2013 : WHAT *SHOULD* WE BE WORRIED ABOUT?

We should be worried about the consequences of our increasing knowledge of what causes disease, and its consequences for human freedom. It's exciting that we can figure out what kind of diet and behavior will keep most people well, and it's good to use that knowledge.

But that raises the question of who bears the responsibility if people don't... Indeed, does society have the right to interfere beforehand, precisely because society bears some of that responsibility, if only by assuming the burden of health care costs.

It calls to mind the medical of irony of the cure being worse than the disease, or the immune reaction worse than the pathogen.

In this case, the trigger is our increasing knowledge of how we make ourselves sick—or how we can keep ourselves healthy: proper diet, regular exercise, no smoking, limited drinking, sufficient sleep.... In other words, it's becoming pretty clear that a squeaky-clean lifestyle (and just for good measure, add in avoidance of stress) is the key to good health for most people, and to reducing medical costs dramatically for society as a whole.

In addition, we are increasing our knowledge of genetics and specific markers for susceptibility to disease. There are certain people with genetic predispositions to certain conditions who need to take additional measures to stay healthy. Over time, we will know more of these specific correlations, and be able to identify—if we want—people with increased predisposition to certain diseases—and there fore increased responsibilities?

The thing to worry about is how society handles this knowledge, both in general and for the specific people who carry extra burdens. We all know of artists and others who were at least somewhat crazy. Many of them avoided treatment for fear—justified or not—of losing their creative gifts. Other people simply want to be themselves, rather than some medicated version.

And while much medical knowledge may be true, not all of it is... Certainly, it keeps changing! Many drugs and other medical treatments don't do much; others cause collateral damage. How much is an extra month of life worth if you're diminished by the side effects of life prolongation?

In short, the notion of unpredictable health catastrophes is giving way to something closer to flood plains. People are rightly asking whether society should pay to protect people who live in predictably dangerous areas, refuse to wear helmets while riding motorcycles, and so on. But when somebody actually undergoes such a catastrophe, even a predictable one, attitudes change, and the government offers disaster relief.

Such rare occasions are becoming more common.

So the questions are: What duty do we have to live properly? What responsibility do we have for the consequences if we do not? How much can we blame on our parents, or society, or whomever—and even so, what responsibilty do we bear? Should society pay for prevention but not for remediation of avoidable outcomes? Should we force special responsibilities on people with particular vulnerabilities?

These questions aren't new, but they will become more urgent as we get better at predicting or avoiding outcomes.

There are no simple answers to define or to allocate responsibility. That's why we should be worried.