First Panel Discussion

THE ISSUES OF MAN AND HIS ENVIRONMENT

Chairman: WARREN WEAVER VICE PRESIDENT, THE ALFRED P. SLOAN FOUNDATION

THE purpose of this session of the Convocation is to consider certain problems posed to us by the new environment which man has been creating for himself, largely through science and technology. It is perhaps interesting for us to think for a moment as to why man is facing a new type of environmental problem at the present time.

We know that over long periods of time evolution adjusted man slowly to his environment and furnished for him a set of physiological and other properties which put him into reasonable balance with nature about him. This was a slow process. This was on the whole a painful process. The balance that was thus achieved was in a certain sense a rather low balance, in that man suffered a great deal from miseries, from malnutrition, from physical limitations, from premature death; but nevertheless he was in a reasonable balance with his environment. And then, over the last few hundred years, came Science. And over the last fifty years, in a mad rush - Science and Technology. And the result is that we now live under scientific and technological rates of change which are so rapid that they completely outstrip the mutation rate. We can no longer hope that evolution will succeed in keeping man in balance with his environment. And since we can no longer accomplish this with our genes, we have only one recourse we must do it with our brain.

Now, let me just mention very briefly a few of the topics which come into play. I will simply mention the topics, because I know that my colleagues here on the panel are going to be discussing various of these. There is the problem of the adulteration of food and of other materials, cosmetics and so forth, of which man makes immediate personal use. There is the problem of air and water pollution, smoke, exhaust gases, pulverized automobile tires, commercial waste and so forth. There is the problem of smoking and lung cancer. There are the problems which we might call those of internal pollution - pollution inside the body - and rather curiously, medicine itself sometimes has dangerous relationship with some of these problems of internal pollution, when we have to make use of blood-transfusions and certain processes of immunization; perhaps in some problems of organ transplants. Then there are the problems connected with the fact that we have completely, in certain localities, upset the ecological balance of nature by spraying certain chemicals all over the landscape and by producing thereby resistant strains. And finally, we have the extremely important and worrisome problem caused by radiation - radiation which permeates the air, the soil, the plants, food, our bones and, worst of all, our germ cells. This comes from X-rays; it comes from fallouts; it comes from the background of natural radiation, from nuclear experimentation, nuclear power and from nuclear waste.

The first five of these problems represent things which, so to speak, we do to ourselves and this poses moral problems - this poses problems of conscience; but they are, I would maintain, of a different order of magnitude than the moral problems posed when we do things to our children, our children's children and their children, and, indeed, when we do things to the whole gene pool of the human race.

Now, I would like to raise just one general underlying problem of morality, which I hope may possibly come to the surface in connection with the discussions of my colleagues. And this I am going to call, for purposes of having a label, "The Problem of Statistical Morality." Let me explain very briefly what I mean by this. Most of the great world religions were formed at a time when man was living in a pastoral society; when his immediate family and his immediate neighbors almost completely limited his contact and his responsibility. I suppose the shepherd boy on the hills of Galilee did not have to worry about what harm he was doing to the black man in Africa, or the yellow man in the Orient, or the red man in North America, because there simply was no way in which he could either hurt or help them. But all of this is now vastly changed. We have so many ways nowadays in which we can help and hurt every individual on this planet

Tne curious thing is that m our Western culture we have a very definite feeling that it's wicked to kill a man, and we also have a very definite prejudice against even permitting any one known specific individual to sacrifice his life for the common good. I believe it is true that even in warfare we do not permit an individual to go to certain death. We do not indulge in the kamikaze type of thing. On the other hand, we have to, in a great many circumstances, submit a lot of individuals to partial risk. It is wicked to kill a man, but when does it cease to be wicked to partly kill a man? Suppose the risk is only one in a million that an individual be seriously harmed. Most of us say: "I suspect I run that sort of risk every day that isn't too serious." But suppose that risk is applied to a million persons. Then you are statistically causing a death, and when that death occurs, it is a comfort to our conscience that we don't know where it occurred, or when it occurred. But that individual is just as dead as though we knew all about it. Suppose you reduce this risk to one in ten million. Well, then there is a school of thought that would say: "Am I to worry about a risk of one in ten million? Why, we run that risk when we perhaps climb into and out of the bath tub. Certainly, I can't worry about a risk of one in ten million!" But now apply that risk to all the three billion-odd people on this planet, and what is the statistical result of that? The result is that three hundred people are dead. They are dead at some comfortably unknown place and at some comfortably unknown time. But on whose conscience does that rest? Is that a problem of morality for our present civilization?

Well, I hope that as the discussion goes on my colleagues will remember that we now have, over and beyond this business of being our brother's keeper, and loving our neighbor as ourself - we have to remember that every individual on this planet has now become our brother and our conscience must encompass all of them.

Speaker: GEORGE B. KISTIAKOWSKYSPECIAL ASSISTANT TO PRESIDENT EISENHOWERFOR SCIENCE AND TECHNOLOGY

A CENTURY or so ago human activities in the domain of science and technology were isolated into rather non-communicating areas. There was virtually no intellectual cross fertilization between, say, physics and biology. There also was virtually no interchange between physics or chemistry and engineering. In much the same way, medicine then was an activity which had only a loose connection to natural sciences and which grew from the belief that humans are uniquely different from everything else. In the intervening period, the boundaries between natural sciences have almost vanished, as is for instance evidenced by the popularity of so many new and hybrid technical disciplines: biophysics, molecular biology, atmospheric sciences, applied mathematics, cybernetics, materials research, basic engineering research, etc. The same period has also seen a major intellectual reorientation of medicine. Just as the engineering and technology of today are firmly rooted in basic research, mainly in the area of physical sciences, so the medicine of today derives much of its spectacular progress from basic research in the natural sciences. More and more, it seems, scientific knowledge of the inanimate world and of animate objects other than man, is being used to advance the medical knowledge of man. In other words, the basic scientific knowledge gained from research on man's environment is more and more being used to solve the practical problems of medical progress. I wonder if this means that changes in medical education are needed to provide a firmer grounding for the medical student in the physical sciences?

Observations of the characteristics of our national effort in areas of science and technology, other than the medical sciences, lead one to certain conclusions which might or might not be applicable to medicine. One of the most striking of these characteristics has been our nation's spectacular success in the advance of technology. Some ten to twenty years ago the realization that the progress of technology is heavily dependent upon the progress of basic scientific knowledge began to spread among our national planners and among many private citizens, both the philanthropists and those whose prime concern it was to further the growth of industrial corporations. The outcome of this realization produced a flourishing of basic research in this country which, measured in terms of its recent rate of growth and present status, has been without parallel in the world. But even in the face of the enormous and rapid growth of basic science, the demands of our expanding technology are outstripping the supply of new ideas and new basic knowledge that comes from science. This can be costly to us in time, in human resources, and in money, because some of our technological development tends to be just an engineering elaboration of what already exists, be it the annual changes in automobile models, or the development of some weapons systems. In many such cases the shortage of new principles is compensated for by an ever greater degree of complexity and redundancy. It is this sort of thing that certainly induces argument in favor of the thesis that far greater effort proportionately should now be put into basic research, if the healthy future growth of technology is to be assured.

When it comes to an evaluation of the proper balance between basic scientific research, applied medical research and what might properly be called practical medical developments - comprising together what is usually called medical research - I am certainly not qualified to render a judgment. In the last few decades, due to private and government efforts, very rapid progress in medicine has been achieved. Much of it can be traced to basic research in the natural sciences, such as the discoveries of antibiotics, of X-rays, or the synthesis of DDT so important in preventive medicine. Other achievements are due to a more empirical approach involving large-scale projects, such as the testing of tens of thousands of new compounds synthesized in chemical laboratories for their possible physiological activity. Anti-malarial drugs, for instance, were the outcome of such an effort. Have we reached the right balance between basic research in natural sciences and the usually more costly group efforts directed at the cure of specific diseases? The former may, but then may not, provide new principles for medical applications. The latter, if unsuccessful, are certainly less profitable in the acquisition of new scientific knowledge. I hear some say that we do not have enough basic research and that its strengthening as well as an increased effort to train young scientists in relevant fields of science are our major tasks for today and tomorrow. Others assert that this is too slow an approach and that well-coordinated mass attacks on particular diseases are the highest priority jobs. Still others assert that both types of effort should be pushed harder, but this may demand great safeguards against mutual interference. Which way, then, should we move?

My second problem area is the effect of technological developments on human environment and the conflict that this might create between the health of the individual and the "welfare" of society. The problem is probably more a social and ethical one than a scientific one. However, let me illustrate the problem by some concrete examples. The human race developed - and rather successfully I would say - in an environment of ionizing radiation from cosmic rays and from naturally present radioactive substances. Yet we know that exposure to higher levels of such radiation causes somatic damage and undesirable genetic effects. It must also be accepted that the development of nuclear power and of the industrial uses of radioactive substances are unavoidably accompanied by exposure to some additional radiation. A few months ago the President approved sound recommendations of the Federal Radiation Council on permissible exposure to man-made radiation. These exposures are comparable to the level of natural background radiation, far lower than the levels which have been shown in the laboratory to cause damage, but they do represent an increase in total exposure.

Therefore, we have no scientific proof that the undesirable biological effects of radiation will not statistically be slightly increased. On the other hand, zero exposure level of manmade radiation would mean an end to the uses of nuclear energy, and would result in serious consequences to national security as well as to valuable technological developments.

A similar situation exists in connection with the use of various chemicals in the food production industry. For centuries humans have consumed table salt which usually contains traces of radium, a known carcinogen. From time immemorial lamb meat has been a part of our diet and yet it frequently contains traces of selenium, another carcinogen when ingested in much larger amounts. Should we then insist on mathematically zero concentration of food additives if administration of massive doses in animal experiments has produced an increased incidence of tumors? The consequences of complete prohibition might not be beneficial to society on balance, but to arrive at such an evaluation is far from simple. Thus a hormone, diethylstylbestrol, is fed to cattle to speed growth. Federal regulations now in force restrict its use in such a way that no diethylstylbestrol can be detected in beef with the available analytical techniques, but it may still be present in trace amounts. Were its use prohibited altogether, and the present beef consumption maintained, the cattle industry would have to raise some one-third million additional head. Moreover, beef prices would likely rise and there might be some attendant dietary effects if consumption were curtailed. There also might be a rise in the number of industrial accidents to workers handling the additional cattle. Where, then, is the happy medium?

A distinguished panel of experts whom I brought together at the President's direction struggled with the problem of food additives. It concluded that we know too little about harmful effects of trace additives and will need to know much more if we are to make scientifically valid decisions.

In a totalitarian society which subordinates the welfare of the individual to the abstract concept of the welfare of society as a whole, the answer to the questions I raised would be easy to find. To us, summary decision is not acceptable and so we seek solutions which necessarily are compounded of ethical, social and scientific considerations. Such solutions are based on the rule of reason, as for example in the food additives problem, for they must indeed take account of the "issues of conscience" inherent to the free society.

Speaker: WALSH MCDERMOTTLIVINGSTON FARRAND PROFESSOR OF PUBLIC HEALTH,CORNELL UNIVERSITY MEDICAL COLLEGE

A FAMILIAR anecdote in our folklore of vulgarisms is the one about the guest inquiring where to dump the garbage and being told: "Oh, we just kick it around until it gets lost!" However practicable this might be for hermits, the habit has obvious disadvantages for any larger social group. Yet as whole nations today we seem to be trying to do just that to kick around the extensive chemical refuse of our highly industrialized society in the innocent hope that somehow or other it will get lost!

As we have heard from our Chairman and from Dr. Kistia-kowsky, the sad reality is that our chemical garbage is not getting lost at all, but is lingering intimately with us, polluting the air we breathe, the water we drink and, to some extent, the food we eat. This problem of our environment and its pollution is certainly an important source of economic loss to our society. What is more, it contributes significantly to the erosion of our spirit, as our surroundings become covered with drabness; and at its worst, this continuous environmental defilement can represent a serious menace to our health. A moment's reflection yields the truth that health is not to be considered as the absence of disease. For all living things are diseased almost constantly - our front lawns, our plants, the lower animals and ourselves. In reality what we call health signifies the degree to which a person can operate effectively within the particular circumstances of his heredity and the particular environment in which he lives. As the environment changes, so do the problems in health.

This has always been the case, but in bygone days, when environmental pollution meant a dead horse under the front parlor window, it could hardly escape notice. Today we cannot see or even smell ionizing radiation, thermonuclear radioactive fallout; we cannot see or smell the detergents in our water, or the penicillin in our milk. Even the most dangerous components of smog are not the visible ones but the invisible chemical molecules. And, if today's most serious environmental defilements are invisible, they are likewise inescapable. No longer can one move away from the railroad track and search for a better physical environment in another part of town. Indeed, it has been estimated that by the end of this decade 75 per cent of the people in the United States will be huddled together on 10 per cent of the land area. For air, these 150 million people will have the air over 10 per cent of our large country. For water, they will have the water beneath the surface and what can be brought into that area. You may say that air moves around, but it does not always move around and when it completely stops - just for a few days over a heavily populated area - the consequences can be very serious indeed.

Of all the factors that characterize our situation today, it is this inescapability of modern-style environmental contamination that gives us the greatest concern. But this leads directly into one of the issues of conscience mentioned by Dr. Dubos last evening, and alluded to by Dr. Weaver - namely, the possible serious consequences not, Dr. Weaver, in one's grandchildren but twenty or thirty years from now in today's children. What is happening to our air is such a complete example of this point with its accompanying major issue of conscience, that I propose to concentrate on that in these remarks.

What is the source of the chemicals that pollute our air? As with any other smoke, the chemicals are thrown into the air as a result of burning. In our daily lives we are constantly involved in the process of burning.... When something is burned completely it ends up oxygen and carbon dioxide which would be quite harmless in the concentration involved. In general, however, our gasoline and other fuels and other debris are only partially consumed in the sense of being reduced to carbon dioxide and water. Instead, large quantities of intermediate compounds are formed and thrown off into the air. Some of these materials are visible as soot, which on the whole is relatively harmless, and others are the chemical molecules that are invisible.

It is not always realized that both the chemicals and the meteorologic forces involved in London smog and Los Angeles smog are quite different. In London it is sulphur compounds from the burning of soft coal and it is the London fog moving in and trapping the air, keeping it from cleansing itself, that causes the trouble. In Los Angeles it is the action of the strong sunlight itself on invisible chemicals known as hydrocarbons that are emitted from the tail-pipes of our automobiles, and the meteorologic condition is the so-called thermal inversion, where a layer of warm air happens to get on top of the cold air, and hence pins the air down. So it is fog in London and sun in southern California that end up in the same way....

Both types of smog are highly irritating to our eyes and the delicate membranes of our nose; both can be shown to damage crops and both are injurious to small animals. If something were happening to our people from the pollution of our air, it presumably would be happening to relatively large numbers of people at once. By the same token, it would have to be something that could occur undramatically in each individual person, otherwise it could not fail to get public notice like an epidemic of poliomyelitis. Knowing that air pollutants are highly irritating to the eyes and the delicate membranes of the nose, it hardly took amazing medical detectives to start looking in the most logical places for disease, if it were disease-producing. Then, of course, the places to look were the bronchial tree and lungs, because these represent the one part of our inside organs, so to speak, that is constantly exposed to our outer environment. And when one does look into this matter, it becomes immediately clear that a commonplace bronchial-pulmonary disorder, both chronic bronchitis or emphysema depending on the size of the larynx, is showing an alarming increase in some places, including Great Britain and California.

This is a disease, or closely related group of diseases, that is characterized by chronic cough, eventual loss of breathing capacity and, in time, by failure of the heart. Just how chronic bronchitis or emphysema gets its start is not certain, but the process apparently begins one or two decades before the symptoms of the breathlessness are first noted. There are a few straws in the wind, but no absolutely sound evidence that the continued exposure to polluted urban air can actually start bronchitis-emphysema. Once the process gets its start, however, there is excellent evidence that both the sulphur type and hydrocarbon type of smog can affect it adversely, and the disease is certainly showing an alarming increase....

The problem here, therefore, is the familar one in biology, in medicine - namely, if a substance or mixture of substances present in low concentration can be highly injurious to certain especially susceptible people after only a few days of exposure, how do we know that two or three decades of exposure will not be similarly injurious to a lot more people in addition to just those who are especially susceptible? Indeed, most of us with biologic experience would predict that would be exactly what would happen in such circumstances. But it is this lack of unequivocally solid evidence that here poses our dilemma or issue of conscience....

In medical matters it is frequently necessary to take action after the careful weighing of evidence that would not in itself constitute evidence in the legal sense, and from the present medical evidence here, the probabilities of a serious health threat for future generations are so strong that it certainly is practical wisdom to act now. But whatever environmental contamination we seek to correct in air, water or food, we are facing a problem of formidable proportions, for the contaminations are not the work of evil men, or even slovenly neighbors, as was the case twenty-five or fifty years ago. Instead, today's contaminations are the impersonal reflections of our highly organized society.

To track these contaminations, therefore, inevitably sets up tremors across the whole delicate network of that society. We can continue to breathe what is very probably toxic air on the premise that it is an unavoidable by-product of our wonderful society and that, on balance, life is pleasanter with the polluted air than it would be without. Or, we can choose to have our wonderful society and have clean air too. But to reduce the pollution significantly would require changes in our personal habits and very costly changes for our industry and for our government.

It is as pointless to search for a culprit in this situation as when the living room has been badly cluttered by four small children. Unlike the veteran parent, we cannot choose the easy way of: "I don't care who did it! You pick it up!" We must pick it up all together!

Sir Charles Snow: Our society, as Dr. McDermott said, is becoming increasingly articulate. We're becoming, in St. Paul's words, "members, one of another," not only in local societies, but all over the world. But the trouble is, that is not making us better people. It is, in many significant senses, making us worse people, because we're lacking the extended imagination, the foresight, which Dr. Dubos talked about last night, which is one result of scientific knowledge, yet one that has astonishingly little effect upon our moral actions. For instance, no one at this table - no one in this hall - if he were going to perform an act or take a decision which would mean that some wretched child in the Amazon Valley, of no great importance to anyone but himself and his parents, got leukemia not one of us would take that choice unless the arguments were stronger than I've ever heard. We should not do it, and yet, people around this table, and people in this room, have taken decisions that mean just that. That is brute hard fact of the modern world. Things that we've done have meant the deaths of completely anonymous people in a random way in different parts of the world....

And I'm inclined to think that the reverse, or obverse, of statistical morality is technological cynicism. And I believe that technological cynicism is a state which grows the more advanced one's country is. I believe this technological cynicism is deeper in Sir George's country and mine and in yours, sir, than it is in less developed societies. I believe it's growing upon us day after day; the actual tone of voice in which we discuss these problems is not the tone in which decent men should discuss them, and we do it in a sort of dry flip way, which means we're not immersed - we're not using the extended imagination.

Now, as to what we should do. It is clearly not easy. Some of these problems are going to be much more intractable than others. But that, itself, is a moral trend, because if some problem is not easy, one's inclination in a climate of technological cynicism is to say all the problems are not easy, and that none of them should be tackled at all. Therefore, it seems to me that the first thing is to tell the truth. I believe that is the first duty of all scientists - I believe it's a built-in feature of science itself, and one which makes me feel that it's wrong for us to say that "science is ethically neutral." I never have believed that - and I don't now! I believe that the very fact that truth is part of the very grain of science means that we have an ethical component right in us.

The first thing, then, is to tell the truth. The second thing is not to leave it to society in quite as easy a fashion as some of my wiser friends, and Dr. Dubos last night, would suggest. We happen to know just a little more, we happen to be a little more articulate, we happen, if we're not very bad men indeed, to have our consciences a little sorer, because this kind of statistical morality is something we have to live with.

Dr. Hermann J. Muller: I'm glad to hear this new term "statistical morality" from two independent sources this morning at a conference dealing with medical matters. I'm glad that it is getting near the consciousness of the medical profession in this way, because I have for a long time felt that it was a concept much needed and largely ignored not only by great multitudes, but by the professions that should be most directly concerned with the idea, namely the medical profession and the legal profession....

Coming back to the matter of radiation, the present damage from nuclear weapons fallout is a relatively small fraction of the damage that is being done by the medical use of X-rays. But there again, the medical men will say they're using these for our own good - you've got to balance that against the deaths and suffering that would occur if they weren't used for purposes of diagnosis and therapy. And they can say, "We have direct evidence that these diagnoses save millions of lives." At the same time I quite agree with Sir Charles Snow that before you can make any new assessment at all you've got to know the truth.

And, therefore, the way to convince people that they should allow their physicians to use medical X-rays is not to blind them to the fact that there is damage, but to let them know that there is - admit it - and then decide where the damage is least and the benefit is most. Medical X-rays confer benefits, but the question should be raised in connection with them - could they in some cases be replaced by other methods not carrying the same risk of damage, or could they be replaced by other means of using medical X-rays which didn't involve the same amount of damage? We find today that with a little research it has been possible, although at great expense, to have ways of getting X-ray diagnoses that use ever-so-much less radiation. Now, this wouldn't have been developed, I think, if it hadn't been that some people (not including myself, I'd like to have you know) were alarmists on this matter. I have, of course, been called an alarmist, because I've tried to tell what I think is the truth about it, but I have never, I think, claimed that there has been more damage done than the minimum we know is done.

Well, if that had not been said, ways of reducing the damage would not have been looked for. Here, then, we come to the question of medical conscience. At the time when I was bringing up the matter of the damage done by medical X-rays, I was told (and I wish you to know that I am not a medical man) people from outside medicine should not talk about medical questions, especially shouldn't stir up the public about medical questions - this should be left to the medical profession. I waited thirty years for that to happen, only occasionally speaking about it, and nothing did happen. The whole matter was ignored. Why is it being considered now by the medical profession, with all due respect to them (and I have a great deal)? It's because of the atomic bombs! If the atomic bombs hadn't dropped, the medical profession would still be giving radiation in the same old way, as many of them still are, and there wouldn't have been any attempts made to reduce the damage — or to devise better ways. I think this illustrates, on the one hand, what was said last night, that it is not merely for the medical profession to decide these matters of medical ethics.

But I think, on the other hand, that it is up to the medical profession, too! And very distinctly so! I think it is up to everyone in fields they're conversant with to speak up and try to work out the truths together with others whose fields overlap, and even with complete outsiders, because only with such free discussion, and not with dictatorship, can we arrive at the decisions that will benefit mankind. And scientists especially should speak up on these matters, because I think that it is by no means true that science has no contributions to make to axiology - that is, to the science of values.