Art Caplan – Bioethics Comes of Age

January 28, 2011

Our guest this week is Arthur Caplan, sometimes called the country’s “most quoted bioethicist” and director of the Center for Bioethics at the University of Pennsylvania. In this wide ranging episode, Caplan discusses not only the latest issues and problems in his field, but also how those issues have changed over time.

Fresh from the ideological fights of the Bush administration-over culture war issues like stem cells, cloning, and Terri Schiavo-bioethicists like Caplan are now more focused on practical matters like access to healthcare. And so is the country as a whole.

However, the religious right remains active-encouraging pharmacists to claim a right of “conscience” and refuse to give patients the “morning after pill.” Meanwhile, as an excuse to restrict abortion, some are now also making the dubious assertion that fetuses can feel pain at 20 weeks of gestation.

So in this interview, Caplan surveys the leading problems in bioethics today-and those we’ll be facing in the very near future.

Arthur Caplan is the Emmanuel and Robert Hart Director of the Center for Bioethics, and the Sydney D Caplan Professor of Bioethics at the University of Pennsylvania in Philadelphia. He’s the author or editor of twenty-nine books-most recently Smart Mice Not So Smart People (Rowman Littlefield, 2006) and the Penn Guide to Bioethics (Springer, 2009)—and over 500 papers in refereed journals. He writes a regular column on bioethics for

This is point of inquiry for Friday, January 28, 2011. 

Welcome the point of inquiry. I’m Chris Mooney point of inquiry is the radio show and podcast of the Center for Inquiry, a think tank advancing reason, science and secular values in public affairs. And at the grassroots. My guest this week is Art Caplan, sometimes called our most quoted bioethicist and director of the Center for Bioethics at the University of Pennsylvania. I asked Dr. Caplan on the discuss some of the latest issues in his field. But once we talked, I realized that the way those issues have changed is a story in and of itself. Fresh from the ideological fights of the Bush administration over culture war topics like stem cells cloning, Terri Shavuot, thinkers like Caplan are now more focused on practical matters like access to health care. But the religious right remains active. It’s encouraging pharmacists to claim a right of conscience and refuse to give patients the morning after pill. Meanwhile, as another excuse to restrict abortion, some are now making the dubious assertion that fetuses can feel pain at 20 weeks of gestation. So in this interview, Kaplan surveys some of the top problems in bioethics today and those will be facing in the near future. Art Caplan is the Emmanual and Robert Hart, director of the Center for Bioethics and the Sydney D. Caplan professor of bioethics at the University of Pennsylvania. He’s the author or editor of 29 books in over 500 papers in refereed journals. He also writes a regular column on bioethics for MSNBC dot com. Art Caplan, welcome to Point of Inquiry. 

Thank you for having me. 

I wanted to have you on because our listeners are very interested in bioethics and you’re officially, I think, known as the most quoted bioethicist. 

And then it occurred to me, you know, we haven’t even had professional bioethicists around for all that long for someone like me to interview or to be quoted. What’s the history of this field? How did it evolve up to the present? 

Well, there certainly has been medical ethics in the field of medicine forever, going back to a poverties but bioethics as we know it, in sort of modern form, thinking about the ethical issues raised by technology or access to health care issues, or looking at some of the challenges that come up in research ethics and so on, really dates from the late 60s. And it was a private of a couple of things. I think the civil rights movement gave some emphasis to what was going on with patient rights and trying to do something about too much paternalism in the doctor patient relationship. There were certainly a bunch of technologies that appeared in the late 60s, early 70s, dialysis transplants, intensive care units, ventilators that raised all kinds of questions, including how could you say someone was dead if their heart and lungs were still functioning, that their brain had stopped. And then there were certainly issues coming up at that time, like abortion and health reform that were part of the social policy debate. So in response to that, you saw the rise of both philosophers, theologians interested in practical or applied ethics issues. And I think you can take bioethics from the appearance of the Hastings Center north of New York City and the Kennedy Institute of Ethics in Washington, D.C., affiliated with Georgetown. Those are probably the two institutions only and marks that started the field. 

It seems that in the last government administration, the Bush administration, we had some really, really sharp bioethics conflicts, most centrally around stem cells. But those have more since subsided. And we’re often dealing with things like access to flu vaccines or something. They don’t have the same partizan edge. 

Well, I think the partizanship got very strong during the Bush administration, partly because Bush made some of those issues central to his administration, what they were trying to push through. So a ban on stem cell research really was the first thing that Bush enacted the push to really do something about limiting abortion, giving doctors and nurses the right of conscience when they didn’t want to get involved with day after pills. These were big issues to his base and his constituency. The Obama administration came in and pretty much liberalized stem cell research. It’s not quite as liberal as I might like, but it’s easier to do. Many states decided to permit stem cell research, so that issue kind of quieted down. And some of the social questions regarding abortion up until now have faded into the background. They may come back with a House in Republican hands. But the politicization, I think, was unfortunate. But it was something that, you know, when when the stakes are high and you’re really trying to push political agendas as part of the battle about bioethics, you’re going to just get a lot of heated partizanship. 

Well, the same thing is as gone with the bioethics councils across the administration. You know, I remember Bush’s bioethics council, headed by Leon Kass, at least for the first part of the Bush administration, was this huge lightning rod. And we’re all watching their every move move. We journalists this Obama’s bioethics council, which just, I guess, got started pretty recently. Ivan? Ah, I’m sure they’re doing things, but it’s not like they’ve been drawing huge amount of attention. 

Well, the Bush council was pretty conservative. 

They claim to have a sort of mixed representation. But I would have to say the chairmanship, the staffing and the key voices, very, very conservative. And so they were a lightning rod because I think they were not espousing positions that were in the mainstream of what America wanted, particularly around this stem cell issue. The Bush council has been asked to look at things like synthetic biology and research in developing nations. Those are certainly thorny and tough issues. They’re a little less polemic sized. And I think the current council, the one under Amy Gutmann, as the attitude that it’s there to facilitate and move policy forward, not get into deep philosophical debates like the Bush council did about what’s an embryo? When is it? Right or wrong to say you’re going to enhance somebody. If anything, the Bush council could be charged with being way too philosophical that current counsel under Obama and Amy Gutmann has almost pivoted 180 and decided to be more policy oriented, not getting hung up at all a philosophical battles. 

Yeah, interesting. Part of it was that Leon Kass said this way of layering on top of some of the religious right objections, a certain kind of research, a secular. But don’t do this because it goes against what’s natural kind of argument, which I’m not hearing that much of at the moment. 

Yeah. I think that’s fair and correct. And I think Cass was more of a sort of a naturalist combined with a sort of intuitionist. And if you didn’t have the intuitions that he did, there was a little bit of name calling that move forward, sort of like you must be kind of morally blind or impaired if you don’t see that something is right or wrong intuitively. And his notion of what flourishing or what was natural, I think, you know, you can’t really guide ethics by what’s natural. I mean, it’s natural that our appendix ruptures. It’s natural that mosquitoes bite us and give us some tips. I don’t think it’s bad to interfere with these things. 

The Guttmann council now is probably fairly described as more consequentialist, more pro the science, more trying to see what benefits you can get while managing risk. That’s a very different philosophical stance than the previous administration council. 

And one really pragmatic issue with many, many biomedical aspects to it, and that is front center is, of course, healthcare. 

I know you pay a lot of attention to this. What’s the thing that’s really surprised you most about the giant battle we’ve had over the last two years? 

Well, I’ve been surprised the most that we have had this long argument about health care reform. It’s really been about health insurance reform. Remember, if you live in parts of the country where there are few doctors or no clinics and no hospitals, even if you have health insurance reform, it doesn’t get your health care. Just get you a card that says you could kill health care if there was some around. But the biggest omission in this fight has been, I think, over prices. We’ve been reforming health care and talking about mandating health care for everybody. And that’s controversial. But I’m not surprised that that’s controversial. I’ve been trying to use evidence to rein in costs. That’s proving controversial, but not particularly surprising that people would get their backs up. Some calling it death panels and so forth. But we never took on the question of why things cost what they do in health care, why drugs in the U.S. are double or triple the price of what they are in Canada or Europe. Why is it that hospital bills are enormously high? 

So if you’re going to do health reform, which is something I favor in trying to bring everybody into the system, you do want to take on the issue of wire prices so high, have hearings, try and figure out why we’re getting gouged all the time and spending too much on our health care bill, far more than any other country. We basically got health insurance reform by the administration. Congress agreed not to get into the price issue. That’s why we didn’t get protests from pharma, from biotech, from hospitals. Their prices were threatened. 

Was it also that if you were to get in that issue, people would start saying, well, I guess they said as anyway that you you’re going to ration health care, you’re going to cut what some people will be able to get because it’s too expensive. 

Well, that’s part of it. And as you know, Christly did say that anyway. So it didn’t sort of stave off the criticism. But I think that’s because the interest groups are so powerful. You got health care as a multitrillion dollar industry. Nobody wants to give up their money. They’re happy if you bring people into the system and they can make more money. They’re certainly happy at notions that might force people to get health insurance because in a way, they get to buy more product. But the core of the issue is why is this product so expensive? And I have to say, I think on that one, we have yet to take on the powerful interests. 

And there’s also this matter of death panels. And you’ve written about this your in your MSNBC column, I like this, you called the charge about death panels utter malarkey, put forward with a straight face in Twitter finger last year by Sarah Palin. 

Pure malarkey. The idea, first of all, that the government is going to make up a panel to decide who lives and who dies is ludicrous politically. It’s the end of your career. If you were sitting on such a panel, we’re never going to do that. We have death panels now. They’re called insurance company benefit panels. They function all the time. They say yes and no to all sorts of programs. And weirdly, the only death panel that has appeared since Sarah Palin wrote that ridiculous Twitter has been in Arizona where the Republican legislature and governor decided to withdraw retrospectively coverage for transplant candidates, thereby sentencing them to death. At least one person has died since then. And that was an administrative decision that I think was exactly what Sarah Palin was worrying about but had nothing to say about. No Republican has condemned it. 

The debate is also ironic because in reality, while we’re saying that, you know, just talking to terminally ill patients, you know, would be a bad thing was what I guess the death panel thing was actually targeting. In fact, physician assisted suicide is getting a foothold at the state level and it’s not turning out to be a disaster. 

Right. Well, first of all, the whole notion that if you had a conversation about end of life care planning and incentivize doctors to do it, that that was somehow a scheme to ration care. I also think it’s not the conversation you had with a doctor about end of life care planning, which you should be having anyway, can say, I want everything. I don’t want anything. There was never any restriction on what you could do. The truth is, most people don’t want to wind up in pain living on machines with no possibility of any recovery of health or cognitive function. Now, that’s true that most people don’t want to wind up that way, but that’s their choice. It’s not some kind of government imposed standard in the conversations about end of life care. And so if you take that a bit further and then say if we’re not going to talk about end of life care, we’re going to leave people fearful that we’re going to wind up suffering and miserable, supported by machines and a lot of pain. You might as well send a contribution to efforts to legalize physician assisted suicide, because that’s what you’re going to see is the response people going to say, if I can’t get out of this health care system with dignity and palliative care in the way I want, then I don’t want to be in this health care system and I want the right in my life. 

And so I guess what happened in war in both Washington and Oregon is that this is happening and it isn’t turning out to be that many people flocking to do it. But just occasionally, it doesn’t seem to be causing too much of a giant controversy now. 

Well, you know, I was a little wary when Oregon first moved toward legalization of physician assisted suicide. 

I worry that people might, who are poor, feel like they were getting coerced or pressured to pick that option when in fact, you know, they might be able to use hospice or something else. 

None of that. None of it has happened. The only critics of Oregon and Washington’s physician assisted programs, which have all kinds of safeguards and checks and balances, are people outside the state who keep saying that there’s something wrong. But the reports and studies within those states, the doctors and hospitals. No one is complaining. Most people don’t use physician assisted suicide. They ask that the pills be there. They like the opportunity to use them. But most people don’t take it. It just gives them a feeling of control. They could end their lives. And there has been no abuse of the poor or the disabled. I think the programs are working effectively. Montana’s Supreme Court recently said that assisted suicide ought to be permitted there. And I know other bills are going to come forward. I think the assisted suicide debate will be one of the big issues over the next decade or two. But I think the Oregon and Washington programs, as they are set up with their protections, are pretty good examples of how to make it work without abuse. 

Another topic that seems to be bubbling up, and you mentioned it briefly before, and I got to say I find this really disturbing, is this idea that, you know, if you’re a pharmacist and you’re a Christian and you oppose the morning after pill, it’s OK for you to somehow not sell it to someone who comes wanting to get it. And this kind of turns my stomach. I mean, is this how is this happening and what regulates it and what prevents it? 

Well, it does happen. Most of the professional organizations do recognize the rights of conscience of. Doctors and even institutions not to do things against their moral beliefs. State legislatures, in the effort to restrict abortion, have been carving out all sorts of conscience clauses for health care workers and pharmacists so they don’t prescribe things that are seen as facilitating abortion or ending pregnancies. But to me, patient rights have to come ahead of professional conscience. It’s that simple. So if I legitimately can get a drug that’s legal for sale and no one else is available to give it to me, then I think the health care worker has to give it to me. And if you’re running a pharmacy and you have conscience issues about prescribing certain types of pills, I think you need to get somebody on your staff who can do it or make sure you can make a referral to somebody else who will do it. And if you can’t do either of those things, then you have to do it. Patient, right. Patient interests to me. Trump what health care, worker rights and moral values ultimately are as one of legal and somebody is prescribed it, then I think patients that, again, of these two ever come completely do ahead with something like the morning after pill, because of course, you have to get it immediately or it doesn’t work. 

And so if you go to where there’s only one person on staff and they will give it to you, then your ability to get it might be effectively canceled. Has it ever been that sharp of a conflict? 

Well, we have had situations where people could not get the day after pill, had to travel hundreds of miles to get someplace else that had it, and wound up with a pregnancy that they didn’t want because they couldn’t take it in time. That hasn’t happened a lot, but it’s happened. There are other situations where people never were told about the day after pill. 

We don’t really know whether they had unwanted pregnancies that resulted in abortion or not. But we do know that institutions don’t always say there is, even after rape, a pill that could help you. And you remember Chris Mooney in a situation not so long ago in Arizona where a mom had an abortion and the Catholic Church stepped in and said they were going to basically disaffiliate the Good Samaritan Hospital out in Phenix because of their involvement with this abortion necessary to save the mother’s life. Those kind of policies, both kinds of decisions, I think are just morally reprehensible. You, again, cannot impose your values on somebody else. And as long as what’s being done is legal, I think institutions have to either do it or find alternative means to do it. But I’m going to come back to that core value. Patient’s interests should trump the rest. 

Well, and then there’s stem cell issues, certainly not is heated now, but on the other hand, you know, just when we thought it was actually dealt with, we had a federal judge essentially step in, citing this obscure writer called the Deqi Wicker Amendment. 

I know you know a lot about this because you’d print you’d been predicting that it might be a problem. And so now I guess we’re waiting for a court to figure it all out. 

Yeah. Congress passed a sort of rider on the budget more than 15 years ago now, Ticky. And that amendment said you can’t spend any federal funds on embryo destruction, anything that involves the destruction of embryos. I’ve been watching that thing and knew it was kind of a poison pill buried in there. It was the last resort for critics of stem cell research to go to. They realized that the Obama administration had liberalized stem cell funding and they went there, filed this lawsuit saying, you know, you can’t have federal funds spent on stem cell research because it involves embryo destruction. Now, the fact is, you could certainly manipulate embryos to get stem cells and not use federal funds to do it. The fact is, the 26th Amendment was passed a good eight years before anybody knew what a stem cell was. So the legislators could have intended it to prohibit that kind of research. But I worry that there are enough literalist out there on the courts that that amendment could still wind up being a real pain in the side of stem cell research in this country. I’m not so sure that it’s not going to be upheld and that we’re not headed back to square one unless Congress can get rid of the Dickey amendment and with a new Republican majority in the House. I don’t know. I’m not sure how that will sort out. 

So we could have another stem cell battle or stem cell researchers, you know, do they feel restricted? The moment I don’t actually know what the status is. Are they their funds cut off? 

I’ll tell you what the attitude is. I have contact with a lot of folks around the country working on stem cells in some states like California that don’t worry about it too much because the state is kind of usurped federal policy and said it’s OK to do it here. But as we all know, the state of California is also broke. So getting any money to do it from the state not likely to happen. I think the senior guys feel like it’s just difficult to do this work, but many of them are plotting on. But where the damage is done in the stem cell area with this court entanglement is that young people say, I’m not going to go into that area. It’s up. It’s down. The funding is on. The funding is off. I can’t build a career out of that. And even if there’s some private money to do it, if you don’t have NIH funding on your resumé as a scientist, you don’t get tenured because that’s sort of the gold standard of peer review and quality control. So it’s really the impact is great on young, younger scientists who decide I just can’t get into stem cells no matter how promising, no matter how exciting, I’m going to have to avoid that area. It’s not a place to make a career. 

Can’t really blame him on that. And underlying all this is abortion, and that never goes away. The science often gets twisted to support anti-abortion advocacy. And one thing that I watched last year on Enough You Watched is I think you probably did probably of you is that Nebraska passed something with one of these ridiculous laws with ridiculous names, the pain capable unborn child act. And this restricted the right to abortion after 20 weeks of pregnancy. And the alleged justification was they got a couple experts in there to claim that fetuses can feel pain at this point. 

I’m actually called to testify in Congress on a bill like that that came up at the federal level about two years ago. I’ve watched all these state laws, but fetal pain article after article in the main Stream Medical Journal says, look, we’re not sure when a fetus can feel pain, but in the notion of being self-aware, self-conscious and suffering, 20 weeks isn’t the point. It happens later. They’re not sure when, but there isn’t enough wiring in the brain to have self-awareness. These acts that are there purely aimed at restricting abortion because they know that delivering pain control to a fetus in utero is something that is so hard that almost no hospitals or doctors could do it, much less the average abortion clinic. But it doesn’t rest on any empirical evidence. It’s pure ideology being used to, if you will, make up the facts. The facts are outside of what a few fringe scientists say, that fetuses do not have the right neurological wiring to be self-aware and therefore feeling pain, as opposed to reacting to a noxious stimulus which are bug or even a plant can do is not present. So I think that’s a great example where ideology is completely. 

Driving the fires and they passed a law on that basis, yeah. 

And, you know, the there are other states we’re going to see these bills coming back again because there are many states with more pro life and conservative legislators. And while many are not willing to twist the science, some are to get to the goal of restricting or eliminating elective abortion. 

One thing we are less about and you’ve written about this is sort of disappearance of cloning is a serious issue. I mean, everybody is obsessed with this. In the 2000s, we had the Star Wars movie Attack of the Clones, and we were afraid that was going to influence Congress. Well, you know, you say it’s sort of subsided, although people, I guess, are now cloning their pets. 

You know, it’s funny, even the pet cloning thing hasn’t really taken off because literally it doesn’t work. That is, if I have a dog and I do have one sitting right next to me and I wanted to clone her, I could certainly get one that looks like her. But I can’t get the temperament and behavior because that’s shaped by early development and experience. So cloned, let’s put it this way. The cloned dog doesn’t know the old pet tricks. It has appearance in many biological similarities, but kind of the personality and the behaviors and the bonding that you do with your pet. That has to be required relearned. It’s not in your genes. So people are very disappointed when they find out what cloning makes possible, both about pets and about cloning a child or bringing back someone who died. Some years ago, I got asked by a group about the ethics of trying to clone Jesus. Their idea was they take material from the Shroud of Turin and see if they could arcanum. And I said, well, you know, first of all, you’re talking about bringing back one of the only people is supposed to come back anyway. But presuming you can’t wait, even if you cloned him, there’s no Roman Empire. There’s no Parad. There’s no temple of the money changers. You can’t bring them to Bethlem. They’re shooting at each other. You’re going to get someone who looks like Jesus, but you’re not going to get Jesus because you can’t replicate all the crucial elements that produced who he was. So cloning, I always thought, was overhyped. Hollywood had a lot to do with that. Some early crazy fears expressed by people had a lot to do with that. But at the end of the day, people are going to be interested in cloning. Humans are going to be interested in engineering ourselves, you know, trying to improve our genes, tweak our genes, enhance ourselves through diet or implants. But I think cloning is a bit of a sideshow. 

That story I have not heard. But it also has another flaw, of course, which is it requires that the Shroud of Turin be real. 

Oh, yeah. Well, I left that up to them last year. 

And you know a lot about this, too. Craig, Venter’s team did successfully create a synthetic bacteria life in the laboratory. And I didn’t detect all that much shock, you know, in a year in favor of this going forward with some kind of regulation. 

Do you expect we’re going to have a fight over it or is it just going to slip by? Kind of like nanotech? Seona slipped by. 

Yeah, a little bit like GMO, too, although GMO certainly produced a fight in Europe. The issue of synthetic biology right now is people are making mental creatures that might prove useful. I don’t think people worry about them as much. The science seems harder to understand. It’s not involving any change in people. It’s just at the microbial level. There still are reasons for concern. We don’t really have enough oversight about the release of these things to make sure we don’t get into a situation where we have historically with, you know, Japanese beetles and rabbits running around and kudzu going crazy, things winding up where we don’t want them. And we do need to watch for that with synthetic biology. There’s also a bad guy challenge. Bad guys can make bedbugs and attack us with them and so forth. But on the whole, it’s kind of esoteric. The science is a little harder to follow, so it doesn’t have the same traction, if you will. You’re not eating it. So it’s not the same as GMO. I do believe the benefits are real and I do believe they’re very important. And I think we should push on finding microbes that could eat pollution or secrete fuel or even make food that could be eaten by other animals. 

And then we can eat the animals all to the good, make the world greener. But we don’t have the right environmental protections yet. That’s what concerns me about symbiote. So I think we could get there. It’s not like we have to invent them all. Tomorrow’s in bio is in its infancy, but we’ve got to get there. 

And Obama’s council, I guess this is the first thing that they look that right. 

And they did pretty they came out strong in favor of the technology. They argued for kind of keeping an eye on the technology. I wish they would have pushed a little harder to get a federal task force going on, environmental oversight. And I think internationally we need the same thing. You know, just because in biology may be restricted here, does it mean that it’s restricted elsewhere? So it’s it’s almost an international issue. I give a sort of an A minus on their report. They did a pretty good job, but not quite as tough as they should have been to jog that regulatory framework into existence. Now. 

And today, a lot of people are also hailing the wonders of personal genetics. I was reading your columns and you were denouncing something you called spittle mix and you called it highly advertised genetic scamming. 

Well, you know, if you go up on the Internet, you can find little companies that say things like we’ll tell you who your ancestors or you’ll find out where you originated in Africa or Will, and we’ll design a diet for you that matches your genes. And there even some companies up there that say we’ll pick your mate. 

Based upon your genome, just put your DNA in a cup and send it off to us with all these miracles will happen. There’s some more mainstream companies. The ones we hear about a little more 23A Me Decode Me Nevitt genomics that say if you spit in a cup and send it to us, we’ll tell you about your health risks. We’ll tell you all about your the way in which drugs will affect you or may give you adverse events. Well, the former set of things is all claptrap, some nonsense. Nobody can do anything about your diet relative to your genes. We don’t understand it enough yet. We don’t even understand food allergies and the genetic basis of those like shellfish or peanuts, much less. Which vegetable is your friend personally? Your friend. And if you look out at the even the more mainstream companies, we’re really not there on profiling health risks. Yeah, you can detect a few things, but you really need to understand whether you have a condition like breast cancer running in your family before it’s worthwhile to do genetic testing for you, just mass screening, sending stuff off the spit in a cup and sending it off to a lab and the precision sensitivity of the tests. Isn’t there a little bit of information has emerged about drug management, particularly for warfarin or Coumadin, as it’s known, but for the most part, that’s still pretty primitive. So I think there is a lot of scheming going on. I think the big guys are trying to position themselves to be the market winners when the real tests appear in five or 10 years. The little guys are just ripping you off with their dreams of, you know, who’s a good athlete or what’s the best diet. Or I can tell you who your ancestors are, by the way, Chris. One limit to telling you who your ancestors are is that we don’t have any genes from four generations or eight generations. So it’s a little hard to know who your ancestors are. We don’t have their genes. All we’ve got is contemporary populations that we can kind of guess at that or maybe similar to what might have been in a certain place at a certain time. But but the whole thing, whole thing is pretty sad. And we haven’t really seen any attempts to reign that industry in. I think it’s scamming. 

And nobody protects us from it. There’s not a oh, no FTC here, something like that. 

Right. No one’s jumped in and said these claims are false. How do you match diet to jeans? Really? I’d like to hear about that. It reminds me, when I was in the middle of the Terri Schiavo fight, I used to have doctors come out and say that they had save people like Terri and just wanted a chance to bring her back to health. You know, from her permanent vegetative state. Well, where are they now? There’s still 10000 people in a permanent vegetative state. Don’t they want to cure them? They only wanted to cure Terri Schiavo. They were quacks. 

And similarly, you know, if you can help somebody optimize their diet, there are plenty of sports teams and Olympic coaches who would love to hear from you. Go out and optimize their diet. Show me I’m wrong. But they can’t. And that’s not going to happen. We’re so in love with that free market. Let the consumer beware that we’re letting people take advantage of ignorance and hype right now. 

Yeah, I guess the worst that happens with a sort of personally genetically tailored diet is that it doesn’t work and you spend a little more money on Whole Foods or something like that. 

Well, I can I can give advice about personally tailored diet, eat more vegetables, eat more fruit, saving the money. 

You don’t even have to send me any spit. I’ll tell you that. 

Well, let me ask you one one final question. You are looking out at what we’ve seen in this conversation actually is weirdly, some bioethics issues come, some go. It’s not even clear how you’re going to predicted part of its political part of its will. 

We get really ramped up about culture, more things than we realize? Actually, there’s all these more pragmatic things. I mean, what are what are we. What do we need to be looking out for going forward that we’re not necessarily paying attention to? 

Oh, give me two one. As much as we were putting down and I was dismissing death panels and all that. It is clear that we’re coming up to a crunch on rationing. We’re going to have to have a discussion about rationing or the market’s going to do it for us. If you look at demographics population, the U.S. and other countries is getting older and older. Large numbers of people who are old mean large consumption of health care. That means what we’re spending now can only go up unless we blow up the NIH or other research places. They’re still making new pills and vaccines and devices. So their cost of those things gets added in the demographics. Advances in science just promise a confrontation with costs that is inevitable. And we better grow up and start to realize that either we have a discussion about how to allocate and ration resources or third parties will be doing it. And they’ll just do it with no transparency and no input from the rest of us. So I’m not saying that’s happening next week, but it’s come in within 10 years. We’re going to be in the thick of the reality of cost crunch on health care and so will many other countries. Not. It’s not just us, Japan, Italy, lots of places are facing the exact same demographic crunch that I’m talking about. Other big issue, I think, that will emerge is the neurosciences, the brain sciences. You know, we’re all hyped up about genes, and that’s great. And genes are important, but there’s a long distance between a gene and human behavior. Your brain is more directly associated with your behavior. And as we begin to learn how the brain functions, how to diagnose abnormal brains, maybe even how to see how chemicals affect the brain or implants. I think the neuroscience here is going to be explosive and controversial in the future, whether it’s in the courtroom trying to decide if somebody is really guilty when they plead that they had a abnormal brain or damaged brain or a bad brain or screening people to say, could you be in the priesthood? Are you inclined toward being a child molester? You inclined toward being gay or are you inclined toward being violent? These screens don’t have to be 100 percent accurate before people start to say, yes, like to use that in the military or national security employment office and just plain trying to figure out how to change our brains so that we perform better. We can see early efforts at that with the NBN and I think we’re ought to see other drugs that do that. Mood stabilizers, things that help us remember better. That’s where the big battle, I think is going to come. Genetics. You know, that’s that’s slower, longer, more difficult. But brain body behavior, connections. I think you weren’t there and haven’t gotten all the attention they deserve. So that would be the other area I’d flag. 

Well, maybe we will have to have you back. But for now, I just want to thank you for a really insightful and in Wide-Ranging conversation. 

My pleasure. Thanks for having me. 

I want to thank you for listening to this episode of Point of Inquiry. To get involved in a discussion about Art Kaplan’s bioethical views, please visit our online forums by going to Center for Inquiry, dot net slash forums and then clicking on point of inquiry. The views expressed on point of inquiry aren’t necessarily the views of the Center for Inquiry, nor of its affiliated organizations. Questions and comments on today’s show can be sent to feedback at point of inquiry, dawg. 

One of inquiry is produced by Adam, Isaac and AMRS. New York and our music is composed by Emmy Award winning Michael Whalen. The show also featured contributions from Debbie Goddard. I’m your host, Chris Mooney. 

Chris Mooney