Senate Subcommittee on Government Research Joshua Lederberg
Hearings on the human impact of advance March 28, 1968
in biological science

I am grateful for this opportunity to complete the
testimony I started three weeks ago. I was mainly concerned
that the proposed commission might have too sweeping a
mandate. I suggested that its main functions be 1) educational --
to alert the public to the realistic probabilities of changes
in the pattern of life likely to emerge from present-day scienti-
fie discovery, and 2) exploratory, to investigate the process
by which social decision is and should be reached on subjects
vital to the human future. I have been charged with being
opposed to inquiry, with professionalism, with the belief
that experts can make decisions that might affect the
deepest public interests. Far from it! I favor the inquiry,
but believe it should be a continuing process, and I am
especially gratified at the present hearings, and the interest
they help to focus on central problems of biology and
medicine.

I am opposed to premature closure of inquiry.

The danger I foresee is that a committee charged with
recommending guidelines on ethical issues after one year's
study might forestall the debate we should continue to have,
that it would help to lock us in to contemporary values just
at the time we are beginning to learn the way to a liberal,
or at least a pluralistic approach to many vital questions.
Our attitudes are in a state of constant evolution com-
mensurate with the constantly expanding level of education
of the electorate.

Suppose such a commission had been in operation ten or
twenty years ago, and had been charged with setting pre-
scriptive guidelines. Would it have helped or hurt the
growing enlightenment of the American people about birth
control or abortion? Or would it have locked us into the
prevailing mores? Even now, is Congress the right agency
to be directly involved with setting moral standards on
subjects like these? Or on new problems as controversial as
these appeared to be a decade or two ago?

But this is merely the negative side. There is unanimous
agreement that such a commission could perform many constructive
tasks.
Many areas of national policy urgently need investiga-
tion. The commission should be charged to frame the questions,
not answers of a kind that will need long and balanced study
by the representatives of the people. Here are some that
touch on the policy responsibilities of the Congress in its
relationship to medicine and health research.

1. The authenticity of medical care:. There is abundant
evidence that Americans’ are over-medicated. Does the

medical profession police itself with the diligence needed

to ensure that practitioners maintain their professional skill,
so that they can make wise judgments about the use of new
drugs? How much variance is there is these skills? How

can the lay individual make the intelligent free choice of
physician that is the hallmark of our system of practice --
that is, how can a layman find and identify a good doctor?

2. The equitable availability of medical care. What is our
social decision about the fair availability of excellent
medical service in relation to the patient's ability to pay?

3. Access toxmedical devises. The artificial kidney (hemodialyser)
is the prototype of many devices that will return the gift of
life for a price beyond many people's means. What is our
policy about the social distribution of that price? At

what point will we draw the line ($10,000 -- $100,000 --
$1,000,000: I stop at what it costs to kill an enemy
soldier)? Is there any limits, or reasonably should there

be any limit to the fraction of the national product that

can be devoted to the maintenance of health or life? After
we have dealt with this, we can take up Senator Mondale's
concern for "who shall live or die", a question that now
seems more troublesome when we dramatize individual targets,
than when we contemplate the inexcusable differences in mass
mortality rate by class, or by country.

4. Availability of medical innovations. We fuss about the
price of drugs; but the most costly one is the drug not yet
developed but needed by a patient. Do we have the ideal
system for the discovery, authentication and distribution of
drugs? If the needs of the Asian war take precedence today,
Wo we at least have plans for an industrial reconversion for
health technology tomanrow?

5. Safety and efficacy of virus vaccines. Since vaccination
for many viruses is or soon will be practically compulsory,
the government has a maximum commitment to the safety,
efficacy and purity of these products. Why do we fail to

use the scientific information already available to meet

that commitment?

6. Biological warfare. Research inthis area, and particularly
the large-scale test and deployment of contagious, anti-human or
anti-food weapons is a threat to the survival of the species.
Are we doing all we can to contain that global threat? How

can we discuss the ethics of experimentation that might be
hazardous to single subjects, and not eontrol secret experi-
ments designed to annihilate whole populations? If we cannot
unilaterally give up some research in this area, why do we

make no effort at international regulation of it?

7. The impact of medical advance on the structure of the

population.

We may eventually have to give serious thought to genetic
and developmental engineering, and their impace on the pupu-
lation. But an exaggerated emphasis on fine details
obscures much larger changes already being implemented.
Medical progress over the next 10 or 20 years is almost cer-
tain to open up the possibility of forestalling death for
every man to ages like 80 or 90. What are the social impli-
cations of this kind of shift in the age of the "average human",
a far more formidable shift in aggregate than any other we
are likely to engender? How do we cope with this possibility
of mastering death, where it is not accompanied by vigorous
health and youthful intelligence?

8. Medical experimantation and the rights of patients and

subjects.

The respect we have for the rights of individuals epto-
mizes our attitudes towards life, and therebygains an importance
out of proportion to the number of people actually involved.
Since this is already a subject of the deepest concern to many
public and professional groups, and is under active dis-
cussion, there is little merit to giving the commission

a unique charge to formulate the binding answers. It should
however investigate whether the right questions are being
asked, and whether reasonable processes are in motion to
achieve wise policies.

9. The "market'' in organs. As organ transplantation progresses
from an experimental to a useful, life-saving procedure,
legiglation governing the provision and distribution of valu-
able organs will surely have to be drafted. Again, a one-

year commission will be more useful as a body to frame the
relevant questions than to make conclusive recommendations.

Public information on the facts is an essential base
for wise policy, as Judge Bazelon has pointed out. The public
conecience often needs only the facts to produce the right answers.

I am guatified that Congress has the foresight to statt
to grapple with these problems, especially the processes by
which we can find the most humane solutions.