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Harvey Fineberg 談我們準備好新演化了嗎?

Harvey Fineberg: Are we ready for neo-evolution?

 

Photo of three lions hunting on the Serengeti.

講者:Harvey Fineberg

2011年3月演講,2011年4月在TED上線

 

翻譯:洪曉慧

編輯:朱學恆

簡繁轉換:洪曉慧

後製:洪曉慧

字幕影片後制:謝旻均

 

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關於這場演講

醫學倫理學家Harvey Fineberg告訴我們,人類物種的持續演化將通往三條路徑:完全停止演化、自然演化-或使用基因改造,控制下階段的人類演化,使我們變得更聰明、更敏捷、更好。新演化是指日可待的。我們該如何面對?

 

關於Harvey Fineberg

Harvey Fineberg從事醫療決策研究-從我們如何發展出新醫療技術,到如何應對新型疾病和流行病的威脅。

 

為什麼要聽他演講

身為美國國家醫學研究院院長,Harvey Fineberg深思關於新型醫藥,以及每一個新療法所帶來的廣泛可能性及道德和哲學問題。在一個棘手病例中,我們如何決定該使用何種療法-無論以個人或社會層面來看?資金最充裕的醫院得到最好的醫療保健是否公平?誰該因嘗試最新療法而承擔風險(並獲得獎勵)?

 

Fineberg協助成立並擔任醫療決策學會會長,亦為世界衛生組織顧問。他於1997年至2001年擔任哈佛大學教務長,並擔任了十三年哈佛大學公共衛生學院院長。他大部分學術生涯致力於衛生政策及醫療決策領域。他過去的研究著重於政策發展和實施過程、醫療技術評估、疫苗使用評估及醫療創新的傳播。

 

Harvey Fineberg的英語網上資料

首頁:iom.edu

 

[TED科技‧娛樂‧設計]

已有中譯字幕的TED影片目錄(繁體)(簡體)。請注意繁簡目錄是不一樣的。

 

Harvey Fineberg 談我們準備好新演化了嗎?

你希望在哪方面變得更好?假如我說,只要稍稍改變你的基因,你就能擁有更好的記憶力,更精確、更準確、更快速,或也許你希望更健康、更強壯、體力更好。你希望更有吸引力和自信嗎?那健康長壽呢?或也許你是個總是渴望擁有更多創造力的人,你最喜歡哪一項?如果只能選一項,你會選哪一項?(聽眾:創造力)。創造力,有多少人會選擇創造力?請舉手,讓我看看有幾個,大概在場許多人都很有創意,這非常好,多少人會選擇記憶?多了些。那健康呢?少了些。那長壽呢?啊,佔大多數,這讓身為一位醫生的我感覺非常好。如果你可以擁有其中任何一項,這將會是一個非常不同的世界。這僅僅是想像的嗎?或者,也許這是可能的?

 

在TED演講中,演化是不斷出現的主題,但今天我想以一位醫生的角度來談這個主題。20世紀偉大的遺傳學家T.G. Dobzhansky,他也是俄羅斯東正教教堂的一位領聖者,他曾寫過一篇文章,標題為〈只有從演化角度來看,生物學才具意義〉。現在,如果你是一個不接受生物演化證據的人,這是關上你的助聽器,拿出你個人通訊裝置的好時機,我允許你們這麼做,也許再看一次Kathryn Schultz《犯錯》這本書,因為這次演講的其餘部份對你來說將會毫無意義。(笑聲)但如果你接受生物演化理論,不妨思考一下,這僅與過去有關,或與未來有關?這適用於其他物種,或適用於我們?

 

這是由另一種角度看生命樹,在這張圖片中,我放了一棵由中心分支至所有方向的樹叢,因為如果你看生命樹的邊緣,每一個在這些樹枝尖端的現存物種已在演化上獲得成功,它存活下來,顯示它適於它的環境。樹枝上人類的部分一端向外伸出,當然,就是我們最感興趣的一端,我們由一個共同祖先分支為現代黑猩猩,大約在六或八百萬年前,在這個期間已有約20或25種不同的原始人類,有些出現之後又消失,我們已存在約13萬年,可能看起來我們與這棵生命樹上其它部份的物種差異頗大,但事實上,在大部份情況下,我們細胞的基本結構幾乎是相同的。

 

你們是否知道,我們可以利用並佔據一般細菌的結構,來生產人類胰島素的蛋白質,用於治療糖尿病?這跟人類胰島素不同,這是相同的蛋白質,與來自你胰腺的蛋白質並無化學上的區別。談到細菌,你們是否知道,我們每個人腸道中,存在著比我們身體其餘部分細胞更多的細菌?也許10倍以上。我的意思是,想想看,當Antonio Damasio問起你的自我形象,你會想到細菌嗎?我們的腸道對這些細菌來說是非常適合居住的環境,它溫暖、黑暗、潮濕、非常舒適,你會提供它們可能需要的所有營養,它們坐享其成,這對細菌來說確實像個安逸的環境,偶爾受到意外被迫離開的干擾,但除此之外,你對細菌來說是個完美的環境,就像它們對你生命來說一樣重要。它們有助於消化必需營養素,它們保護你對抗某些疾病。

 

但未來會如何?身為一個物種,我們是某種演化的平衡力?或者,我們注定會變成某種不同的,或許是更適合環境的物種?現在,讓我們在時間上往回走一步。140億年前的大爆炸,地球、太陽系存在約四十五億年,第一個原始生命的跡象也許是三十至四十億年前出現在地球上,第一個多細胞生物體可能出現在八或十億年前,然後人類這個物種終於在13萬年前出現。在這片遼闊宇宙的未完成交響曲中,地球上的生命是生命中短暫的小節,動物王國像一個小節,人類生命是小裝飾音,(音樂),這就是我們,這也構成了這場演講的娛樂部分,我希望你們會喜歡。

 

(笑聲)

 

當我還是個大學新鮮人時,我上了我第一堂生物課,我對生物學的優雅和美麗著迷,我迷戀於演化的力量,我瞭解到一些非常基本的概念,大多數以單細胞有機體存在的生命形式,每個細胞單純地分裂,細胞所有的遺傳能量都由兩個子細胞攜帶,但當多細胞有機體出現後,事情開始發生變化。有性生殖進入這個環境,相當重要的,當藉由基因組傳遞遺傳訊息的有性生殖開始後,身體其餘部份成為犧牲品。事實上,你可以說我們身體死亡的必然性進入演化的時間,跟有性生殖是一樣的。

 

現在我不得不承認,當我還是個大學生時,我想,好吧,性/死亡,性/死亡,為性而死,當時這似乎很合理。但每過一年,我就有越來越多的疑問,我開始了解George Burns的觀點,他90多歲仍在拉斯維加斯演出。一天晚上,有人敲他旅館房間的門,他開了門,站在他面前的是一位迷人、穿著暴露的表演女郎。她看著他,說,「我來這裡提供超棒(super)的性服務。」「很好,」George說,「我喝湯(soup)就好。」

 

(笑聲)

 

我開始瞭解,身為一名醫生,我正朝著一個目標努力,這不同於演化的目標,這不見得是矛盾的,只是不同而已。我試圖保有我們的身體,我希望保持我們的健康,我希望從疾病中恢復健康,我希望我們過著健康長壽的生活。演化就是藉由基因組傳遞給下一代,代代相傳適應和生存的法則。從演化的角度來看,你我就像設計成發送遺傳訊息的火箭推進器,將它送入下一層軌道,然後落進大海。我想大家都明白伍迪艾倫所表達的想法,他說,「我不想藉著工作來達成不朽,我想藉著不死來達成。」

 

(笑聲)

 

演化不一定有利於最長壽的生命,不一定有利於最大、最強或最快,甚至是最聰明的生命,演化有利於最適應他們環境的生物,這是生存和成功唯一的考驗。在海底,嗜熱細菌能存活在噴熱汽的洞口,否則將產生,如果那裡有魚的話,真空法烹煮熟魚。然而,它們已成功讓這裡成為適合它們生存的環境。

 

所以,這意味著什麼?當我們回顧演化過程中發生的事,我們再度思考人類在演化中的位置,特別是當我們展望下個階段,我會說,有幾種可能性。第一,我們將不會演化,我們已經達成某種平衡,背後的推論是,首先,我們藉由醫學設法保存了很多的基因,否則它將會從人類中被篩選出而淘汰。其次,身為一個相當能塑造環境的物種,我們必須設法讓它適應我們,就像我們適應它一樣。順帶一提,我們遷移、散佈、混種的如此頻繁,不再有演化發生所必要的隔離條件。

 

第二個可能是,將會有傳統形式的演化,由大自然力量所賦予的自然演化,這個論點是,演化之輪轉動緩慢,卻是無情的。就隔離來說,當我們成為一個進行遙遠行星殖民的物種,將產生隔離和環境變化,就可能產生自然狀態下的演化。

 

但還有第三種可能性,一個誘人、有趣而可怕的可能性,我稱它為新演化論。一種新型演化,不單純是自然的演化,而是由我們個人所作決定引導和選擇。這是怎麼發生的?我們怎麼可能這麼做?首先思考這個事實。當今的人們,在某些文化中,正對他們的後代做選擇,他們是,在一些文化中,選擇生下更多的男性而不是女性,這對社會不一定有好處,但這是個人和家庭所做的選擇。

 

再想想,如果你有選擇的可能,不僅僅是選擇你孩子的性別,而是在你的身體上做能治癒或預防疾病的基因調整,如果你可以讓基因改變,避免糖尿病或老年癡呆症,或減少癌症發生的風險,或避免中風?難道你不想在你的基因上做這些改變嗎?如果展望未來,這類型改變的可能性將與日俱增。

 

人類基因組計劃始於1990年,花了13年時間,27億美元,它完成後一年,即2004年,你可以花兩千萬美元,在三到四個月內完成同樣工作。今天,你可以得到人類基因組中三十億個鹼基對的完整序列,花費約兩萬美元,時間大約是一星期。不需很久,1000美元的人類基因組就會成真,每個人越來越容易就可以獲得。就在一周前,國家工程學院將Draper獎頒給Francis Arnold 及 Willem Stemmer,這兩位科學家獨立開發一些技術,使演化的自然過程加速,並以更有效方式產生預想中的蛋白質,Frances Arnold稱之為「定向演化」。幾年前,Lasker獎頒給了科學家Shinya Yamanaka,他的研究是用一個成人皮膚細胞,一個纖維細胞,只調控了四個基因,他誘導那個細胞回復成一個多潛能的幹細胞,一個有潛能成為你身體中任何細胞的細胞。

 

這些變化正迎面而來,能在細菌中生產人類胰島素的相同技術,可使病毒不僅能保護你對抗它本身,也能誘導對其他病毒的免疫力。信不信由你,有一個正在進行中的、預防流感疫苗的實驗已在煙草植物細胞中生長,你能想像菸草也能生出好東西嗎?

 

這些都是今天的現實情況,在未來,可能性將會更大。再想像一下其他兩個小變化,你可以改變你身體中的細胞,但如果可以改變你後代體內的細胞呢?如果你可以改變精子和卵子,或改變新生的受精卵,給你後代更好的機會,過一個更健康的生活,免於糖尿病、免於血友病、降低癌症的風險?誰不想要更健康的孩子?然後,同樣的分析技術、同樣的科學工具,這些可以造成改變以預防疾病的科技,也能賦予我們超強特質、超棒能力、更佳的記憶力。為什麼不擁有Ken Jennings的機智,特別是如果你可以用下一代的Watson超級電腦來增加它?為什麼不擁有快速伸縮的肌肉,這將能使你跑得更快、更久?為什麼不活久一點?這些都將是不可抗拒的。

 

當我們正處於一個可以將它傳給下一代的位置,我們可以採用我們想要的特質,我們將使舊式演化轉變成新型演化,我們將使一個通常可能需要十萬年的過程壓縮到一千年,甚至可能在未來的一百年。這些都是你的孫子,或他們的孫子將面臨的選擇,我們將使用這些選擇,建立一個更好、更成功、更友善的社會嗎?或者,我們將選擇性地選擇不同的特質,希望給我們其中一些人,而不給其他人?我們會建立一個更乏味、更一成不變,或是更有活力、更多采多姿的社會?這些是我們將不得不面對的問題。

 

其中最值得深思的是,我們是否能發展,並傳承明智做出這些選擇所需要的智慧?不管是好是壞,可能比你想的還快,這些選擇將取決於我們。

 

謝謝。

 

(掌聲)

 

以下為系統擷取之英文原文

About this talk

Medical ethicist Harvey Fineberg shows us three paths forward for the ever-evolving human species: to stop evolving completely, to evolve naturally -- or to control the next steps of human evolution, using genetic modification, to make ourselves smarter, faster, better. Neo-evolution is within our grasp. What will we do with it?

About Harvey Fineberg

Harvey Fineberg studies medical decisionmaking -- from how we roll out new medical technology, to how we cope with new illnesses and threatened epidemics. Full bio and more links

Transcript

How would you like to be better than you are? Suppose I said that, with just a few changes in your genes, you could get a better memory -- more precise, more accurate and quicker. Or maybe you'd like to be more fit, stronger, with more stamina. Would you like to be more attractive and self-confident? How about living longer with good health? Or perhaps you're one of those who's always yearned for more creativity. Which one would you like the most? Which would you like, if you could have just one? (Audience Member: Creativity.) Creativity. How many people would choose creativity? Raise your hands. Let me see. A few. Probably about as many as there are creative people here. That's very good. How many would opt for memory? Quite a few more. How about fitness? A few less. What about longevity? Ah, the majority. That makes me feel very good as a doctor. If you could have any one of these, it would be a very different world. Is it just imaginary? Or, is it perhaps possible?

Evolution has been a perennial topic here at the TED Conference, but I want to give you today one doctor's take on the subject. The great 20th century geneticist, T.G. Dobzhansky, who was also a communicant in the Russian Orthodox Church, once wrote an essay that he titled "Nothing in Biology Makes Sense Except in the Light of Evolution." Now if you are one of those who does not accept the evidence for biological evolution, this would be a very good time to turn off your hearing aid, take out your personal communications device -- I give you permission -- and perhaps take another look at Kathryn Schultz' book on being wrong, because nothing in the rest of this talk is going to make any sense whatsoever to you. (Laughter) But if you do accept biological evolution, consider this: is it just about the past, or is it about the future? Does it apply to others, or does it apply to us?

This is another look at the tree of life. In this picture, I've put a bush with a center branching out in all directions, because if you look at the edges of the tree of life, every existing species at the tips of those branches has succeeded in evolutionary terms: it has survived; it has demonstrated a fitness to its environment. The human part of this branch, way out on one end, is, of course, the one that we are most interested in. We branch off of a common ancestor to modern chimpanzees about six or eight million years ago. In the interval, there have been perhaps 20 or 25 different species of hominids. Some have come and gone. We have been here for about 130,000 years. It may seem like we're quite remote from other parts of this tree of life, but actually, for the most part, the basic machinery of our cells is pretty much the same.

Do you realize that we can take advantage and commandeer the machinery of a common bacterium to produce the protein of human insulin used to treat diabetics? This is not like human insulin; this is the same protein that is chemically indistinguishable from what comes out of your pancreas. And speaking of bacteria, do you realize that each of us carries in our gut more bacteria than there are cells in the rest of our body? Maybe 10 times more. I mean think of it, when Antonio Damasio asks about your self-image, do you think about the bacteria? Our gut is a wonderfully hospitable environment for those bacteria. It's warm, it's dark, it's moist, it's very cozy. And you're going to provide all the nutrition that they could possibly want with no effort on their part. It's really like an Easy Street for bacteria, with the occasional interruption of the unintended forced rush to the exit. But otherwise, you are a wonderful environment for those bacteria, just as they are essential to your life. They help in the digestion of essential nutrients. And they protect you against certain diseases.

But what will come in the future? Are we at some kind of evolutionary equipoise as a species? Or, are we destined to become something different -- something perhaps even better adapted to the environment? Now let's take a step back in time to the Big Bang, 14 billion years ago -- the Earth, the solar system, about four and a half billion years -- the first signs of proto-life, maybe three to four billion years ago on Earth -- the first multi-celled organisms, perhaps as much as 800 or a billion years ago -- and then the human species, finally emerging in the last 130,000 years. In this vast unfinished symphony of the universe, life on Earth is life a brief measure; the animal kingdom, like a single measure; and human life, a small grace note. That was us. That also constitutes the entertainment portion of this talk, so I hope you enjoyed it.

(Laughter)

Now when I was a freshman in college, I took my first biology class. I was fascinated by the elegance and beauty of biology. I became enamored of the power of evolution, and I realized something very fundamental: in most of the existence of life in single-celled organisms, each cell simply divides, and all of the genetic energy of that cell is carried on in both daughter cells. But at the time multi-celled organisms come online, things start to change. Sexual reproduction enters the picture. And very importantly, with the introduction of sexual reproduction that passes on the genome, the rest of the body becomes expendable. In fact, you could say that the inevitability of the death of our bodies enters in evolutionary time at the same moment as sexual reproduction.

Now I have to confess, when I was a college undergraduate, I thought, okay, sex/death, sex/death, death for sex -- it seemed pretty reasonable at the time, but with each passing year, I've come to have increasing doubts. I've come to understand the sentiments of George Burns, who was performing still in Las Vegas well into his 90s. And one night, there's a knock at his hotel room door. He answers the door. Standing before him is a gorgeous scantily-clad showgirl. She looks at him and says, "I'm here for super sex." "That's fine," says George, "I'll take the soup."

(Laughter)

I came to realize as a physician that I was working toward a goal which was different from the goal of evolution -- not necessarily contradictory, just different. I was trying to preserve the body. I wanted to keep us healthy. I wanted to restore health from disease. I wanted us to live long and healthy lives. Evolution is all about passing on the genome to the next generation, adapting and surviving through generation after generation. From an evolutionary point of view, you and I are like the booster rockets designed to send the genetic payload into the next level of orbit and then drop off into the sea. I think we would all understand the sentiment that Woody Allen expressed when he said, "I don't want to achieve immortality through my work. I want to achieve it through not dying."

(Laughter)

Evolution does not necessarily favor the longest lived. It doesn't necessarily favor the biggest or the strongest or the fastest, and not even the smartest. Evolution favors those creatures best adapted to their environment. That is the sole test of survival and success. At the bottom of the ocean, bacteria that are thermophilic and can survive at the steam vent heat that would otherwise produce, if fish were there, sous-vide cooked fish, nevertheless, have managed to make that a hospitable environment for them.

So what does this mean, as we look back at what is happening in evolution, and as we think about the place again of humans in evolution, and particularly as we look ahead to the next phase, I would say that there are a number of possibilities. The first is that we will not evolve. We have have reached a kind of equipoise. And the reasoning behind that would be, first, we have, through medicine, managed to preserve a lot of genes that would otherwise be selected out and be removed from the population. And secondly, we as a species have so configured our environment that we have managed to make it adapt to us as well as we adapt to it. And by the way, we immigrate and circulate and intermix so much that you can't any longer have the isolation that is necessary for evolution to take place.

A second possibility is that there will be evolution of the traditional kind, natural, imposed by the forces of nature. And the argument here would be that the wheels of evolution grind slowly, but they are inexorable. And as far as isolation goes, when we as a species do colonize distant planets, there will be the isolation and the environmental changes that could produce evolution in the natural way.

But there's a third possibility, an enticing, intriguing and frightening possibility. I call it neo-evolution -- the new evolution that is not simply natural, but guided and chosen by us as individuals in the choices that we will make. Now how could this come about? How could it be possible that we would do this? Consider first the reality that people today, in some cultures, are making choices about their offspring. They're, in some cultures, choosing to have more males than females. It's not necessarily good for the society, but it's what the individual and the family are choosing.

Think also, if it were possible ever for you to choose, not simply to choose the sex of your child, but for you in your body to make the genetic adjustments that would cure or prevent diseases. What if you could make the genetic changes to eliminate diabetes or Alzheimer's or reduce the risk of cancer or eliminate stroke? Wouldn't you want to make those changes in your genes? If we look ahead, these kind of changes are going to be increasingly possible.

The Human Genome Project started in 1990, and it took 13 years. It cost 2.7 billion dollars. The year after it was finished in 2004, you could do the same job for 20 million dollars in three to four months. Today, you can have a complete sequence of the three billion base pairs in the human genome at a cost of about $20,000 and in the space of about a week. It won't be very long before the reality will be the $1,000 human genome, and it will be increasingly available for everyone. Just a week ago, the National Academy of Engineering awarded its Draper Prize to Francis Arnold and Willem Stemmer, two scientists who independently developed techniques to encourage the natural process of evolution to work faster and to lead to desirable proteins in a more efficient way -- what Frances Arnold calls "directed evolution." A couple of years ago, the Lasker Prize was awarded to the scientist Shinya Yamanaka for his research in which he took an adult skin cell, a fibroblast, and by manipulating just four genes, he induced that cell to revert to a pluripotential stem cell -- a cell potentially capable of becoming any cell in your body.

These changes are coming. The same technology that has produced the human insulin in bacteria can make viruses that will not only protect you against themselves, but induce immunity against other viruses. Believe it or not, there's an experimental trial going on with vaccine against influenza that has been grown in the cells of a tobacco plant. Can you imagine something good coming out of tobacco?

These are all reality today, and in the future, will be evermore possible. Imagine then just two other little changes. You can change the cells in your body, but what if you could change the cells in your offspring? What if you could change the sperm and the ova, or change the newly fertilized egg, and give your offspring a better chance at a healthier life -- eliminate the diabetes, eliminate the hemophilia, reduce the risk of cancer? Who doesn't want healthier children? And then, that same analytic technology, that same engine of science that can produce the changes to prevent disease, will also enable us to adopt super-attributes, hyper-capacities -- that better memory. Why not have the quick wit of a Ken Jennings, especially if you can augment it with the next generation of the Watson machine? Why not have the quick twitch muscle that will enable you to run faster and longer? Why not live longer? These will be irresistible.

And when we are at a position where we can pass it on to the next generation, and we can adopt the attributes we want, we will have converted old-style evolution into neo-evolution. We'll take a process that normally might require 100,000 years, and we can compress it down to a thousand years -- and maybe even in the next 100 years. These are choices that your grandchildren, or their grandchildren, are going to have before them. Will we use these choices to make a society that is better, that is more successful, that is kinder? Or, will we selectively choose different attributes that we want for some of us and not for others of us? Will we make a society that is more boring and more uniform, or more robust and more versatile? These are the kinds of questions that we will have to face.

And most profoundly of all, will we ever be able to develop the wisdom, and to inherit the wisdom, that we'll need to make these choices wisely? For better or worse, and sooner than you may think, these choices will be up to us.

Thank you.

(Applause)
 


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