2009 : WHAT WILL CHANGE EVERYTHING?

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Johnstone Family Professor, Department of Psychology; Harvard University; Author, The Better Angels of Our Nature
IF YOU INSIST: PERSONAL GENOMICS?

I have little faith in anyone’s ability to predict what will change everything. A look at the futurology of the past turns up many chastening examples of confident predictions of technological revolutions that never happened, such as domed cities, nuclear-powered cars, and meat grown in dishes. By the year 2001, according to the eponymous movie, we were supposed to have suspended animation, missions to Jupiter, and humanlike mainframe computers (though not laptop computers or word processing – the characters used typewriters.) And remember interactive television, the internet refrigerator, and the paperless office?

Technology may change everything, but it’s impossible to predict how. Take another way in which 2001: A Space Odyssey missed the boat. The American women in the film were “girl assistants”: secretaries, receptionists, and flight attendants. As late as 1968, few people foresaw the second feminist revolution that would change everything in the 1970s. It’s not that the revolution didn’t have roots in technological change. Not only did oral contraceptives make it possible for women to time their childbearing, but a slew of earlier technologies (sanitation, mass production, modern medicine, electricity) had reduced the domestic workload, extended the lifespan, and shifted the basis of the economy from brawn to brains, collectively emancipating women from round-the-clock childrearing.

The effects of technology depend not just on what the gadgets do but on billions of people’s judgments of their costs and benefits (do you really want to have call a help line to debug your refrigerator?). They also depend on countless nonlinear network effects, sleeper effects, and other nuisances. The popularity of baby names (Mildred, Deborah, Jennifer, Chloe), and the rates of homicide (down in the 1940s, up in the 1960s, down again in the 1990s) are just two of the social trends that fluctuate wildly in defiance of the best efforts of social scientists to explain them after the fact, let alone predict them beforehand.

But if you insist. This past year saw the introduction of direct-to-consumer genomics. A number of new companies have been recently launched. You can get everything from a complete sequencing of your genome (for a cool $350,000), to a screen of more than a hundred Mendelian disease genes, to a list of traits, disease risks, and ancestry data. Here are some possible outcomes:

• Personalized medicine, in which drugs are prescribed according to the patient’s molecular background rather than by trial and error, and in which prevention and screening recommendations are narrowcasted to those who would most benefit.

• An end to many genetic diseases. Just as Tay-Sachs has almost been wiped out in the decades since Ashkenazi Jews have tested themselves for the gene, a universal carrier screen, combined with preimplantation genetic diagnosis for carrier couples who want biological children, will eliminate a hundred others.

• Universal insurance for health, disability, and home care. Forget the political debates about the socialization of medicine. Cafeteria insurance will no longer be actuarially viable if the highest-risk consumers can load up on generous policies while the low-risk ones get by with the bare minimum.

• An end to the genophobia of many academics and pundits, whose blank-slate doctrines will look increasingly implausible as people learn their about genes that affect their temperament and cognition.

• The ultimate empowerment of medical consumers, who will know their own disease risks and seek commensurate treatment, rather than relying on the hunches and folklore of a paternalistic family doctor.

But then again, maybe not.