As a Columbia University philosophy student in the 1970s, Arthur Caplan listened to ongoing discussions about the ethics of genetic testing for intelligence and wondered whether similar debates were stirring in medicine. He ended up studying medicine for two years before deciding it wasn't for him, but the experience fueled his fascination with the fledgling field of medical ethics.
"In fact I witnessed a screaming fight between Landrum Shettles [a pioneer of in vitro fertilization techniques] and the head of the OB-GYN department, whose name was Raymond Vande Wiele, about whether or not a test-tube baby experiment could go on, so I knew then there was something going on that was worth paying attention to," recalls Caplan.
While writing his dissertation in philosophy, Caplan attended a conference in Boston on ethical issues in genetic testing. On the flight back to New York, he happened to sit next to Daniel Callahan, a cofounder and, at the time, president of the Hastings Center, an independent bioethics think tank. That serendipitous meeting launched Caplan's career in bioethics.
Today as the Emanuel and Robert Hart Professor of Bioethics, chair of the Department of Medical Ethics, and director of the Center for Bioethics at the University of Pennsylvania, the 57-year-old presides over a world-renowned research and teaching enterprise, staffed by more than 20 full- and part-time faculty members.
Despite his iconic status in the field of bioethics, Caplan is no stuffed shirt. He briefly interrupted our interview when an eagerly awaited envelope arrived at his office. The grist for some hot bioethical debate, perhaps? No. Inside were tickets to a Bruce Springsteen concert.
The Scientist: What are the biggest ethical issues we face in biotechnology?
Art Caplan: The shift from generic medicine to personalized or individualized medicine is going to raise huge ethical problems. There will be fights about whether some people are too risk-prone to employ or insure. We're going to learn that some ethnic groups are prone to certain diseases. That's going to raise issues about stigma and stereotyping. There will be behavioral diseases that we find out have genetic components, and how will that be handled? Privacy protection and confidentially will come out of biotechnology. Who gets to see genetic information? There'll be lots of arguing about biobanking and who owns genes, who can use them, and who can profit from them.
TS: Do you feel that bioethics will, or even can, keep up with the current rate of technology growth?
Caplan: People ask, "Is the science going to run ahead of the ethics?" I don't think that's always the problem. I think it's that the science runs ahead of the politics. Bioethics can alert people to something coming down the road, but it doesn't mean policy and politicians are going to pay attention. They tend to respond when there's an immediate crisis. The job of the ethicist, in some ways, is to warn or be prophetic. You can yell loudly, but you can't necessarily get everybody to leave the cinema, so to speak.
TS: What's your outlook on the future of embryonic stem cell research in this country?
Caplan: Embryonic stem cell research is inevitable. There will be government funding from state and probably federal sources in the next few years. The pressures to keep up with the rest of the world will push funding, too. I am skeptical that anything of value will come out of embryonic stem cell research for 10 years.
TS: Why so long?
Caplan: It's going to take a long time to learn to grow cells in a uniform, functional manner in dishes so they don't revert back to embryo-like things or turn into other things that would cause problems if implanted. It's going to take a while to figure out how to do this in a way that's cost-effective ... and to make it practical for large-scale use.
TS: The Greater Philadelphia region is one of the nation's premier life science centers. What's your advice to leaders in academia and industry?
Caplan: This region will absolutely be a player because it has tremendous resources. You must have the whole package to be a real participant in the biotech revolution, and relatively few areas of the country have that. That said, I'd offer three bits of advice.
First, it's very important to invest in high schools and colleges to support science expertise - and interest. The citizens must not fear biotech and the biological revolution.
Second, it's important for a region to show off its legal/ethical resources. There are patent people and licensing people, and that must be part of the competitive edge that's touted. Having a good bioethics program in an area can help startups and move things along with fewer bumps in the road.
Third, pick out certain specialty areas and go with them.
TS: You had polio as a child. How did that experience shape the way you approach ethical questions today?
Caplan: It gives me some empathy with patients when I remember my experience because I understand what it's like to be scared, frightened, and also disabled. I couldn't move my legs for a while, and my neck was paralyzed too. I never went in an iron lung but I definitely had limits, so that made me think a lot about illness. I also thought a lot about truthfulness. In those days you didn't tell kids the truth about what was going on with their disease or anybody else's disease. So some of my feelings about ethics - the need to figure out ways to be more forthright and allow people to have more independence in dealing with doctors - I'm sure came from that experience. I also learned to understand the limits of medicine, because there wasn't much you could do for polio. Back then, you had to wait it out to see what was going to happen.