Part 9 (1/2)

After examining more than thirty studies of this issue, the International Inst.i.tute for Environment and Development concluded that many of the large-scale foreign investments have already failed because of miscalculations concerning difficulties in financing the projects or unrealistic business plans. Part of the underlying problem is a gross imbalance in political power, with elites in nondemocratic governments dealing with multinational corporations and foreign countries to make short-term profits at the expense of the sustainability of their nations' food production capability and often at the expense of poor farmers who are evicted from the land when owners.h.i.+p is transferred.

Several nations suffering from loss of topsoil, sharply declining crop yields, and shortages of freshwater have been forced to increase food imports. Saudi Arabia may have its last wheat harvest in 2013; it previously announced that it will rely entirely on wheat imports by 2016. In the 1970s, fearful that its central role in organizing the OPEC oil embargo might make it vulnerable to a counterembargo on the grain imports it relied upon heavily to feed its people, Saudi Arabia launched a crash program to subsidize (at almost $1,000 per ton) the growing of wheat irrigated with water from a deep nonrenewable aquifer underneath the Arabian Peninsula. However, years later, it belatedly realized that it was rapidly depleting the aquifer and announced cancellation of the program. ”The decision to import is to preserve water,” said Saudi deputy minister of agriculture for research and development Abdullah al-Obaid. Agriculture absorbs 85 to 90 percent of Saudi Arabia's water, and 80 to 85 percent of that water comes from underground aquifers. (Elsewhere in the region, Israel banned the irrigation of wheat in 2000.) THE OCEANS.

The need to meet increasing demand for freshwater and food, especially protein, has led many to look to the oceans for relief. Saudi Arabia is among many nations that have long dreamed that a logical solution to our water problems will eventually involve desalination of seawater. After all, 97.5 percent of all of the water on Earth is salt.w.a.ter, and most plans to deal with the current and projected shortages of freshwater involve the use and allocation of the other 2.5 percent of Earth's water resources-70 percent of which is locked up in the ice and snow of Antarctica and Greenland.

Unfortunately, even with the best currently available technology, the amount of energy required to remove the salt and other minerals from seawater is so great that even energy-rich Saudi Arabia cannot afford it. It is more beneficial, in their view, to sell the oil they would otherwise have to burn in desalination plants and use the money to purchase the use of water-rich land in Africa. There are, of course, many desalination plants in the world-including in Saudi Arabia. However, the quant.i.ties produced are still relatively small and the expense makes wider use of desalination for the world's growing water needs financially unsustainable.

Nevertheless, there are many scientists and engineers working to invent new, more cost-effective technologies for desalination. Some believe that this challenge is yet another reason why the world should embark on a ma.s.sive, large-scale global effort to accelerate the cost reductions now under way in solar energy. I have seen many intriguing business plans aimed at solving this problem, but none that yet appears to be close to financial feasibility.

As a measure of the desperation that water shortages can cause, one Saudi prince, Mohammed al-Faisal, provided funding to a French engineer, Georges Mougin, to develop a business plan for la.s.soing icebergs in the North Atlantic and then towing them to areas experiencing severe droughts. According to their calculations, a 30-million-ton iceberg could supply 500,000 people with freshwater for a year.

The production of food crops, of course, normally requires both freshwater and topsoil. Some techno-optimists, though, have touted the possibility of growing crops without topsoil in hydroponic facilities where the plants are suspended from racks and supplied with ample amounts of water, nutrients, and sunlight. Unfortunately, hydroponics is the food equivalent of desalination: it is prohibitively expensive, largely because it too is so energy-intensive.

Yet there is one source of high-quality protein that does not require topsoil-seafood. Today, more than 4.3 billion people rely on fish for approximately 15 percent of their animal protein consumption. Unfortunately, however, the demand for fish is far outstripping the supply. Consumption of fish has increased significantly because of two familiar trends: growth in population and growth in per capita consumption. Over the last half century, the average person's fish consumption globally increased from twenty-two pounds per person per year to almost thirty-eight pounds in 2012. As a result, the majority of the world's ocean fisheries have been overexploited and almost one third of fish stocks in the oceans, according to the United Nations, are in danger. Stocks of large fish-tuna, swordfish, marlin, cod, halibut, and flounder, for example-have been reduced by 90 percent since the 1960s.

Although other factors play a role-including the destruction of coral reefs and changes in ocean temperature and acidity due to global warming pollution-the overexploitation of the ocean fisheries is the princ.i.p.al cause of the decline. The world reached ”peak fish” twenty-five years ago. According to the Secretariat of the Convention on Biological Diversity, ”About 80 percent of the world marine fish stocks for which a.s.sessment information is available are fully exploited or overexploited.... The average maximum size of fish caught declined by 22% since 1959 globally for all a.s.sessed communities. There is also an increasing trend of stock collapses over time, with 14% of a.s.sessed stocks collapsed in 2007.”

The good news is that ocean fisheries that are carefully managed can and do recover. The United States has led the way in such protections, and many of the U.S. fisheries are now improving in their health and abundance. President George W. Bush enacted an excellent system of protection for a large marine area in the Pacific Ocean northwest of the Hawaiian Islands. However, most fis.h.i.+ng countries have not yet followed the example of the U.S. restrictions on overfis.h.i.+ng, and global fish consumption is continuing to increase steadily.

Most of the continuing increase in fish consumption is now being supplied by farmed fish. However, there are growing concerns about the rapid expansion of aquaculture-61 percent of which will occur in China over the next seven years. Farmed fish do not have the same healthy qualities as wild fish, and often-particularly if they are imported from China or other jurisdictions that lack adequate environmental enforcement-can be tainted by pollution, antibiotics, and antifungals. In addition, most farmed fish are fed large amounts of smaller wild fish processed for formulated fishmeal. Salmon, for example, are fed at a ratio of five pounds of wild fish for each pound of farmed salmon produced. Consequently, the netting of enormous volumes of small fish in the oceans is now causing further disruption to the ocean food chain.

During an expedition to Antarctica in 2012, I talked with scientists who are deeply concerned about the overexploitation of the krill population in the Antarctic Ocean, largely for fishmeal and pet food. The U.S. Department of Agriculture has noted that the overexploitation of so-called industrial species that are used for fishmeal instead of direct human consumption will begin to impose limits on the production of fishmeal and fish oil for aquaculture in 2013. Over half of the fish food in agriculture is now made from plant protein, and some operators are trying to increase that percentage, but it is still difficult to provide essential nutrients economically without fishmeal.

In addition, any major expansion of plant protein dedicated to aquaculture would represent yet another diversion of arable land from the production of food that can be directly consumed by people.

The overexploitation of the oceans, like the reckless depletion of the world's resources of freshwater and topsoil, has increased the amount of attention being paid to the genetic engineering of plants and animals-to give them traits that will enable them to thrive in the new conditions we are creating in the world. Although more than 10 percent of all cropland is now planted with genetically engineered crops, the issues raised are complex, as we shall now see.

* At least, it's noncommunicable by means of pathogens transferred from one person to another; research shows that it is communicable socially in families, communities, and nations in which the people one normally comes into contact with include many who are obese and overweight.

Obesity is also a major risk factor for osteoarthritis and other musculoskeletal disorders, some cancers-particularly colon, breast, and endometrial-and kidney failure. Health experts estimate that the cost of treating these obesity-related diseases consumes roughly 10 to 20 percent of U.S. health care spending each year. Globally, approximately 6.4 percent of the world's adult population now has diabetes, and according to the World Health Organization that number is expected to grow to 7.8 percent in the next seventeen years, to a total of 438 million-more than 70 percent of them in low- and middle-income countries.

For a larger version of the following image, click here.

5.

THE REINVENTION OF LIFE AND DEATH.

FOR THE FIRST TIME IN HISTORY, THE DIGITIZATION OF PEOPLE IS CREATING a new capability to change the being in human being. The convergence of the Digital Revolution and the Life Sciences Revolution is altering not only what we know and how we communicate, not just what we do and how we do it-it is beginning to change who we are.

Already, the outsourcing and robosourcing of the genetic, biochemical, and structural building blocks of life itself are leading to the emergence of new forms of microbes, plants, animals, and humans. We are crossing ancient boundaries: the boundary that separates one species from another, the divide between people and animals, and the distinction between living things and man-made machinery.

In mythology, the lines dividing powers reserved for the G.o.ds from those allowed to people were marked by warnings; transgressions were severely punished. Yet no Zeus has forbidden us to introduce human genes into other animals; or to create hybrid creatures by mixing the genes of spiders and goats; or to surgically imbed silicon computer chips into the gray matter of human brains; or to provide a genetic menu of selectable traits for parents who wish to design their own children.

The use of science and technology in an effort to enhance human beings is taking us beyond the outer edges of the moral, ethical, and religious maps bequeathed to us by previous generations. We are now in terra incognita, where the ancient maps sometimes noted, ”There Be Monsters.” But those with enough courage to sail into the unknown were often richly rewarded, and in this case, the scientific community tells us with great confidence that in health care and other fields great advances await us, even though great wisdom will be needed in deciding how to proceed.

When humankind takes possession of a new and previously unimaginable power, the experience often creates a mixture of exhilaration and trepidation. In the teachings of the Abrahamic religions, the first man and the first woman were condemned to a life of toil when they seized knowledge that had been forbidden them. When Prometheus stole fire from the G.o.ds, he was condemned to eternal suffering. Every day, eagles tore into his flesh and consumed his liver, but every night his liver was regenerated so he could endure the same fate the next morning.

Ironically, scientists at Wake Forest University are now genetically engineering replacement livers in their laboratory bioreactors-and no one doubts that their groundbreaking work is anything but good. The prospects for advances in virtually all forms of health care are creating exhilaration in many fields of medical research-though it is obvious that the culture and practice of medicine, along with all of the health care professions and inst.i.tutions, will soon be as disruptively reorganized as the typewriter and long-playing record businesses before it.

”PRECISION HEALTH CARE”

With exciting and nearly miraculous potential new cures for deadly diseases and debilitating conditions on the research horizon, many health care experts believe that it is inevitable that the practice of medicine will soon be radically transformed. ”Personalized medicine,” or, as some now refer to it, ”precision medicine,” is based on digital and molecular models of an individual's genes, proteins, microbial communities, and other sources of medically relevant information. Most experts believe it will almost certainly become the model for medical care.

The ability to monitor and continuously update individuals' health functions and trends will make preventive care much more effective. The new economics of health care driven by this revolution may soon make the traditional insurance model based on large risk pools obsolete because of the huge volume of fine-grained information about every individual that can now be gathered. The role of insurance companies is already being reinvented as these firms begin to adopt digital health models and mine the ”big data” being created.

Pharmaceuticals, which are now aimed at large groups of individuals manifesting similar symptoms, will soon be targeted toward genetic and molecular signatures of individual patients. This revolution is already taking place in cancer treatment and in the treatment of ”orphan diseases” (those that affect fewer than 200,000 people in the U.S.; the definition varies from country to country). This trend is expected to broaden as our knowledge of diseases improves.

The use of artificial intelligence-like IBM's Watson system-to a.s.sist doctors in making diagnoses and prescribing treatment options promises to reduce medical errors and enhance the skills of physicians. Just as artificial intelligence is revolutionizing the work of lawyers, it will profoundly change the work of doctors. Dr. Eric Topol, in his book The Creative Destruction of Medicine, writes, ”This is much bigger than a change; this is the essence of creative destruction as conceptualized by [Austrian economist Joseph] Schumpeter. Not a single aspect of health and medicine today will ultimately be spared or unaffected in some way. Doctors, hospitals, the life science industry, government and its regulatory bodies: all are subject to radical transformation.”

Individuals will play a different role in their own health care as well. Numerous medical teams are working with software engineers to develop more sophisticated self-tracking programs that empower individuals to be more successful in modifying unhealthy behaviors in order to manage chronic diseases. Some of these programs facilitate more regular communication between doctors and patients to discuss and interpret the continuous data flows from digital monitors that are on-and inside-the patient's body. This is part of a broader trend known as the ”quantified self” movement.

Other programs and apps create social networks of individuals attempting to deal with the same health challenges-partly to take advantage of what scientists refer to as the Hawthorne effect: the simple knowledge that one's progress is being watched by others leads to an improvement in the amount of progress made. For example, some people (I do not include myself in this group) are fond of the new scales that automatically tweet their weight so that everyone who follows them will see their progress or lack thereof. There are new companies being developed based on the translation of landmark clinical trials (such as the Diabetes Prevention Program) from resource-intensive studies into social and digital media programs. Some experts believe that global access to large-scale digital programs aimed at changing destructive behaviors may soon make it possible to significantly reduce the incidence of chronic diseases like diabetes and obesity.

THE NEW ABILITIES scientists have gained to see, study, map, modify, and manipulate cells in living systems are also being applied to the human brain. These techniques have already been used to give amputees the ability to control advanced prosthetic arms and legs with their brains, as if they were using their own natural limbs-by connecting the artificial limbs to neural implants. Doctors have also empowered paralyzed monkeys to operate their arms and hands by implanting a device in the brain that is wired to the appropriate muscles. In addition, these breakthroughs offer the possibility of curing some brain diseases.

Just as the discovery of DNA led to the mapping of the human genome, the discovery of how neurons in the brain connect to and communicate with one another is leading inexorably toward the complete mapping of what brain scientists call the ”connectome.”* Although the data processing required is an estimated ten times greater than that required for mapping the genome, and even though several of the key technologies necessary to complete the map are still in development, brain scientists are highly confident that they will be able to complete the first ”larger-scale maps of neural wiring” within the next few years.

The significance of a complete wiring diagram for the human brain can hardly be overstated. More than sixty years ago, Teilhard de Chardin predicted that ”Thought might artificially perfect the thinking instrument itself.”

Some doctors are using neural implants to serve as pacemakers for the brains of people who have Parkinson's disease-and provide deep brain stimulation to alleviate their symptoms. Others have used a similar technique to alert people with epilepsy to the first signs of a seizure and stimulate the brain to minimize its impact. Others have long used cochlear implants connected to an external microphone to deliver sound into the brain and the auditory nerve. Interestingly, these devices must be activated in stages to give the brain a chance to adjust to them. In Boston, scientists at the Ma.s.sachusetts Eye and Ear Infirmary connected a lens to a blind man's optic nerve, enabling him to perceive color and even to read large print.

Yet for all of the joy and exhilaration that accompany such miraculous advances in health care, there is also an undercurrent of apprehension for some, because the scope, magnitude, and speed of the multiple revolutions in biotechnology and the life sciences will soon require us to make almost G.o.dlike distinctions between what is likely to be good or bad for the entire future of the human species, particularly where permanently modifying the gene pool is concerned. Are we ready to make such decisions? The available evidence would suggest that the answer is not really, but we are going to make them anyway.

A COMPLEX ETHICAL CALCULUS.

We know intuitively that we desperately need more wisdom than we currently have in order to responsibly wield some of these new powers. To be sure, many of the choices are easy because the obvious benefits of most new genetically based interventions make it immoral not to use them. The prospect of eliminating cancer, diabetes, Alzheimer's, multiple sclerosis, and other deadly and fearsome diseases ensures these new capabilities will proceed at an ever accelerating rate.

Other choices may not be as straightforward. The prospective ability to pick traits like hair and eye color, height, strength, and intelligence to create ”designer babies” may be highly appealing to some parents. After all, consider what compet.i.tive parenting has already done for the test preparation industry. If some parents are seen to be giving their children a decisive advantage through the insertion of beneficial genetic traits, other parents may feel that they have to do the same.

Yet some genetic alterations will be pa.s.sed on to future generations and may trigger collateral genetic changes that are not yet fully understood. Are we ready to seize control of heredity and take responsibility for actively directing the future course of evolution? As Dr. Harvey Fineberg, president of the Inst.i.tute of Medicine, put it in 2011, ”We will have converted old-style evolution into neo-evolution.” Are we ready to make these choices? Again, the answer seems to be no, yet we are going to make them anyway.

But who is the ”we” who will make these choices? These incredibly powerful changes are overwhelming the present capacity of humankind for deliberative collective decision making. The atrophy of American democracy and the consequent absence of leaders.h.i.+p in the global community have created a power vacuum at the very time when human civilization should be shaping the imperatives of this revolution in ways that protect human values. Instead of seizing the opportunity to drive down health costs and improve outcomes, the United States is decreasing its investment in biomedical research. The budget for the National Inst.i.tutes of Health has declined over the past ten years, and the U.S. education system is waning in science, math, and engineering.

One of the early pioneers of in vitro fertilization, Dr. Jeffrey Steinberg, who runs the Los Angeles Fertility Inst.i.tutes, said that the beginning of the age of active trait selection is now upon us. ”It's time for everyone to pull their heads out of the sand,” says Steinberg. One of his colleagues at the center, Marcy Darnovsky, said that the discovery in 2012 of a noninvasive process to sequence a complete fetal genome is already raising ”some scenarios that are extremely troubling,” adding that among the questions that may emerge from wider use of such tests is ”who deserves to be born?”

Richard Hayes, executive director of the Center for Genetics and Society, expressed his concern that the debate on the ethical questions involved with fetal genomic screening and trait selection thus far has primarily involved a small expert community and that, ”Average people feel overwhelmed with the technical detail. They feel disempowered.” He also expressed concern that the widespread use of trait selection could lead to ”an objectification of children as commodities.... We support the use of [preimplantation genetic diagnosis (PGD)] to allow couples at risk to have healthy children. But for non-medical, cosmetic purposes, we believe this would undermine humanity and create a techno-eugenic rat race.”

Nations are compet.i.tive too. China's Beijing Genomic Inst.i.tute (BGI) has installed 167 of the world's most powerful genomic sequencing machines in their Hong Kong and Shenzhen facilities that experts say will soon exceed the sequencing capacity of the entire United States.

Its initial focus is finding genes a.s.sociated with higher intelligence and matching individual students with professions or occupations that make the best use of their capabilities.