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Wondergenes not only imagines a future world in which genetic enhancement is the norm, but asserts that this future has already begun. Genetically engineered substances are already in use by athletes, in vitro fertilization already provides the primitive means by which parents can select an embryo, and the ability to create new forms of genetically engineered human beings is not far off. What happens when gene therapy becomes gene enhancement? Who will benefit and who might be left behind? What are the costs to our values and beliefs, and to the future of our society? To answer these questions, Maxwell J. Mehlman provides an overview of the scientific advances that have led to the present state of genetic enhancement and explains how these advances will be used in the future to redefine what we think of as a normal human being. He explores the ethical dilemmas already facing researchers and medical practitioners, and the dilemmas we will all be expected to face. In his forecast of the dangers inherent in this technology, he is particularly concerned with the emergence of a genobility made up of those able to afford increasingly expensive enhancement. Wondergenes is a serious, accessible introduction to the social and personal implications of genetic engineering. Mehlman weighs the social and economic costs of the many proposals to regulate or limit genetic engineering and provides six concrete policy recommendations -- from professional licensing to a ban on germ-line enhancement -- that propose to make the future of genetic enhancement more equitable and safe.

What will happen when technology allows us to direct our own evolution? Transhumanists advocate for the development and distribution of technologies that will enhance human intellectual, physical, and psychological capacities, even eliminate aging. What if the dystopian futures and transhumanist utopias found in the pages of science journals, Margaret Atwood novels, films like Gattaca, and television shows like Dark Angel are realized? What kind of world would humans have created? Maxwell J. Mehlman considers the promises and perils of using genetic engineering in an effort to direct the future course of human evolution. He addresses scientific and ethical issues without choosing sides in the dispute between transhumanists and their challengers. However, Transhumanist Dreams and Dystopian Nightmares reveals that radical forms of genetic engineering could become a reality much sooner than many people think, and that we need to encourage risk-management efforts. Whether scientists are dubious or optimistic about the prospects for directed evolution, they tend to agree on two things. First, however long it takes to perfect the necessary technology, it is inevitable that humans will attempt to control their evolutionary future, and second, in the process of learning how to direct evolution, we are bound to make mistakes. Our responsibility is to learn how to balance innovation with caution.

Few would question the necessity of artificial limbs for amputees. But what of surgery to lengthen the legs of children who are merely shorter than average? Hardly anyone would challenge the decision to prescribe Aricept to people with dementia. But is it acceptable to give the same medication to airline pilots seeking sharper mental focus on long-haul flights? Humans have engaged in biological self-improvement since long before recorded history, from the impotence-curing wild lotus brew of the ancient Egyptians to the herbal energy drink favored by early Olympians. Now biomedical enhancements are pushing the boundaries of possibility and acceptability. Where do we draw the line? How do we know the true ramifications of pioneering medicine? What price are we willing to pay for perfection? Maxwell J. Mehlman's provocative examination of these issues speaks to fundamental questions of what it means to be human. He finds public officials ill-equipped to handle the ethical, scientific, and public policy quandaries of biomedical enhancement. Instead of engaging difficult questions of morality, access, fairness, and freedom, elected officials have crafted toothless and counterproductive laws and regulations. Mehlman outlines policy options to boost the societal benefits and minimize the risks from these technologies. In the process, he urges the public to face the ethical issues surrounding biomedical enhancement, lest our quest for perfection compromise our very humanity.

The idea that physicians should accept recommendations from learned colleagues on how to practice medicine is probably as old as medicine itself, but beginning around 1990, it took on new urgency in the face of rising health care costs, widespread, unjustifiable variation in practice patterns, concerns about medical errors and quality of care, and what some perceived to be perverse effects of the malpractice system. One solution put forward was practice guidelines, which the Institute of Medicine (IOM) defined as systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.

The ability of patients to trust physicians to act in their best interests is a critical aspect of a welfare-maximizing relationship. This commentary discusses physician trustworthiness within the framework of the Affordable Care Act and considers steps to reinforce trustworthy behavior.

A large and highly heterogeneous group of individuals conducts genetic and genomic research outside of traditional corporate and academic settings. They can be an important source of innovation, but their activities largely take place beyond the purview of existing regulatory systems for promoting safe and ethical practices. Historically the gene-targeting technology available for non-traditional genomic research has been limited, and therefore these activities have attracted little regulatory attention. New technologies such as CRISPR/Cas9, however, give nonconventional experimenters more extensive gene editing abilities at an unprecedented level of accessibility. The affordability and accessibility of these powerful technologies are raising questions about whether the current largely laissez-faire governance approach is adequate. This article recommends steps to enhance self-governance, including establishing umbrella organizations to represent community interests, creating a community IRB modelled on the DIYBio Ask a Safety Expert Service, and adopting an ethical obligation to report rogue experiments.

Purpose The use of genomic sequencing (GS) in military settings poses unique considerations, including the potential for GS to impact service members’ careers. The MilSeq Project investigated the use of GS in clinical care of active duty Airmen in the United States Air Force (USAF). Methods We assessed perceived risks, benefits, and attitudes toward use of GS in the USAF among patient participants ( n  = 93) and health-care provider participants (HCPs) ( n  = 12) prior to receiving or disclosing GS results. Results Participants agreed that there are health benefits associated with GS (90% patients, 75% HCPs), though more HCPs (75%) than patients (40%) agreed that there are risks ( p  = 0.048). The majority of both groups (67% HCPs, 77% patients) agreed that they trust the USAF with genetic information, but far fewer agreed that genetic information should be used to make decisions about deployment (5% patients, 17% HCPs) or duty assignments (3% patients, 17% HCPs). Despite their hesitancy, patients were supportive of the USAF testing for nondisease traits that could impact their duty performance. Eighty-seven percent of patients did not think their GS results would influence their career. Conclusion Results suggest favorable attitudes toward the use of GS in the USAF when not used for deployment or assignment decisions.

The abortion controversy has dominated the conversation about the relationship between reproductive information and reproductive decision-making, as Rachel Rebouché aptly demonstrates in her article in this collection entitled “Non-Invasive Testing, Non-Invasive Counseling.” Professor Rebouché focuses on the newest reproductive information technology, non-invasive prenatal testing (NIPT). She describes legislative efforts to restrict both the information that can be obtained from NIPT and the actions that can be taken as a result of that information: Tennessee’s prohibition of government-sponsored NIPT for incurable conditions; Arizona’s and Oklahoma’s extension of immunity to physicians who decline to disclose fetal anomalies; Virginia and Nebraska permitting genetic counselors to omit discussing abortion as an option; North Dakota’s ban on abortions for fetal anomalies detected through prenatal testing; requirements that physicians record their patients’ reasons for seeking abortions; prohibitions in nine states on abortions based on the gender of the fetus; as well as a federal bill, the Prenatal Non-Discrimination Act (PRENDA), that would make it illegal to abort a fetus on account of its sex or race.

New drugs that enhance cognition in cognitively healthy individuals present difficult public policy challenges. While their use is not inherently unethical, steps must be taken to ensure that they are safe, that they are widely available to promote equality of opportunity, and that individuals are free to decide whether or not to use them.