"It's Hard To Make Predictions, Especially About the Future"

Lust, Longevity, and FDA reform at the World Future Society Conference

Minneapolis—The hoary aphorism headlined above, variously attributed to Yogi Berra, Neils Bohr or Mark Twain, didn't stop the 1000 or so people gathered at the World Future Society's (WFS) annual meeting, including me, from trying their hand at prognostication. I was also invited to give a keynote talk entitled "The Great Ecological Restoration Begins."

The WFS claims 25,000 members in 80 countries around the world. Timothy Mack, president of the WFS, told me that the membership skewed 70-30, men to women. I was also struck by the amount of grey hair in the audience. My guess is that the average age of attendees is around 60. Talking with people in the corridors between sessions, it appeared to me that the older participants tended to think that the future was dire, while the younger set was anticipating the next big technical innovation. I also have to say with some disappointment that a lot of futurists I've encountered at the meeting uncritically accept politically correct notions of impending environmental doom. In addition, a high percentage of the presenters are consultants who make a living by providing insights on future products, services, and other consumer trends.

The WFS meeting is a protean affair with lots of concurrent sessions, so one person can't report on it all. The titles of some of the sessions should give you a flavor of the proceedings:

• "Clash to Confluence of Civilizations: A Spiral Dynamics Perspective on Global Integration and Human Emergence"

• "Cognitive Transition and the New Consumer Mind"

• "The Future of RFID"

• "An Examination of the Future of Wind Energy"

• "What Use Are Men?' The Future of Gender Roles in Society"

• "The Evolution and Future Direction of Marriage"

• "Technological Prospective as a Driver for Innovation in High-Complexity Products"

• "The Future of Teams: Emerging Imperatives for Managing in a Complex and Virtual World Data by the Yottabyte by 2050"

• "Holy Terror: Thinking the Unthinkable"

And these sessions are just a few of those that were held on Monday.

The Future of Love and Family

The WFS conference started with two keynote talks. The first was by Rutgers University anthropologist and the chief scientific officer of the web dating site chemistry.com, Helen Fisher. Her interest in human sexuality drives her academic research, and she is the author of a number of popular books on the topic, e.g., The Sex Contract, The Anatomy of Love, The First Sex, and Why We Love. The title of Fisher's presentation—"The Future of the Family: Lust, Romance, and Attachment"—was titillating enough.

Fisher opened by noting that her current research uses fMRIs to look at the brains of people who claim to be madly in love, and those who have just been painfully dumped. What brain circuits are fired up in love and romantic disappointment? As the name of her personals site indicates, Fisher wants to get beyond mere flowers and candy, to the chemical bases of human sexual attraction. When it comes to love, "chemistry" is not just a euphemism to Fisher.

Fisher claims that the gap between men and women is closing in 129 of 130 societies that she has analyzed; that is, gender differences in social goods like economic power and literacy are diminishing. Fisher believes that this process is a return to an earlier era of gender equality that existed before the advent of agriculture ten thousand years ago. Whatever advantages stemmed from agriculture, Fisher argues, it was a disaster for the social standing of women. Agricultural societies devalued women by declaring them to be less intelligent and competent than men, she argues, and by empowering men as the sole providers and heads of households. Women consequently became chattel.

However, technology and the modern world are reversing this cultural oppression. "Today we are shedding 10,000 years of our farming culture," said Fisher. "What we are seeing is a return to life as it was 100,000 years ago." What did she mean? Well, among other things, Fisher argues that modern serial monogamy is similar to what happens in hunting and gathering societies in which men and women often have two or three spouses over their lifetimes. In addition, the gender power imbalance is being righted. In cases where both men and women work from home, 25 percent of women make more money than their spouses. But even if we are heading back to the Pleistocene era, there are some things about human sexuality that Fisher believes will remain constant, chiefly "love."

Fisher dissects "love" into three components—lust, romantic love, and attachment. In both sexes, lust is associated with testosterone, which is responsible for the sex drive, or a craving for sexual satisfaction. One can experience feelings of lust without having a specific partner in mind. Romantic love is passionate infatuation, or obsessively thinking about and craving for a particular person. Romantic love is associated with dopamine pathways in the brain. Dopamine is associated with addiction, and romantic love mirrors addictions to cigarettes, alcohol and cocaine all of which activate dopamine brain circuits in similar ways. People in the throes of romantic love are blind to the faults of the loved one. Fisher amusingly quoted George Bernard Shaw's cynical aphorism: "Love consists of overestimating the differences between one woman and another." The final aspect of love is attachment. Here the sex drive moderates and bonds are established between the two partners. This long term affection is associated with the expression of oxytocin in women, and vasopressin in men. Fisher suggested that these brain circuits developed to enable people to tolerate each through child-rearing.

Since love boils down to chemistry, Fisher worries about the effects of neuropharmaceuticals on love. For example, she pointed to the deleterious effects that selective serotonin re-uptake inhibitors (SSRIs) antidepressants can have on romantic love. SSRIs can kill the sex drive and can also kill the ability to fall in—and stay in—love. Some people taking SSRIs can no longer have orgasms, and that means that they are deprived of the floods of vasopressin and oxytocin that strengthen pair-bonds. Fisher cited the case of a Dutch college student who began taking SSRIs for depression. He decided that he no longer loved his girlfriend, so he moved out. A few months later, he stopped taking the pills and realized that he did love her. As Fisher tells the story, he bought as many flowers as he could carry and went back to her apartment and asked her to take him back. The happy ending was that she did. (I should note that when I took Prozac a few years ago to combat depression of my father's death, I did not experience this side effect.) Fisher isn't saying that one shouldn't take SSRIs if depressed, but that physicians and patients should be more aware of the romance-killing downsides of these medications.

Fisher claimed that women are more openly expressing their sexuality, beginning sex at earlier ages, having more partners, telling their partners what they want from intimacy, and having more regrets. The "he's a stud, she's a whore" mentality, she said, is "finally disappearing." Fisher also asserted that male adultery is on the wane, and society is beginning to adopt a more female-oriented definition of intimacy, which seems to involve a lot of face-to-face conversation. She anthropologized that men's intimacy (if one can even call it that) developed as men sat side-by-side facing their enemies. She joked that this same male behavior is still exhibited during football season every Sunday afternoon.

What else has changed? In agrarian societies, people didn't believe that they needed love in marriage. Our chief preoccupations were our duties to God and clan. Now the central focus of marriage is intimacy. A recent survey of Americans found that 86 percent of men and 91 percent of women said that they could not marry someone unless they were in love with them (I wonder about the 14 percent of men and 9 percent of women who said otherwise).

Nevertheless, Fisher declared, "We can no longer say that we live in a traditional marriage culture." Today, the form of modern American marriages can be increasingly described as companionate or peer marriage, or a marriage between equals. She ended by pointing to some positive trends in marriage. American couples are working harder on their relationships. The divorce rate is down from 50 percent in 1991 to 43 percent today. Part of the reason is people are waiting longer to get married, and the later people marry the less likely they are to get divorced. Fisher ended by declaring that family is going to be around as long we live on this mortal coil, suggesting that we are never going to be able control the brain systems that govern lust, romantic love and attachment.

Actually, the SSRI story that Fisher told suggests that she is wrong, at least in the long run, about whether or not humanity will gain direct chemical control of the brain systems associated with human sexuality. One can easily imagine someday concocting a biotech love potion consisting of oxytocin or vasopressin analogues that one could slip into the drink of the object one's affection to nudge him or her into thinking more favorably of your charms.

Welcoming the New Biotech

The next keynoter was Gregory Stock, the head UCLA's Program on Medicine, Technology and Society, and author of Redesigning Humans. Stock addressed on how biotechnological progress will affect human health. Stock's visionary talk urged the assembled futurists to welcome impending biotech developments that will radically boost human life spans, enable parents to genetically enhance their children, allow people to diagnose diseases using a biochip installed in their homes, and permit us to better manage our emotional states. Future medicine will focus less on cures and more on prevention of illness, as researchers reveal more about how the interactions of genes and the environment produce disease.

But how to speed along this kind of medical progress? Stock pointed to some of the regulatory barriers that impede medical progress, especially our current drug approval process. The Food and Drug Administration (FDA) is institutionally risk averse and slow. It now takes 12 years and $1 billion to develop a new drug. "When you read about how much it costs, it's amazing that there any new drugs at all," said Stock. This forces pharmaceutical companies to aim for blockbuster drugs that could treat millions as a way to recover their research and regulatory costs. Therapies that could dramatically benefit smaller patient populations are brushed over. Many of the costs are associated with the attempt to prove the efficacy of new drugs. Stock asked if proving the efficacy of a new drug in advance of its release really necessary. Perhaps not.

Stock suggested reforming the FDA approval process so that new drugs that have passed through phase 1 and 2 clinical trials—which involve initial safety testing, dosage setting and preliminary clinical results—could be made available more quickly to patients. Specifically, before companies could offer their new therapies to patients, they must reveal everything that they know about their drugs, especially side effects and risks. Withholding information would subject the companies to liability and perhaps even criminal prosecution. Using that information, patients and their physicians could then determine their own balance of risks and benefits and decide whether or not to use new therapies. "Let people know all of the information, and then let them make up their own minds," Stock said.

In a sense, this is already happening. Once a new drug gets FDA approval, physicians are free to prescribe it to treat any malady that they think it might help. In fact, such "off label use" occurs in about one in every five prescriptions filled in the United States today. In other words, patients and physicians are already balancing risks and benefits of drugs without specific FDA oversight.

Stock concluded by noting that rapid biotechnological progress makes a lot of people uncomfortable. Indeed, many of the fiercest opponents of biotechnology are concerned that advances will come faster than many boosters believe they will. Stock himself admitted, "I suspect that I would not be comfortable in the world 100 years from now, but so what if we wouldn't like it." After all, a lot of us like modernity despite the fact that many of our ancestors living as adults 100 years ago may not have been comfortable with our world. Stock ended with a quote from the ancient Greek historian Thucydides: "The bravest are surely those who have the clearest vision of what is before them, glory and danger alike, and yet notwithstanding, go out to meet it."

That would be a good motto for the futurists here in Minneapolis to adopt. I will be filing another dispatch rounding up various sessions and talks here at the WFS tomorrow.

Disclosure: Greg Stock is a personal friend, but I don't let his brilliance get in the way of my objective reporting of his work.

Ronald Bailey is Reason's science correspondent. His book Liberation Biology: The Scientific and Moral Case for the Biotech Revolution is now available from Prometheus Books.