment but not for

efforts, the

moon

reasonable to instigate action

apparently the most promising ones. But

it

is

but not for treatment

in the areas

which are

absolutely necessary to

more on the grounds of present knowledge. At any time, one must be able, and know how to adapt to the unforeseeable." The scientists who have agreed to talk to me have naturally taken this view. The purpose of this book is to provide the reader not with fantasies but with projections if not always reasonable that have been thought

leave an important part for the unforeseeable. Nothing will be sterile to

research

work than

trying to shape the future

—

—

and long-term biomedical prospects, over of the shortmiddlethrough the analyses, deductions, assumptions, ,mo\ creative lma^ina,

,

w

Scientists in Search of the

don (supported by experience)

of

some

Future

most famous names of

of the

science today.

rhese texts are nol interviews in the journalistic and the product of long talks, after

which those men

strict

sense but

who have

already

tried to envisage the future in their particular field continue to think

over topics in which they have a special competence. These are (and I wanted it that way) "profiles" as well as talks, profiles of most remarkable men, often ignored by the public, and who are remarkable in more than one respect. Some of these talks those with Robert Good, Roy Vagelos, Konrad Lorenz, Floyd Bloom, Elie Shneour, Jonas Salk, Jos£ Delgado, Hans Krebs, and Niko Tinbergen were conducted not in French but in English. Rather than translate them from the French of L'Avenir de la Vie back into English, they appear here edited from the original transcripts. All the other talks have been ably translated by

—

—

Guy

Daniels.

The author,

a physician himself,

background, keeping his "subject" Listening to the other

nowadays

detail;

is

He

has chosen to

listen.

not easy, in this world which

is

and overinformed; where the essential disappears where the important is erased by the trivial; the complex

altogether under-

behind

has voluntarily remained in the

in the fore.

by the simplifying slogan. Listen to these

men

with me.

FUTURE

LIFE

—

E

A

Futurologist Considers His Past

The future

.

.

.

is

preparing

Winner of the Nobel

man

for

what he has never been.

Pa u

l

Va

l e r

y

Prize in Medicine in 1956 for his work on carColumbia University, author

diac catheterization, professor emeritus at of

numerous scientific articles and essays on ethics as they concern Andre Cournand discovered futurology with the team oi

sciences,

the the

Centre International de Prospective (International Center for Futurology) in France in the ing in

New

sixties,

and subsequently applied

it

to his teach-

York.

Andre Cournand, quickly climbing the stone stairs that lead to his Parisian apartment on the seventh floor of a building on the rue du Bac, the vestige of some princely townhouse (majestic, but without an elevator); Andre Cournand going about his business in the bustle of Manhattan at noon, or swimming vigorously in the stream that runs through

his farm,

Konkapot,

in

Massachusetts during I

1

1

a

long

summer

— Future Life

2

weekend; Andre Cournand, globetrotter and lecturer at once accessible and pressed tor time, seemingly artless (a form of courtesy?), with a relentless curiosity and indefatigable generosity: this is my impression ot Cournand; based on a few snapshot images, memories of meetings that were all too brief. When this book is published he will be eightynine years old.

May Providence

preserve him for us until he reaches the age of

Methuselah.

An anecdote.

Recently, a congress of gerontologists meeting in

Mo-

main speaker for the opening address when the man who was supposed to speak, a distinguished Swiss writer, withdrew. The organizer of the congress asked for my help. I telephoned Andre Cournand, who, always very lively, took a plane from New York almost immediately. Once the decision had been made, the organizer of the congress began having some doubts as to whether my choice was appropriate. "He's no doubt a great scientist," he said, "but does he know anything was

rocco

left

without

its

about geriatrics?" I

could not avoid retorting that Andre Cournand was a living exam-

hopes of gerontologists; that in order to prove it, all do was appear, even without making a speech. In the end, he did more than that: His speech delighted his learned audience. It is easy to see that I have more than just professional esteem for him. It is also easy to see why I wanted to lead off this collection of interviews with a man who, born at the turn of the century, has always been concerned with the future. ple of the wildest

he had

to

M.S.

You were

the

first

person

—in France,

at

any

rate

—

to

apply

futurology to the field of medicine.

A.C.

That's not entirely accurate, because at

futurology

in

—in

its

methodology

first

—without applying

I

it

was

interested

particularly to

medicine. I

even admit that I was more interested in problems of education developing the futurological attitude as it was applied to other

will

than in

remember that the president of the Rockefeller Foundation had sent him a book that was a veritable compendium of the articles of Gaston Berger and his friends, translated into English under the title, Shaping the Future asked me if I was familiar with articles on the futurology of health and medicine. At the time, I had had only one experience, dating from the sixties, in that field: the organization, at Columbia University's medical school, fields.

after

I

I

—

— .4

Futurohgist Considers His Past

3

—

which students nurses, young biologists, and even a once a week. The experiment lasted six months. All of us were volunteers. We discussed problems having to do with the organization of hospitals and medical practice, and debated ethical questions in particular. Our ideas on the different types of medical practice and the general organization of the health-care system were of a

seminar

journalist

for

— gathered

incorporated into the teaching done at Columbia. M.S. And yet you straddled the Atlantic, shuttling between the United States and France, where vou were a member of Gaston Berger's famous team. And, in that group, you were concerned only with later

general futurology?

No. would even say that worked very hard for several what has been called "the scientist's code," which of course incorporates the scientific part of medicine and the behavior of the doctor engaged in research and experimentation. As a matter of fact, A.C.

I

I

years on

.

.

.

published a revised version of

it in a French journal in 1977. (ProspecNo. 3, Autumn 1977.) That particular form of futurological reflection has always fascinated me. The only futurological aim that I had then (and I still have it) was to show that the principles on which one can found a scientific ethic intellectual integrity and objectivity, tolerance, doubt as to accepted certainties, recognition of errors, etc. could play a role in human interactions. It is this problem that still interests me most at present, along with that of man's relation to his environment. It has its counterpart, of course, in our relation to our intellectual, spiritual, and genetic characteristics. I was trying to show, by elaborating an ethic for our time, that the principles on which scientists founded the practice of their profession and the direction of their research could be applied to human relations. I was trying to make I

tive et Sante',

—

a

kind of reply to the antiscientific

maintaining that science to

itself

and the

become universal could play

derstanding and harmony

spirit that

was manifested then by

principles that have allowed

a favorable role in fostering

among human

it

more un-

beings.

M.S. What, for you, is the dividing line between futurology and utopianism? A.C. My preferred definition of futurology is the one given by

Gaston Berger in his memorable speech to the Societe Mediterraneenne de Philosophie (Mediterranean Philosophical Society) in 19 'The necessity of constructing the present in terms of the future instead of regarding

it

as a secretion of the past."

that anything imaginative it

is

is

Some

people claim

futunstic. That's not necessarily true.

sometimes claimed that anything Utopian

is

And,

futuristic. That's not

Future Life

4

An

urate either.

authentic futuristic study

made

is

very thoroughgoing analysis of the system as

it

in

two

stages: a

given mo-

exists at a

ment, and then, flowing from that, the construction of a future that is desirable and feasible. In the course of studying the present system,

one must

trv

to

discover what Pierre Masse called "facts

full of

the

meant discerning in the future, and

future/' lor example; engaging in futurology in 1900 the importance of radioactivity, anticipating

its

role

then imagining what has been called "futurible" by a bold contraction: future images of what is deemed poss'b/e. Unlike futurology, which tries to find in the

present "facts

full

of the future," utopianism has not the

slightest root in the present. That

the essential difference. Moreover,

is

Utopian projections are not necessarily desirable, not necessarily conceived for the benefit of mankind.

It is

right there,

I

believe, that

we

which envismankind and thus has an ethical

see the thrust of the fundamental notion of futurology,

ages possible futures for the benefit of

dimension that

is

absolutely essential.

fact, followed by on all ensuant possibilities. If one studies, point by point, the development of certain truths in biology, one can then establish a kind

Futurology begins with a very precise, established

reflection

of politics of the probable. Futurology, a kind of long-distance strategy,

supposes feedback about the present, which again modifies the version of the future fact

we

then entertain.

—

dynamic system not a static one, as in Utopian projection. The latter may be something definitively established, a goal pursued, starting from a certain reality or even a "fact" of pure imagination. But is

It

a

not,

it is

M.S.

I

repeat, necessarily to the benefit or advantage of humanity.

The idea

for futurology.

But

it

of constant material progress could

turns out that

it

was

a Utopian

have passed

dream.

agree. And, through that example, the distinction between utopianism and futurology brings us into the field of philosophy rather than of semantics. The problem humankind faced was to know whether growth and development would always follow an ascending

A.C.

I

curve. History .

.

.

seemed

Until very recently,

who believed it, the Utopians. we were living in an open system

to favor those

we

thought

with unlimited possibilities for the future.

made us change

I

believe that

two

factors

the angle of our perceptions: the view of the earth

from the moon, and the energy

crisis.

Our

earth suddenly appeared to

us as generally limited, at least in certain respects. The growth curve,

and in particular that of technology, was logarithmic to the point where it opened up all Utopias to man. To engage in futurology today is to be able to bend and correct that curve, which is now transforming itself.

A

Futurologist Considers His Past

The fundamental thing hard or

soft, in

is

to

5

manage

to control technology,

terms of the advantages that

man

whether

can derive from

it

in

another model of growth and development.

M.S.

way, zero population growth may be

In a

the future.

A.C.

.

.

a "fact big with

."

Yes, certainly. Sooner or later

teaus" in order to establish

achieved up to now, thanks

more to

we may have and

firmly

solidly

to create "pla-

what has been

technology.

M.S. Do you see man of the twenty-first century as less aggresand more congenial? Or will he be made more aggressive by the changes in his life wrought by population explosion, the increased density of the urban fabric, and the scarcity of natural resources? A.C. Fundamentally, I'm not a pessimist. But the answer to your question depends on man's future education. He is more and more aware that he lives in a group and that pressures exerted by the group influence the decisions that he makes, his behavior. ... As Gaston Berger used to say, "Man must get used to living in a world that is in continual transformation, and learn to be happy in such a world. The future will inevitably mean densification, massification. Whether that world will be more or less aggressive, more or less congenial, depends upon us. One must learn very early to live in a group context, because everything in this world comes down to a question of interaction. Education must make this plain early on. Gaston Berger promoted an educational system that would take the child into adulthood by bringsive

him or her through various stages of life within the societal unit of the group what would amount to an apprenticeship for the collective

ing

—

life.

M.S. anarchists

A.C.

And

so the world of

tomorrow

will

have no more room

and deviants? It

will

be "completed."

It

will

be more dense and, for pur-

poses of survival, more structured and organized. space

is

for

more

limited than

On

board ship, where

on shore, passengers must obey

certain rules.

More than fifty years ago Paul Valery, presiding over a graduation ceremony, made the following remark, which quote from memory: "The preparing man to essential component of education is the mind be able to foresee not be what he has never been." Although one may the future, one can prepare to face up to it. M.S. For many people, genetics seems to be one of the keys to I

.

the future.

Many

Second Coming neric

.

.

people see genetic engineering as heralding a kind universal and total well-being. It is claimed that

ol

—

manipulation

will

provide answers to such problems as dwin-

Future Life

6

energy and food supplies, and disease. This cosmic vision of may be a parallel to the cosmic vision of atomic

dlinj;

genetic manipulation

which has been considered by some as a promise of a Golden the best of all possible worlds. Others, on the contrary, proclaim both the atom and genetic engineering will cast us into the abyss. A.C. To begin with, don't believe that tomorrow will bring either

energy thai

I

Golden Age or the apocalypse. They are absolutes

a

And

—Utopias

don't think absolutes are attainable. For that matter,

I

amusing

to realize that the pre-Socratic

think the absolute

it's

really.

rather

philosophers already had that

necessary as a beacon, as a vision of

notion.

I

what

possible, generating hope. Let's take, for example, the notion

is

of absolute equality.

One

is

can wish for

and dream

it

of

it

but not really

absolute equality?

human being is unique, how could there be What we must do is to see how one can take advan-

tage of that quest

...

conceive of

we

Since each

it.

humankind. Unquestionably, is transforming itself, where

for the benefit of

when medicine

are living in an age

immunology and genetics (among other things) are going to play a bigger and bigger role; they are sciences that are developing rapidly, opening up new roads and exciting prospects. Man must learn to live in an unstable, totally dynamic system in which each of the variables influences the others. Genetic engineering will not escape this constant

—inevitable

change

be excessively afraid of

M.S. through that

of nature,

and there

When someone

is

no reason

is

or to expect miracles of

is

on the verge of making

A.C.

try to

I'll

who

doing something crucial

either to

it.

—as you did with cardiac catheterization—

he or she

entists

—

it

is

a scientific break-

that person

aware

for the future?

answer you as honestly as possible. There are

sci-

give the impression, speaking with hindsight, that they

had foreseen all the consequences of their discovery. And sometimes they do this in good faith. It's a phenomenon called cryptomnesia, the so-called secret

memory

of

which no one knows the

origins.

.

.

.

Thirty

years later, one sincerely believes that the entire process leading to the

discovery had been clear from the start and that everything happened in

accordance with some well-defined plan. was not "future-oriented" right away. But

I I

it

happened

that in 1932

decided to remain in the United States to do medical research

time. Actually, after six

with a

man

months

it

was suggested

man whom,

that

I

full

begin working

I had met by The work had to do with respiratory physiopathology. Our aim was to find a means of identifying, before a I

respected

chance) on a totally

new

(a

for that matter,

project.

thoracoplasty, those individuals

who might have

secondary complica-

—

)Y(otW A

Futurologist Considers His Past

Thus,

tions.

we had

to devise

7

methods

for

studying the lungs' various

functions.

Among

those functions,

we

tion of the air

breathe.

we

We

first

became

interested in the distribu-

devised a method that enabled us

to

study the curve of the appearance and disappearance of nitrogen in the air exhaled after the respiration of pure oxygen, and to learn if the pure oxygen inhaled was uniformly distributed to deplace the nitrogen.

Then we studied

the alveolar-capillary function; that

tion

between the

diffused in the alveoli and the blood in the

air

Eventually

capillaries.

we wound up

a study that, subsequently,

But you already

M.S.

studying pulmonary circulation

was very

knew

rich in results.

method

that the application of your

would be extended from pulmonary exploration tionary method of cardiac exploration?

to

Absolutely. At the outset of our work,

A.C.

the rela-

is,

become

my

a revolu-

colleague had

placed a catheter in the auricle in order to measure the heart rate.

M.S.

am

Is

it

possible, or

even desirable,

putting that question to you, a

man

of

to live to the

most sprightly and creative people I know. A.C. It's indeed possible because, as we ready people it's

who

live to

be 120. But

it's

age of 120?

some years and one

hard

all

know, there

to say

I

of the

are al-

whether, today,

With the knowledge desirable? It would be desir-

possible to arrive at an average age of 120.

.

.

.

now, the question is, is it able under only one condition: that increased longevity not pose problems for society that would handicap the younger generations. believe available to us

I

it is

possible to conceive of an increase in the elderly population. But,

again,

to

is it

be desired

longer productive,

way

tions? In a tate to

use

who no

this

it

is

term

if

a

if,

after a certain period, the very old are

they become a burden to the younger genera-

—

problem of the disposal and I very much hesihuman beings of what is called "waste." Those role are waste matter. So is there anything to be

—

for

longer play a

no

gained by increasing their number?

That depends on the model of society we set up and, even The elderly, provided they on our model of the family. retain their physical and mental faculties, would have no trouble finding their place in an extended family and a tolerant society. They could

M.S.

more

e\

so,

.

en exercise a very useful

Can one

A.C.

lem you pose of faith will

if

it

human

is

.

.

social function.

.

.

.

practice a futurology of feelings? Because the prob-

one of

sensitivity. Projecting into the future

involves the realm of emotions, of subjectivity. sensitivity be in fifty years?

If

is

an

act

What

society develops in such a

— Future Life

s

way

human

thai

relations lose in large part their generosity, charity,

mu\ mutual love and respect, the problem of aging will be posed in a totally different tashion. In a way this is my attempt at making a kind the

o\ apologia tor

monogamous

family of the Judeo-Christian tradition,

For the moment,

my

arguments are based on that wager, or hope. am not a practicing believer and I belong to no church. will even say that when I speak of the divine I speak of it as a concept to be surmised, of a life experience to which I don't want to attach any label or any particular credo, except perhaps my faith in which

I

hope

will survive.

all

I

I

creativity.

M.S.

.

.

.

Obviously, you believe in a morality for the future.

Can

Euthanasia, for example. cal constraints

A.C.

In

—

of a

my

new

it

become

part

—under

social

and

.

.

.

politi-

morality?

opinion, euthanasia

is

one of those problems that

it

would be preferable not to discuss publicly. The media take it up and make the most serious and important matters trivial and vulgar. But, in saying that, I don't want to defend the position of the doctor who plays God and imposes his views without an exchange of opinion with the patient, the patient's family, and society in general. Although the majority of doctors have practiced euthanasia at one time or another that is, they have cut off an intravenous drip, and perhaps in certain circumstances have seen to it that an agony was not prolonged, that a patient's death was gentle I wonder whether such a decision, made in all good conscience, can be codified, discussed, or subjected to legislation. We are still under the influence of what happened in Germany, and we still cannot talk about such things rationally. In certain

—

circumstances, abortions can be induced: to it

It is

better that a child

who is me

be born without arms or legs not be "helped" to survive. But for is

inconceivable that a democratic system should spell out the con-

under which killing is permissible. M.S. For many futurologists, the future of medicine, of health care, of man himself is to be found in his normalization and conditioning via an entire panoply of psychotropic drugs. We would thus have ditions

a society that

was smug and very obedient, thanks

to those drugs,

instruments of power and manipulation by comparison with which the

methods

of control

imagined by Huxley, Orwell, or Burgess seem

strictly

elementary.

A.C.

Needless to say,

chotropic drugs, except

I

am

completely opposed to the use of psy-

when used

for purely therapeutic

for a well-established condition or disease. In

made by

qualified people, either as a

purposes

such cases, decisions are

group or individually,

who

treat

A

Futurologist Considers His Past

9

rather than experiment. But to go from that to Imagining thai

man

be enslaved by psychotropic drugs

realm

the imaginary, because of people

any

man

who would have

real influence

M.S.

on

.

.

.

this gets us into the

with a capital

to

can ol

M doesn't exist. The number

be injected before such drugs could have

would be considerable.

society

Isn't this already the case,

without Big Brother?

.

.

.

Psy-

chotropic drugs have been put on unrestricted sale and are advertised

on

massive scale so that they

a

will

be used widely,

resulted in the conditioning of millions

people

they can't

feel

their disposal.

sleeping

pills

A.C.

live

Many

of

and millions

of

all

which has

of people.

Many

without an arsenal of psychotropic drugs

them

live

on

at

tranquilizers, euphoriants, or

sold freely or distributed larga manu.

No

medication having any influence on the psyche should

be distributed without a medical prescription. The doctor must exercise his or her role as a dispenser of prescriptions in a judicious

manner,

with great care. Of course, one can conceive of doctors, as during the time of the Nazis,

who have no

conscience or

who

are terrorized

and

forced into the service of a dictatorship. But in that case the problem

not the doctor or the patient but the nature of the I

would hope

that

is

degraded

as

just

every other

is.

M.S.

So be

is

regime.

people would revolt against such abominable

regimes, under which the doctor citizen

political

That's a very optimistic bet

on democracy and human kind.

But, assuming that

no such disquieting political transformayou think that the mentally ill, in the clinical sense of the term, could benefit from alteration of the states of consciousness, either by psychotropic drugs or electronic means? A.C. The problem of mental illness is primarily a neurochemical it.

tion of society takes place, don't

one.

I

believe that the future of treatment in this area

rophysiological

work

tainly play a role

that

is

the neu-

lies in

being done right now. Electronics

—one that

I

cannot yet discern very clearly

diagnostics and treatment. Unquestionably, "facts

full

will cer-

—both

in

of the future"

neurochemistry and neurosurgery, which are generating procedures and therapeutic approaches that are not yet completely perfected, validated, or understood. Thanks to neurobiology, which is

will

emerge

in its

in

infancy

now, we know

are extraordinarily complex. lies in a better

M.S.

knowledge

What kind

that the brain's structure

The future

of cerebral biochemistry.

of sexuality will

where, from the contraceptive vaccine tion

and sexualitv

will

be

and metabolism

of treatments for mental illness

we have tomorrow, to the test-tube

totally dissociated?

in a

world

baby, con.

Future Life

10

AC.

Will they, really? Eros, the notion of pleasure, will last as

and as long as we do not find chemical methods for eliminating erotic emotion from our brains. The search for and satisfaction of sexual pleasure, regardless of cycles and seasons, are specific to human beings and unique among animal species. Again, the need to reproduce is innate. Reproduction, like survival, stems from an urge one that is inscribed in the genetic code. that cannot be suppressed Reproduction, transference, the passage of life from one to another being are fundamental processes. So the in vitro reproduction of humans, the test-tube baby, and cloning will never become general pracat any rate, not as long as humans remain humans tice, in my opinion and do not abandon the natural employment of their free will. M.S. But isn't it possible that we're witnessing a search for a new sexual morality based on biology rather than on social utility or relilong as

man

lasts

—

—

.

.

.

gious faith? Since the beginning of time, people have been in search of

A.C. a

new

the

sexual morality. But as the saying goes, the

more they remain the same.

.

.

seemed) or more can only go by what seems to have been true).

By turns, people have been either puritanical (again,

we

more things change,

.

freer (or so

it

Fashions have varied; but feelings, frustration, and the search for love

have remained the same. I don't think there has been the slightest change since my adolescence. My youth was marked in part by the search for pleasure;

more

precisely, for shared pleasure.

It's

portant to share one's desire and one's pleasure. I'd say that a

very im-

it's

almost

manifestation of generosity that goes beyond the demonstration of

any

virility

ning

—

is

or femininity.

relatively recent.

The notion It

valuable in a given society

of birth control

—

of family plan-

flows from the idea that procreation if it is

Thus, dissociation of the sexual act and conception already

whether

it

most

exists,

occurs outside of or within the framework that has been

codified, legalized, will

is

not a burden for oneself and others.

encouraged by the churches and

society.

The future

not change that.

M.S. Can you imagine a world where, thanks to prosthetic deand transplants, defective organs will be replaced like the parts of an automobile? How shall we devise an ethic that can govern the vices

management of "organ banks" as they become necessary? A.C. You don't have to imagine such a world. We are right

now,

in a

crude way, within certain

limits.

I

in the

it

don't believe brain

transplants will ever be successful, but as for the rest.

have been perfected

living in

.

.

.

Organ banks

United States, with a system of computers

1

Futurob^ist Considers His Past

y4

that

makes

possible to send organs to the tour corners of the country

it

and even of the world. justifiable to set aside I

1

believe in organ hanks.

I

organs that are

still

don't see any difference between

I

fed

it

is

perfectly

and may serve others and ordinary restorative

viable

that

surgery.

But on that point there

M.S. lic

opinion

—

in France, at

any

rate.

is

considerable resistance from pub-

The

Caillavet

Law

doesn't seem to

have changed people's attitudes. For the adversaries of that law, establishing organ banks is the same thing as condoning generalized autopsy:

provides for the systematic violation of the corporeal integritv

It

of the dead.

A.C.

.

.

.

But one must begin with education and try

to gain public

Germany, autopsies have been compulsory since the Anyone who dies in a hospital will be autopsied, unless family opposes it. Of course that poses problems of public opinthe churches, among other organizations. But it is a policv bear-

acceptance. In last

the

ion

century.

—

stamp of good sense. M.S. Either because of

ing the

of natural resources,

is

it

demographic explosion or the

scarcitv

reasonable to conceive of sizeable

human

a

communities in space or at sea? A.C. Yes, I think so. But I don't believe that the population explosion is fundamental to that idea. I cannot imagine that one day we

would send

entire populations into space so that they could establish

settlements there.

What would be gained by

it? It

would be

better to

destroy superfluous individuals or prevent undesirable births than to

send people off into the galaxy. And then, too, there would be problems of economics and energy that would make such a course unfeasible. It

would perhaps be

easier to harness solar energy

the earth's atmosphere. But

I

from outside

believe that satellite platforms manipu-

from our good old planet earth would do the job just as well. It's possible that one day we will send little groups of men to live on

lated

another planet for a certain length of time in order to do research or

conduct mining explorations. of

new

And

there

may

graphic problems.

M.S. A.C. were lake

And on To

.

.

.

in

a certain extent, yes. After all, the first

villages.

demo-

—or — the seas? human

habitats

The example of Holland proves that one can expand

the stretch of land by conquering the sea.

One

entire section of the

New York has been filled in with waste material coming from London. Buildings twentv storeys high, including Bellevue

East River in in

also be tourists in search

diversions. But those ventures will not serve to solve

Future Life

12

on that landfill. I don't, however, believe we'll hunger and overpopulation by this kind of thing. solve the problems of Those problems will be solved by a set of measures running the gamut \

tospital,

have been

built

from birth control to extending agriculture so that people to conquering deserts and mountains,

it

can feed more

etc.

M.S. Can you imagine that one day immunology will succeed where chemotherapy and surgery have failed and that it will become

—

the major thrust of tomorrow's medicine?

A.C.

What

is

immunology?

element that

tries to

immunology

will

unique "self"

introduce

make

It is

the body's response to a foreign

itself into

the organism.

I

believe that

great strides, favoring the responses of the

to the aggressions of foreign bodies. Will

we

find other

immunology, beyond the vaccine response to bacterial can hope, but our knowledge is still limited. Take cancer. Scientists know very well although most of the public doesn't that we are all, so to speak, healthy "carriers" of abnormal cells, cancerous cells, which are eliminated by our bodies natural defense processes. Can those processes be reinforced and stimulated? That's the big question for immunology today, and, I think, one of the most promising roads before us. But it's not the final answer, because not all illnesses or afflictions of the organism are necessarily associated with incursions by external agents. For example, pulmonary emphysema results in a transformation of the structure of the lung due to chemical assaults that are sometimes aggravated by a genetic factor. I don't believe, however, that there exists a truly preventive immunological procedure apart from suppressing the polluting elements that are the cause of this disease. Great advances have been made in immunology. But to want to apply immunology to all diseases is unrealistic, because it supposes that all pathological processes derive from one simple and universal cause. M.S. One idea that is "big with the future" is the management of health care by computer. Doesn't the computer printout represent both a great hope and a great danger? A.C. Very early in my life as a doctor I wondered why each of us did not have a medical file. I was frightened by the fact that in a great many cases it was necessary to repeat again and again the job of taking a case history something that could have been very much simapplications for

aggression?

We

.

.

.

—

—

—

—

plified.

I

believe in the value of identification, of the medical

part at least, the

life

file.

I

computer to organize, in of each individual, and to supplement his or her

believe in the importance of recourse to the

A

Futurologist Considers His Past

i

j

memory. But

this notion

can only really be applied,

for the

moment,

in highly industrialized countries.

one may harbor about the abuse of a technology that many advantages are political in nature. You won't have

All the fears

otherwise has

aided in the creation of a police state just because you have chosen to

computer all existing information on the health of all the The problem is one of maintaining our democratic valthe face of whatever progress is made in technology and

store in a

state's citizens.

ues in science.

.

.

.

M.S. Will man be able to exercise biological control over his own body by means of miniaturized appliances using microprocessors?

Would

this

be desirable?

problem associated with the more general one of Can one condone, from the moral and ethical points of view, the use of absolutely any technique that permits a person to influence his biological responses? This becomes strictly a problem of education. If you could train everyone to control his physical responses, that would be perfect. But I don't think it's possible. I'll give you a very simple example. You could go to any "service station" to have your blood pressure taken. It seems simple. But is it really? Depending on whether you take your pressure standing, sitting, lying down, in a state of fatigue, or in a rested state, you will get considerably different readings. So taking one's blood pressure is not as simple as it seems. If, with adequate education, the man in the street learns A.C.

That

a

is

the role of medicine in society.

to evaluate certain

problems, as the diabetic learns to control the amount

of sugar in his urine, I'm that

all

these devices

all

for

But

it.

we

can't rule out the possibility

might serve no purpose and remain mere

gadgets.

M.S.

People hope for so

many

miracles from the

"new

biology"

that some see it as capable of providing answers not only to therapeutic problems but to nutritional, energy, industrial, and other future

needs.

Do you

A.C. a

I

agree?

don't believe in a panbiology that will enable us to reach

Golden Age. Biology

is

a flourishing science

and

—

like particle, or

— has been and

still is on the brink of important expand our knowledge of the physical world. Biology is the living world; and think, as a matter of fact, that applying biology to a growing number of areas, is natural and necessar\ But doubt whether it can solve all our problems. Each solution to a problem creates another problem. don't believe, as Hitler believed, in

high-energy, physics

developments that

will

I

.

I

I

Future Life

M "find solutions."

think that biology will enable us to take great steps

I

—

hope such progress will not have perverse effects as was true in physics and the atomk peril it has engendered. There must always, at all times, be a control in place, one similar to the continually observed biological phenomenon of inhibition as a check on stimulaforward.

tion

I

study of the nervous system, in genetics, in

In the

systems

inhibitive

—

(as

many

areas,

Benacerraf has clearly shown) play a consider-

where, without them, stimuli would have no development of life as characterized by their interaction. M.S. Fortune magazine published an article in which biology was virtually made out to be the heavy industry of tomorrow. And today it is in the Wall Street Journal that we find the most details available on the practical applications of genetic engineering. But, on the other hand, while we are witnessing the enthusiasm of these businessmen for the "new frontier" of genetics, we confront considerable uneasiness on the part of the general public and even of numerous scientists. What do you think of this situation? A.C. Both the enthusiasm and the uneasiness are legitimate. The businessmen are perhaps operating under certain delusions, because what they are calling for will not be easy. Moreover, a number of scientists interested in the problem of introducing DNA elements into microbial cells have asked themselves if what they're doing doesn't involve certain dangers. This is a result of what one might call the notion of scientific responsibility; but some of the doubts have grown out of exaggerated statements made by enemies of science. Scientists, frightened by what the communications media let loose, asked themselves: "Shouldn't we perhaps reconsider the problem before going any further?" Then there was Asilomar, and people tried to define the conditions under which research in genetic engineering could be carried out. Guidelines were imposed. But, as time has passed, they have been able role

to the point

effect on the

relaxed because the scientific

community

realizes that,

if

precautions are taken, the danger involved in this research

certain basic is

no greater

than that associated with work on the plague or yellow fever.

But is

let's

get back to biology as "the heavy industry of tomorrow."

much more than

scientific

It

can be applied to a number of areas

embodies the natural forward movement of recent developments. Biology is the science that will make it possi-

that involve

ble,

that. Biology

life;

it

during the next

progress in respect for

fifty

many broad life, we have

or

one hundred years,

endeavors.

If

to

make

that progress

reason for great hope.

people's health but of the quality of their lives.

I

Man

is

considerable controlled in

speak not only of does not

live solely

— A

Futurologist Considers His Past

with his environment: within himself he has a destiny

in interaction

imponderable something

that

15

we

are

search

all in

An affirmative answer to your question. Yes,

many

in a great

answers

areas, provide

of.

So

I

would give

believe that biology will,

I

to the

needs of humanity.

M.S.

How

Some

people have already consigned him to the footnotes of his-

ety?

do you see the

role of the doctor in

tomorrow's

Others denounce the abuses of "medical power." A.C. There is a lot of demagoguery and confusion on

soci-

tory.

ject.

am

I

completely in favor of what

rather developing countries

officiers

is

called in

de sante*

this sub-

underdeveloped, or

and very good nurses who

can recognize symptoms as a result of their long medical experience.

We

have

wounded people and know when to call or

ill

I

emergency rooms. They do the screening

in the

the doctor.

believe in the efficacy of these auxiliary people, but

their

work

is

sufficient to

officiers

M.S.

don't think

would

like to

I

be treated only by nurses

de sante.

Do you remember

Medical Nemesis]

and

others,

the polemic involving Ivan

which

opinion? That dispute, originating cal

I

be considered complete medical practice.

don't think French or Americans or

example, nurses examine

their equivalents at the hospital; for

Illich

[see

some extent was echoed in public in what has been called the "medi-

to

population explosion," was at times instigated by doctors them-

A

number of young doctors were showing up on the labor market. Many of them had trouble finding jobs, and some were politically radicalized. It was in that context that they echoed Illich's chalselves.

large

lenging theses. Either through idealism or through idealism mixed with

egoism, those doctors developed a kind of masochistic devaluation of their

own

role. In trying to protest against

"medical power" conceived

as a by-product of the "capitalist society," against the "haughtiness" of the

name

professors, etc.

.

.

.

they more or less threw the baby out

with the bath water. largely coming out of the United States, gained most part, from the rather ambivalent feelings that people have toward doctors and medicine. Illich and his followers have dealt their blows successively against the church, medicine, and education. They are revolutionaries. They think they are, at any rate. Unquestionably, some of the judgments made bv Illich are correct so far as doctors are concerned. But on the whole think his ideas are misconceptions. It is verv dangerous to destrov the confidence one has in

A.C.

Those ideas,

influence, for the

I

*

A person who, although not possessing

certain types of medicine. (Tr.)

a

medical degree,

i^

authorized to practice

Future Life

if,

I

not BO OlUCh for the doctor's sake as for the patients

doctaf

Because

his of her help.

tor

comment.

first

I

he second

who

is

who

ask

could replace the doctor? That's

my

not

was

that the situation

is

all

simple, as

demonstrated by the seminar in which we studied the problem of the relations between the doctor and society and that was in 1965; that is, Long before that issue became fashionable. We have not yet fully

—

among young medical students, the future Dr. Schweitzer. We do not yet know how to determine to what degree students choose medicine to make money or to found an

infallible

serve humanity. oi

method

It's

for discovering,

as simple

and as complex as

that.

So

it's

a

problem

education and a problem of choice. In France, in order to maintain

high standards of instruction, 80 percent of the tremendous influx of

medical students

is

with

have nothing

criteria that

Thus the

eliminated after the

method

traditional

year and in accordance

first

do with the

to

of selection, as

practice of medicine.

it

is

practiced

now,

is

absurd.

What can be done on

M.S.

the problem

lies.

ideally, the desire to

are material

What kind

the institutional level? That's

devote oneself to others. The

and very strong. As

for the third,

of examination or questioning

the latent idealism of an individual?

order to bring

would

laborer,

A.C. social

it

where

Motivations can be varied: money, social status, and,

out?

If

we

first

how

makes

it

two motivations

can

it

Must we pauperize

decided to pay a doctor

be isolated?

possible to discern

less

all

doctors in

than a manual

that facilitate solving the matter? critical

from the

standpoint and one in which certain moral and ethical

criteria of

I

think that in a profession like ours, so

behavior should play an essential role, the selection of our future doc-

should be entrusted to people of experience who have proven their competence and their devotion to medicine. M.S. You are an illustrious doctor. You have been a teacher and a recognized authority. Is it your experience of the past that prompts you to imagine new methods of screening? A.C. But I was also a nurse. And when I was a student taking tors

the

I was already what medicine was to see if I

preparatory courses in physics and chemistry,

spending time

at the hospital to see

—

really liked the profession.

Then

joined the army,

where

was

combat soldier and again a nurse. realized that anything I could do, even emptying bedpans, would help me be able to care for people. I accepted it. So the solution and believe that to a certain extent the Russians have found it, as proved by Solzhenitsyn's book Cancer Ward is in nurses' taking the I

I

a

I

—

I

—

A

Futurologist Considers His Past

steps necessary to

become

doctors.

I

17

believe that, before beginning

full

medical practice, a person should spend a year in a hospital as a nurse.

one of the solutions, in my opinion. It takes ten years and good hands to make a good surgeon. We could begin rather early, even be-

That

is

fore the students enter medical school, to train

movements

students by their expressions and responses

rounds, should see

how

essential thing. For those

lem

is

them

to control their

better. In hospitals, the chief of service, instead of

when he

is

judging

making

his

they behave with patients, because that's the

who want

to

do research, however, the prob-

totally different.

M.S.

And how

A.C.

In the United States, medical students are greatly helped in

are the students going to live in the

meantime?

They can get scholarships, state loans, federal loans, etc. not really an obstacle. To conclude, I believe that the pa-

their studies.

Money

is

tient/doctor relationship specialty,

and

I

hope

it

is

will

of essential importance regardless of the

remain so

in the year 2000

and beyond.

ROBERT

GOOD

Crusade Against Cancer An

optimistic immunologist, "Bob" Good, with the incisive writer

and

Lewis Thomas, directs the most prestigious cancer

biologist

search center in the United States, the Sloan-Kettering Center in

York

re-

New

which is simultaneously a research center and a hospital. and an impassioned one these two very American traits go together. For Robert Good, biology, like space or energy, is the new City,

An

—

optimist,

frontier to conquer, a frontier

M.S.

Among

with limitless promise.

the wildest Utopias

After false expectations, people are again.

The question

is,

is

a cure for cancer or cancers.

coming

to despair,

and

to

hope

where are we with cancer?

made immense strides. Certainly in my sciwe have made real strides in developing our capacity to diagnose, to understand cancer, and there are now about fourteen different cancers that were otherwise fatal diseases when was a young pediatrician that are now curable diseases. But look on this as just a R.G.

I

think we've

entific lifetime

I

I

[18]

Crusade Against Cancer

19

because we are seeing — progressively, with — seeing important new discoveries about we're tempo beginning!

increasing

and about most cancers

cells

We

cancer.

and

are going to develop the ability to prevent

those cancers that do occur.

to treat effectively

Now, you

say there

we have had and then we get depressed and we go on

reason to be concerned because

is

our hopes raised too high

when we cannot realize this expectation. that we are taught to really appreciate the Steady progress that is being made and that there is an increasing tempo call "the scientific revolution in of discovery, because we are in what with this cyclic behavior

I

think the important thing

is

I

medicine." This revolution has only been going on about one hundred years,

So

has only been in

it

have as

will

it

is

its

not a

within any particular time.

we had

that

thinking of

ascendancy

for

about forty years, and

it

consequence the capacity to prevent and treat cancer. false hope, it is a real hope, but we musn't expect it

its

for a

it

in

I

think that

what was wrong with the idea

conquest of cancer program was that people were

terms of a certain restricted number of years and that

we would cure and prevent cancer by American Bicentennial was a false hope. was a political gimmick. Put an end to cancer, like con-

raised false hopes; the idea that

the time of the

M.S.

It

quering space. Well, maybe.

R.G.

volved as people think

we

sential that

cancer, it

and

I

don't think that politics were as

I

now

in retrospect.

I

really believed

much

in-

was

es-

it

generate more support for the scientific approach to

think that the

way

it

should have had cautions with

was done was legitimate, but I think it and should not have raised false

an addressable disease. I think every single scientist that I know who is working on an aspect of cancer is convinced that cancer is now a problem that can be addressed scientifically, and that was not true about fifteen years ago. M.S. Francois Jacob says there is no valuable research in the field hopes.

I

think cancer

of cancer, or

R.G. he

is

is

any valuable cure or treatment of cancer.

That's a very snobbish view.

a lovely snob.

There

is

a lot of

He

is

a magnificent

good research

in cancer

man, but and really

valuable research in cancer, and there are valuable treatments for, as

I

forms of cancer. We can cure them. M.S. Fourteen forms out of how manv 9 R.G. would say that if you talked about all the forms of cancer you would have to talk in terms of maybe one hundred fifty in this said, fourteen different

I

kind of generic concept.

You know

that every cancer

is

event. Children used to die regularly of leukemias, but

an individual

now we have

Future Life

20

85 percent o\ the children surviving more than five or six years, thai is a cure. These Leukemiaa used to kill in three to six weeks.

M.S.

Would you

R.G.

Oh,

no.

I

and

say 10 percent of cancers can be cured?

think of the cancers that

come

to us here at

Me-

moria] Hospital of the Sloan-Kettering Center, our cures are between

we can treat first. If we get them first, main means of curing cancer, but we are curing surgery cancers by radiation, some by chemotherapy. I was just talking about the fourteen cancers that can be cured by chemotherapy alone. There is good research in cancer. I just have to say that I think that Jacob would agree to what is being done in this institution by Boyce, which is absolutely brilliant research and by Lloyd Old. And I don't know whether he would consider Dr. Dennitt to be working on cancer, but she does. She is one of his collaborators. So there is a lot of good research going on in cancer. M.S. What do you see in the future for the treatment of cancer? R.G. I think that the most encouraging and the most hopeful approach to cancer is the immunological approach. That is not far enough along to talk about immunotherapeutics or anything of that sort. The immunological approach to cancer has its greatest value in analyzing cancer, in early detection of cancer, and in the ultimate development of the means of prevention of cancer and then finally in immunotherapeutics. I think all of them will be of value, so the immunological approach is the main hope in approaching cancer. But I think there may even be the possibility of immunizing against chemical agents. M.S. Is this a conclusion you've drawn from your antigen exper40 and 50 percent of those that is

still

the

iments with animals?

R.G. I think that we've come a long way not only in rats and mice but in every experimental animal where we have looked for the antigens, defining antigens occurring in cancer, but in isolated five different forms of

we

human

humans. We've me as though

cancer that look to

are seeing evidence of the sufficiently specific antigens that occur

with the cancer so that

we

can use the immunological approach in

So it is in man have antigens on their cancers that are the host. The generation of specific immunological responses

therapeutic terms or in combination with chemotherapy. as well as the animals

foreign to

has been cells

itive

difficult

now

that

with cancer

cells,

probably in part because the cancer

can turn on negative responses of immunity rather than just posresponses. That

M.S.

is

a target for the

immunologist.

Roughly how many Americans are suffering from one form

of cancer or another.

— Crusade Against Cancer

We

R.G.

anticipate this year that there will be perhaps

where near 600,000 cases will

be

21

of cancer in America, of

somewhich perhaps 350,000

fatal.

M.S.

Is

the

R.G.

It

is

number growing

interesting, there

and that tobacco smoke,

or declining?

is

one kind

ing in America,

is

take of

largely in the

of cancer that

form of

declining very dramatically, like stomach cancer.

we have some good

Some

We

in-

All other

cigarettes.

cancers, site cancers, are probably declining slightly.

sure of the reasons, but

increas-

is

cancer of the lung, associated with the

of

them are

are not entirely

ideas about that.

Which are? Stomach cancer began to decline in this country when we got universally good communications, that is railroads and trucking and so on. We also got universal refrigeration, and so it was a change in diet that related to the decline. About that time the use of vitamin C was promulgated for children, and I think it is a very real possibility M.S. R.G.

that just the

change

in the intake of

vitamin

C —because

of fresh fruit

and vegetables that so characterized the American diet, and the intake of vitamin C from artificial sources has really interfered with the development of carcinogenic substances that act on the stomach. M.S. Does this tie in with Linus Pauling's theories? think that anything that has been through Pauling's comR.G. puter is worth controlled study. That has not been done yet. I'm not talking about megavitamin C, even in relatively small amounts. There is an interesting observation by a man by the name of William Robert Bruce up in Toronto. He has found that there are N nitroso compounds probably, actually, mutagens and carcinogens present in the gastrointestinal contents of Americans and Canadians. But if he gives these normal people large amounts of vitamin C, he can prevent the formation of those N nitroso compounds. Will that prevent colon cancer? don't know. But think it is a real possibility, and it is being investigated. It will be inexpensive. One of the things I would like to do in some of the underdeveloped countries, where they have an extraordi-

—

I

—

I

I

narily high frequency of of

stomach cancer,

them have high instances

see

if

we

to just use vitamin C.

Some

Use vitamin C and

it would be cheap. an idea of what the budget

can prevent the cancers there;

M.S. roughly

is

of esophagal cancer.

Could you give

how many

me

people are involved in

this

is and war against cancer in

America.

R.G.

The budget

in

America

now

to fight cancer, that

is

the basic research, clinical investigations, the attempt to applv

with

all

what we

Future Life and the control studios and so on, approaches

know I

w.ii

But

would

I

like to

a billion dollars

put that figure in perspective for you, be-

money

government cancer redon't think by any means that it is an overabundance. search, hut think there is good cancer research that we would like to do that is going unfunded m spite of that very large budget. When asked what they tear the most, 65 percent of Americans given all the choices in the universe say "cancer." Now that is an awful thing, to have that fear. We don't need that, and the only way to get answers that will change thai is through scientific investigation, and I think that we need an army of investigators to approach all the possible directions, good investigations, of course, and the most imaginative investigations we can cause

we have

think

I

got lots of

for

I

I

possibly marshal. But

I

think that support for cancer research

is justi-

Looked at another way, since the very first grant was given to Harvard University in 1922 for the study of cancer, until yesterday, the total amount that has been used by the government to fight cancer through research is about two times what it took to put Sky Lab up in fied.

We can afford more. you see patients dying of cancer, it is a serious problem, and it is a problem that warrants our very best minds. And if bright people are not interested in cancer because very bright people aren't working there, maybe we need a little more money to attract the bright people. A little better focus on the problems would get the answers more quickly, the

air.

If

perhaps.

M.S.

don't think

I

it's

some, but people don't want cancer

is

to

R.G.

work on

a

to

dead end. Some may think

That's right.

at least

be losers, and to work in the

Some may

mental molecular biology. But you

You

money,

just a question of

say

it's

know

with

field of

like that.

better to

that that

is

work on fundaworking on can-

working on cancer if he's working on the basic molecular mechanisms by which the genes operate, because that is the kind of thing that is going to give us the answer to the cancer problem. Here at this institution we are approaching cancer in many ways. The place I'm placing my best bets and my best resources is on fundamental issues that may relate to the cancer problem ulti-

cer.

see,

I

say that Jacob

is

mately but molecular biology, differentiation of cells,

cells,

the biology of

the chemistry of the cells, the nature of the cell's surfaces, these

are the things that

we

are trying to develop here so that

address cancer. Cancer immortal. The cancer

dying out.

is

cells

so close to

life,

life

we

can really

in the sense of

being

have learned to keep replicating without

Crusade Against Carnn

Your

M.S.

institution

23

major element

a

is

many

cer in America, but there are

in the fight against can-

Where would you

others.

say the

Btrenghts were of the major anticancer forces in the United States?

R.G. In three major locations: they are in that whole world of academic biology and modern revolution in biology. That is the major, major strength, wherever you find

wherever. The second strength

it,

in institutes, in universities, or

in facilities for cancer research like

is

one and others that are scattered around the country, where exwork in cancer can go on and can be fostered. There are prob-

this

cellent

And

ably fifteen of those centers.

then

resource in the clinical investigation

from the

all, is

Can we expect something from I'm very positive about that.

among

where the questions

the safest technologies

genetic manipulation?

I

think recombinant

I

have ever seen.

I

DNA, first am not the

worried about making pathogens and manipulating the genes

least bit

of bacteria field is

think that the other major

I

hospitals,

being placed in focus.

clinic are

M.S. R.G. of

is

and the way

we

that

we

so exciting that

are going to utilize them.

from working with recombinant physics.

I

think that

it

is

DNA

that

think this

I

sort of

we have from

rewards

solid state

going to be that kind of a major influence on

industry and on products and

an extraordinary resource. discoveries are

same

are going to see the

Now

And

the rest.

all

I

think that

it

will

be

there are a lot of problems, several

necessary but they will be worked out.

still

We

are

tities,

we

know

the exact structure of interferon, we'll be dissecting the molecule

working with hormones that can be made in very large quanwill be working with recombinant technology as soon as we

with the idea in mind of getting genetic material so that this into bacteria

make cells.

and have

interferon for us instead of having to take I

think

we

are looking to recombinant

DNA

if

well as experimental cancers, I

am

can put

technology as a source

of vaccines for the viruses that are associated with

of a year or two,

we

even human cell from the body's own

that bacteria or yeast or

sure

and

—

if

we'll be

not in

human

cancer as

beginning within a matter

this institution

then in other

institutions.

M.S. R.G.

But you are working on

Oh

it?

— —

what worries me as a scientific administrator I'm three things: I'm a scientist, clinician, and scientific administrator is here at the Sloane-Kettering Institute we may not be doing enough work vet with recombinant DNA technology, that is a potent tool, one oi the most potent tools that has been introduced into the field of cell biology. Part of what call this scientific revolution in medicine is reyes,

I

Future Life

24

COOlbinanl

DNA

technology.

man good. et me tell you about I

you

really like for

going to be a powerful tool for hu-

is

It

way

understand the

to

minute, because

that revolution for a I

feel

about

it.

I

the continuation of the scientific revolution in medicine can

good

influence tor tions,

I

mean

Political

Do

this revolution

KG. real

is

in general

and the

are just starting to see them. feel that

it

is.

It

started back in the mid-30s

where the

chemotherapeutics began, and antibiotics, the im-

mean

all

of the things that

worked on the wards. Don't

we

of the other revolu-

and the doctors themselves

of tuberculosis, the fear of meningitis.

that

think that

under way?

They know I

we

think that

I

people

availability of

munizations,

any

would

have more

the Industrial Revolution, the Sexual Revolution,

Revolution.

M.S.

the lives of people than

in

I

tell

me

have freed us from the

When

I

was

a

wasn't thrilled

I

fear

young man,

I

when we found

could treat meningitis and rheumatic fever and cure them

rather than have

M.S.

the patients die.

all

In France,

we

use the term "biological revolution" because

of the recent progress in cellular biology.

R.G.

No,

that's different.

give us is

what

I

I

am

talking about the scientific revolution in medicine,

Now, call

a part of the scientific revolution in

macromolecular and

marrow

I

— —we can now

introduced in 1968

transplantation

otherwise regularly

fatal diseases.

are going to be able to cure. That

We is

a

will

and this by using a maps of the donors to do bone cure fourteen diseases that were

already in the works. For example, in

technique that

medicine

cellular engineering,

my own

have got

work,

just

lots of others that

beginning,

it is

we

just a beginning.

and with genetic engineering we will be able to prevent many of these diseases. So I really the revolution is here, and I think that when we say that we

But, with macromolecular engineering

ultimately

think that

don't see

it,

we

take too short a time table.

In the mid-40S,

what about

infectious disease, that

is

arithroblastosis fatalis? That

is

an immunological disease. That used

devastating disease producing hydropic babies

who

not an to

be a

died as stillborns

and producing fatal anemia that resulted in heart failure. Then we got exchange transfusion, that was a cumbersome high-technology answer. But we really understood that disease, we could work a little bit with the immunity system, we could prevent it completely. It is almost malpractice not to prevent it now. But there are so many diseases, I could recite almost all the diseases that were problems when I was a young man.

Crusade Against Cancer

25

But these were rare diseases. No, rheumatic fever was not

M.S. R.G.

becoming able

to

a rare disease.

Now we

are

prevent rheumatic fever and to prevent recurrences

was revolutionary because that was a common it was not a rare disease. Leukemia is an uncommon disease, and it so happens that the malignancies in childhood are the most common cause of death from disease in childhood: accidents have replaced them as the most common cause of death. Now in most of the cancers in childhood we can get between 60 and of

rheumatic fever;

disease.

Pneumonia

it

killed children;

And then there are burns, that's not rare. If we had burn in a child, that was a fatal disease; now we rarely child from burns because we know how to manage electrolytes.

80 percent cures. a 25 percent

lose a

Cholera, that fluids,

it

is

not a rare disease. Just knowing

as simple as that,

is

scientific revolution in

how

proper

to give the

by mouth even. But that was part

of the

medicine, to be able to quantify the electrolytes

and know what was screwed up. I remember those diseases that I saw on the pediatric wards. There was nephritis and nephrosis, there were whole wards of children with those diseases in the teaching hospital. We never see those patients in the teaching hospital any more because the doctors can take care of them. These are all the consequences of the scientific revolution in medicine. They're not lution,

some

of

them

are the ionic revolution,

all

some

the cellular revoof

them

are the

We

are just

molecular revolution, some are the microbial revolution.

beginning to get the influence of the cellular revolution, and part of is

to

understand the immunity system well enough so that

child that cells

born without an immunity system and give him

is

from a sibling donor matched

— that

I

it

can take a a

few seed

at the majoristic compatibility sys-

we

didn't even know anything about when I was a young and the patient would be absolutely well. This is happening already; we see it all the time. You can see what we can do with just the crude tool we have now, and compare it to what we will have ten or twenty years from now. M.S. So you feel that we are approaching a breakthrough? R.G. It's coming all the time. It's not a breakthrough, it's just a constant effort. You can't jump to the top of the mountain; you have to climb it one step at a time, but you know you can get there, and the way you get there is by answering the questions that are raised in the clinic with the very best possible analyses and bringing the answers

tem

pediatrician

back

—

to the clinic.

M

5.

R.G.

Were you in China recently? Yes, was there twice. I've made an extensive studv I

of

Future Life medicine now

Asian countries, and

in

about the comparative values.

Chinese have done

me

M.S.

Whal

R.G.

It

afl

far as

s

in

I

am

tools, tor

did they

do

in

o!

I

know something

an admirer of what the

cancer?

really interesting.

what they've done

example!

frequency

really think

really

the People's Republic of China.

A number

in cancer.

the laboratories; they are really just

a

I

liver

of things

have impressed

They've achieved nothing

in

beginning. They took really simple

cancer in the central coastal area of China has

maybe 30 per 100,000 per annum,

that

is

about as

fre-

quent as most of our most frequently occurring cancers in the United States. By the time

and there like

is

really

it is

observed by the physician,

no sense

in trying

it is

a fatal disease,

treatment although they do things

plugging up the blood vessels, so maybe they will

than they

will kill liver; that's pretty

crude. But

kill more cancer what these people did

was to go out and look at their population, screening millions of people and finding that alphafeta protein described by a Russian biologist was being elevated in the blood in the presence of hepatic cancer. They found that the alphafeta protein level was also elevated in the blood of patients who had chronically active hepatitis because of the proliferative diseases associated with hepatitis; alphafeta protein is produced when the primitive cells of the liver undergo division. So when cancer is undergoing division, the protein is produced in the liver, and when in this phase of the hepatitis, the protein is also delivered into the blood. The level of alphafeta protein was sometimes diagnostic; very, very high levels were seen pretty exclusively in liver cancer, but that didn't help because those were already far advanced cancer. Then, when they found slightly elevated levels and then made serial studies of the patients and found an increase of a linear growth of the levels of alphafeta protein, they could say that's cancer. The immunologist could send the surgeon in before the liver scan was even positive, and the surgeon could make a diagnosis by bimanual palpation, find the little tumor and take it out when it was still curable. The cure now with a disease that was otherwise uniformly fatal may be 40 percent of the cases of liver cancer. That is not a great accomplishment, but there is another exciting observation: they seem to have evidence that if you take out that cancer early in the disease, before

it

spreads the under-

lying disease that gives rise to the cancer (the proliferative disease of

the liver,

which

is

associated with exposure to afflatoxins in their

food, gives rise to cancer) the patients don't get

immunity, the

new

cancers.

Now

what we in cancer immunology call concomitant immunity acquired while the cancer is spreading. They

that really rings of

Crusade Against Cancer

27

have raised an interesting question that can now be investigated. But they have done things in other areas, in the south of China they have linked the cancer of the postnasal space inextricably Barr virus.

know whether

don't

I

that virus

is

to Epstein-

the only cause of cancer

a superinfection in more than 95 percent of the and that might portend a vaccine. With a hepatic virus causing it, on one hand, and Epstein-Barr virus on the other, the possibility of immunization has got to be considered. And then in certain areas they found cancer of the esophagus. Just think, 263 cases per 100,000 per annum, that's nearly two times the incidence of all cancer in America. The Chinese, through extensive studies in the field and epidemiological studies, link this cancer to the soil content of molybdenum, to the vitamin A and vitamin C borderline deficiencies in those areas, and to the exposure to the nitrosomines that are generated in their grains and in their gastrointestinal tracts from eating grains high in nitrate and nitrite because of the lack of molybdenum in the soil. Now, I don't know whether they are right, but their investigations are really provocative, and they give us new ways of looking at cancer and cancer causes. They can be addressed on a community basis. M.S. What did you learn in China that could be related to the American situation? Is there a lesson to be learned? R.G. I think there are lots of lessons. You know, we can all learn from each other. I just don't believe that all this learning has got to go to waste. They have a lot to learn from us from the standpoint of laboratory approaches to problems and precise scientific approaches, but think that we have a lot to learn from them in terms of means by which we can help our people by studying relatively simple things. I wish that we had information as good as they have about cancer of the in those areas,

but

it

is

patients with cancer,

I

esophagus, cancer of the

liver, cervical

cancer, to relate to

all

of our

major epidemics of cancer. They're relating in highly practical terms their

epidemics of cancer. They have had

six

to

epidemics of cancer, and

they are really beginning to understand them in terms of what the

people do and what happens to the people.

M.S.

In a

way, preventive medicine and

all

these inquiries are

very easy in a totalitarian society. Are they possible in a free country?

Can

methods be pursued without coercion? wouldn't for one minute advocate a change to a totalitarsociety; the excesses of any kind of authority are too well known. these

R.G.

ian

I

That doesn't prevention

mean we

in

everyone does

approach these problems with the idea of mind. They can order everybody to be immunized, and it.

can't

So they eliminate

all

of the horror diseases associated

Future Life with poliomyelitis, small pox, diphtheria, tetanus, and thai are preventible by

know we can do

hut you

that we can do And motivation,

it

it,

in isolated

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Future Life

230

problem was solved.

as the polio

It

is

based upon an entirely different

set of causal factors.

M.S.

Is

computer-controlled public health care a prelude to an

even more police-like society of tomorrow, one that would not have any possible escape? do not believe that computer-controlled public health care J. 5. is a prelude to an even more police-like society. First of all, what do you mean by the computer-controlled health care? M.S. That everything will be in a computerized file including I

HLA, for instance, or other features of our genetic code. Then it will much more accurate than the usual files. You know, you can't have it both ways. There are advanJ.S.

be

tages that could be turned into disadvantages,

and

what you are a good thing you bring in somethat's

talking about. Computer-controlled public health care for prevention

thing from

and diagnosis or prognosis. Now that has nothing to do with the

we

think that

and way,

And

there

It

because nobody wants be

all

M.S. over his in

will largely

it.

Everyone

is

aware

of society,

of the danger.

kinds of safeguards possible.

man

Will the average

own body by

mind

don't believe Nazi-

I

depend on the type

are going to resist totalitarianism in every possible

type times will recur.

will

price of beans.

left field

This type of fear should be eradicated because

I

is

all

be able to exercise biological control

the use of microprocessors?

Is it

desirable?

I

have

kinds of small gadgets that are (or are on the verge of

being) sold in drugstores, gadgets controlling different functions of the

body. J.S.

M.S.

and the

new

Such as? Such as,

in the case of diabetes, control of the flow of sugar,

possibility of injecting insulin automatically.

There

is

a

whole

field of self- treatment.

J.S.

M.S. J.S.

Marvellous!

You think

that's

marvellous?

Even- kind of help

is

marvellous. Are you assuming, are you

talking about people doing things for

knowledge? M.S. Of course.

It

which they do not have the

self- treatment,

is

just

as

you have

self-

diagnosis. J.S.

M.S.

Well, in principle,

You

I

are going to

am

against that.

have

in

every drugstore, automatic de-

vices to take an electrocardiogram, blood pressure,

and so on.

When

I

A was

Stoic of

Our Time

a practicing doctor,

2^

it

was not an easy

i

thing to take blood pressure

properly.

Well. First of all, you are talking about one particular sit no one particular country. There are four billion people on the face of the earth. Do you imagine that these things you can buy in a drugStore in France are going to be made available to four billion peoplr on J.S.

tion in

Of course not. These questions are, in my view, obviously Western-oriented. ... I just cannot visualize people having ten such gadgets. I do not think there are many people in the Western world who are going to succumb to the fear you are conjuring up here. We must have a more sober approach. I think it's fine that we have, for example, pacemakers. For the same reason, think it's fine that people can take their own blood pressure and monitor that. So they the face of the earth?

I

know

they have hypertension, they can control

if

her urine.

test his or

Now,

I

don't

know anything

diograms that people take themselves. be properly interpreted, and

I

It is

it

about the electrocar-

obvious that they have to

do not know the use

be put. Unless people have arrythmias.

as a diabetic can

And

to

which they

will

they have arrythmias,

if

and the electrocardigram monitors the arrythmias, it may be of some use. These continuous electrocardiograms can conceivably be of some value for the physician in that he can make a diagnosis from reading them.

own bodies is fine, if own minds and exercise

think people exercising control over their

I

own bodies and their and self-restraint. What you are talking about is a form of biofeedback, which I see as extremely desirable because it makes people aware of what they are not doing. Or what they are doing that

they can control their

more

self-discipline

perhaps

is

disadvantageous.

One

M.S.

expects so

many

miracles of the

new

biology that some,

already, are speaking of this discipline as being able to give answers

not only to therapeutic problems but also to food, energy, industrial

and other needs Well,

J.S. it

must be

in I

tomorrow's world.

think that the

realized

it

has limits.

new And

coincide with the needs that exist in

Do you

believe this?

biology has enormous value, but it

is

done

essential that this be

humankind.

Now we

to

have created

by the successes that have already been achieved, in human evolution up to this point in time. There are many more people on the face of the earth. We have developed many more devices with which

the needs

housing, urbanization, transportation. And so can see biology as a means toward a better understanding of our-

to live: there

the

new

selves,

and

is

also for helping us to better cope with

I

life,

now and

in the

Future Life

232

And

future.

that

twenty or lution

will

it

continue to change.

I

do

not, for a

moment,

think

going to be the same a hundred years from now. Or even

life is

fifty

now

years from now.

we

are going through such rapid evo-

are being challenged.

needs and changing needs, that the technical

We

To meet new and growing where biology is useful, not only for things you have mentioned therapeutic, food, energy,

that

is

—

—

and other needs but also to develop a concept of ourselves, and our involvement and participation in the evolutionary process. It is basically a philosophy and also a basis for underindustrial

our

own

nature,

standing the changing morality that

is

changes that are

implicit in the

being brought about.

M.S. Can one really say that we are leaving the era of physics and entering the era of biology? Yes. The biological sciences become more important by virJ.S. tue of the great importance of the physical sciences that preceded them,

and to

I

think

are entering an era

where the human sciences are going

be even more important. The biological sciences contributing to the

human

and the physical sciences contributing

sciences

sciences: I

we

can see that as a natural evolutionary flow.

I

my books. How do you see

to the biological

And

that

is

what

tried to say in

M.S.

power" J.S.

will

the role of the doctor and of "medical

tomorrow's society?

in

It is

going to be different, because the problems and the needs

be different.

It

will

be different in different parts of the world.

We

are already experiencing serious problems because of the costs that are

involved in dealing with disease.

We

will

have

to

reduce them by im-

see the need for physicians to deal with probmain task will be to deal with the problems of health, and I mean the enhancement of health. M.S. Today, public opinion tends to disagree with some aspects of medical power. They want doctors to explain everything. They want to be educated and to discuss everything with the doctor.

proving health. So,

lems of disease,

J.S.

Well,

I

if I

their

believe that

is

a natural evolutionary

development, as

becomes more educated and more informed; more of them go to school, more of them have been exposed to stories in the press, books about the body. They can pick up any encyclopedia, and it tells you much more than it did before. The invention of the printing press. the public

There are more people

who

are literate.

They have

radio, television.

You'd have to satisfy that need. It is for this reason that I believe people will have to be educated and become partners in the process. They want to become collaborators in the process of health improvement.

A

Stoic of

Otherwise,

Our Time

233

we have two

one hand, and

antagonistic groups: patients and public, OH physicians and professionals, on the other. should say I

any human being deserves the right to know and to be informed. Honestly and truly. And it raises the question as to whether people want to be told that they have cancer, th.it they are seriously ill. Some want to and some do not. It is a matter that has to be negotiated. And some people prefer knowledge and others prefer illusion. It is just whether you want to think realistically or that in a democratic society,

ideally

about these matters.

My own

preference

is

standing, consciousness, awareness, so as to have

own

We

to

develop under-

some

influence over

supposed to have choices. Scientific knowledge and medical knowledge have to become common knowledge. And that is going to take a long time. There is a need for bringing the two groups doctors and patients into closer harmony. The consumer and the provider. So that you don't have the consumer lacking in confidence and trust in the provider. The professional should be serving the client, the patient in this case, serving to build and maintain a state of common trust based on explaining things. At least, this is my opinion in the matter, offhand. So the doctor needs to be as human as possible, and as scientific as possible. M.S. You mean he would be less of a priest and more of a our

destiny.

are

—

—

professional.

No, I said human. You used the word priest and used the J.S. word human. He should be human and competent. Previously, the doctor was kind of a magician or priest because that was the only methodology that was available. We have a different methodology now, and just because it involves technology does not make him a techniI

It should not, because the techniques or technology should be used by the physician; the physician should not be used by the machine. So, it is just a matter of balance, of proportion, of judgment, of

cian.

wisdom, and the training of the physician should make him increashuman and competent in the use of the very best methods. The objective is healing, curing, and not doing harm, in the sense ot the Hippocratic Oath, the basis for an ethic and morality that is practiced today. The tendency prevailing at the moment— physicians behaving like technicians has to be countered, to whatever extent possible. One must take into account what the public is going to demand and require. It would be good to be aware of and to anticipate that. M.S. Can vou conceive of a preventive medicine that is not

ingly

—

coercive J.S.

Yes,

I

can.

And

that requires education again.

It

the public

Future Life

234 is

adequately educated and informed, and free of some prejudices (such

as the

ones prevailing

in certain religious

groups,

who

refuse preven-

and immunization), think it is feasible. I do not know would not suggest any in particular. You may have to capture the bishop or high priest of some religious groups and convince them that preventive medicine is God's will if you like, do not care what device is used, but we must get to it. M.S. Moses' method on Mt. Sinai. Ethics and hygiene prescribed by God to the Hebrews. Exactly. But we have other means of persuasion today. You J.S. show them the statistics that can be compared with their own experiences. And that is why poliomyelitis has been eliminated, to a great extent, in those parts of the world where immunization is available. You can see that recent polio outbreaks have occurred within religious groups that have rejected immunization; this happened in the United States, Canada and in some areas of Holland, in some fringes of the protestant Church, some small sects. But that is just an illustration of the ambiguous question of coercion versus noncoercion. Coercion can be gentle and eventually become a new practice. M.S. Aren't vaccinations, mandatory vaccinations, coercion? They may be, but they don't have to be. Vaccination is a J.S. personal duty and a duty toward society. It can be fostered by civil education. If not by education, sometimes you have to use mild coercion in the same way that you tell people to drive on the right side of the street, to stop at traffic lights and not to hit people when they cross the street: it's the same kind of coercion. Indeed, you are not free to do anything you like with your automobile. And you have to take the same attitude about whether you are free to get sick and pass on the illness to other people. So, I do not know why, suddenly, the public feels concerned about it, but they do become aware and concerned. And so you attempt to avoid coercion and if people are victimized because they do not like to be coerced they finally discover, by themselves, that epidemics are a problem. It is just a transient period. So my preference would be to use education whenever possible. And where it fails, then you have to do something. M.S. Persuasion. tive intervention

by what means, and

I

I

I

J.S.

Yes, persuasion:

it

also performs miracles.

1

OSE

DELGADO

Colorf ulness and Exactitude It is

symbolic that one

of the

most impressive neurologists

of our time,

the colorful Jose Delgado, has his laboratories in a hospital complex in the

Madrid suburb named

Spanish physiologist of the turn of the Prize in 1906 for his research Built within the ish public health

plant and, for

on the nervous system.

decade, "Cajal" system.

Delgado and

It

Ramon y Cajal, the noted century who won the Nobel

after Santiago

is

the newest hospital in the Span-

has 1700 beds, an ultramodern physical

his international

team

of researchers, there

are 9,000 square feet of space spread over three floors

and overlooking

the "meseta."

As

huge American university-cum-medical centers, a research facility grafted onto a complex modern hospital is valuable for its research capabilities and useful in the treatment of disease. Delgado administers a large budget and oversees eight units (Histology, Physiology, NIeurochemistry, Bioelectronics, Computers, and Veterinary Medicine) composed of fifty researchers who turn out one hundred publications in the

1

235

— Future Life

236 a year,

some

— such as those on transder— unavailable elsewhere.

of a degree of sophistication

mal brain stimulation

"The proximity and exchanges between scientists are often responsible for

can be applied rapidly to alleviate

clinical

doctors and research

breakthroughs in health care that

human

suffering,"

Delgado empha-

sizes.

"Properly directed, research can be of great importance in patient

We

care.

facilitate projects in

clinicians in research in

the clinical services

many

and

collaborate with

areas: recording activity of single neu-

rons in patients scheduled for brain surgery; monitoring the general mobility of psychiatric patients to assess the effectiveness of their

medication.

"We have many istry,

related

programs

in biochemistry

and neurochem-

and experiments, such as electrical stimulation of the brain and those in primate colonies, that are equally useful

single animals

those in the ical

field.

services.

We

Our

engineers are in contact with the

to

clin-

develop the instrumentation for therapeutic brain

stimulation that can be

and

electrical

of

for telemetered

programmed according

monitoring of

many

to the patient's

needs

physiological activities, vital

and treatment of the sick." one of the most spectacular scientists of our time. Many people remember because they were so striking his experiments on fighting bulls and on monkey colonies in Bermuda. So I asked him where he was in his amazing, continuing investigation of the animal and human brain, and what was its scope in a global for the diagnosis

Delgado

is

—

—

vision of the future.

J.D.

I

think, looking at the future, that there are three

pects to our scientific research.

Our

main

as-

technology; our working hy-

potheses; and their medical and philosophical implications. In order to increase our knowledge of brain functions, we need to improve our technology. Research today is a coordinated effort of many specialists. While naturally we buy much of our research equipment and import it when necessary we depend on our bioelectronic engineers not only for maintenance but for development of instrumentation. In a moment I will describe some of our methodology, but first I should give you some background information about the state of brain

—

research.

M.S. J.D.

the brain,

You mean how

it is

conducted

in

major institutes?

Yes. While X-rays can give us important information about

and the new scanner machine

is

vital in locating cerebral

— Colorfulness

and Exactitude

237

tumors, to be in direct contact with a behaving neuron

wc must

im-

and cannulae. Implantation of these tiny electrodes and chemitrodes for injection of chemical for electrical stimulation substanc givo us access to any chosen cerebral area. We can stimulate the brain electrically and record spontaneous or evoked activity; we can inject micro amounts of drugs to explore local action and beplant fine wires

—

—

havioral reactions. Implantation

is

a

simple procedure performed with

One or two days later brain exand the same animals may be investigated for many years, proving the tolerance of implants and reliability of results. M.S. But do you always know where your targets are in the brain? the animal under general anesthesia.

plorations can begin,

Implantation of multilead electrodes in an area generally

J.D.

known

to

be related to certain brain functions

often successful. In

is

other cases, however, a functional exploration of brain

is

necessary; for example, to

map

many

points of the

the location of inhibitory areas

which are so important for blocking intractable pain or uncontrollable motor movements. Research in lower animals is basic for later application to human patients with these problems. The best method for step-by-step brain exploration ings, like

many

little

chimneys,

is

the implantation of stainless sted tub-

in holes drilled in the skull.

We

hav