In 1932, during that brief interval between the unimaginable horrors of World War I and the inconceivable atrocities of World War II, the British author Aldous Huxley published the novel Brave New World.  He lifted the title from a line in Shakespeare’s play “The Tempest” and described a future in which people were produced without the burden of parenting or parents.  They were simply cloned or manufactured in facilities that not only allowed their development into full-fledged humans but also dictated what they would be capable of when they became adults.

Human cells were grown in containers that enabled them to develop into what we call embryos, the earliest stage of fetal development. The embryos destined to become society’s elite were provided with the optimal support and nutrition available. They were called the Alphas and were reminiscent of colonial Britain’s aristocracy.  Those destined to become the least capable were systematically poisoned.  They were called Epsilons and were reminiscent of India’s Untouchables, a class ground down by a suffocating caste system that doomed them to perform menial tasks throughout their lives. The Alphas enjoyed luxuries only recently available in the wealthiest of industrial nations. In contemporary terms, they would be the billionaires who can afford to take rocket rides into space or dive to explore the wreck of the Titanic in submersible coffins. The Epsilons were tasked with cleaning up after the Alphas. Their social standing was predetermined and inescapable.

Of course, in this hypothetical future, there was a drug to manage emotions that might intrude on those feeling any dissatisfaction with the status quo. It was called Soma, and Huxley described it as “Christianity without tears.” It gave comfort without arousing guilt. It quashed ambivalence without provoking uncertainty. It was like heroin, cocaine, or methamphetamine, but it did not suppress breathing, provoke seizures, or rot the gums.

Unlikely as it may seem, we are moving ever more rapidly toward the brave new world that Huxley envisioned.  In recent months, the development of human embryos grown from what are referred to as stem cells has made enormous strides.  Unlike in vitro fertilization, the techniques being developed do not involve human eggs or sperm. Stem cells are cells that can be coaxed into multiplying and differentiating into the various tissues that constitute a person. If logically pursued with the benefit of additional technical advances, these embryos would produce people. Rather than calling this very human material ‘embryos,’ the investigators have opted to call their creations ‘embryo models.’

They are apparently hoping to deflect criticism of their work by renaming their creations.  This is a necessary measure since work on human embryos is already the target of those who view a one-day-old collection of human tissues as a ‘person.’ Some national laws and international agreements limit the development of these embryos and ‘embryo models’ to 14 days. Nations that enforce these barriers to investigation, like those that barred human dissections and limited the use of anesthetic agents, will simply fall behind in the evolution of medicine.

Laws restricting medical advances and investigations inevitably fail.  Philosophical qualms never survive the implementation of technological advances. Many of the physicists working on the Manhattan Project argued against using atomic bombs to obliterate entire cities, but we ended up demonstrating the awful power we had harnessed with the Hiroshima and Nagasaki detonations. Individuals who hope to replicate themselves and have the resources to advance this type of human cloning will support further work on ‘embryo models,’ whether or not governments sanction these investigations.

If techniques can be developed to allow the development of a healthy child without risking the life of the mother, it is unlikely that people with access to such techniques will opt for the more hazardous but traditional nine months of discomfort and danger.  Some couples already hire surrogates to incubate their fetuses even if the genetic ‘mother’ has no contra-indications to pregnancy.  There are numerous disadvantages to these surrogate arrangements, such as misbehavior by the baby-carrier or refusal to surrender the child after delivery, all of which could be avoided if methods were developed to take the support of the fetus to term outside a uterus.

The idea of an artificial uterus may seem improbable, but the construction of an artificial kidney (the dialysis machine), the artificial lung (extracorporeal membrane oxygenation- the ECMO machine), programmable insulin delivery systems, etc. were all technical challenges that were overcome.  These substitutes for human organs are constantly being improved upon and may soon replace or at least further supplement organ transplants.

And what of the notion that we shall have designer babies, children with traits we want and devoid of the anomalies we want to avoid?  To address that longstanding desire, geneticists have developed what is currently called CRISPR/cas9 technology. Simply put, this is gene editing.  If it is used to modify the genetic information in a fertilized egg, it could potentially eliminate the risk of a hereditary disease, such as sickle cell anemia, or change the appearance of the resulting child, from blue-eyed to brown-eyed.  Most nations are limiting or banning the application of this technique to humans, but it has already been adopted by some investigators, and its availability will spread as surely as the availability of illicit drugs has spread over the past century.

Developments in human cloning, embryo development, gene editing and other medical advances that affect the natural history and characteristics of humanity are racing ahead while religious, philosophical, and cultural forces are standing firmly in opposition. Several centuries ago, the head of the Roman Catholic church tried to dictate what weapons Christians could use in wars between rival factions.  Those prohibitions had no impact on warfare, and guidelines intended to halt or curb the development of techniques that can dramatically alter human development will be equally ineffective.

In Huxley’s book, a man, born of a woman and living outside this world order, is thrust into this brave new world and is challenged to find familiar emotions in the people around him. He struggles and fails and commits suicide. Hopefully we shall do better in facing our future.

Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan.  He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.

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