The risk of a sixth mass extinction of life and the role of medicine

The worst enemy of man after physical catastrophes is man himself. The process of the sixth mass extinction of life on the planet has been in progress for quite a long time1–3 and the process is anthropogenic. It keeps warning for the end of the most wonderful era in the history of life – the Cenozoic era, the period of mammals. And it's the first time in the history of life a major catastrophe will not be caused by an abrupt and substantial change in the environment, but by a species – the human species. How did man create this crisis? Our biologically reproductive success and Western consumer societies led to environmental disruption. We are almost seven billion on earth and continue to increase by around 80 million a year (we were 3.7 billion in 1970). How many people can this planet support and feed without annihilating the environment? Food production accounts for one-third of greenhouse gas emissions and roughly for 70% of worldwide water use. ‘There can be no permanent progress in the battle against hunger until the agencies that fight for increase food production and those that fight for population control unite in a common effort.’4 Another possible major cause for the sixth mass extinction of life is wars with means of mass destruction – atomic, chemical and biological. Medicine has not been particularly involved with the health of future communities and with our survival as a species. Hippocratic medicine, practised for more than 2500 years, has impressively improved our lives. Yet we are now on the edge of the precipice and medicine is at least partially responsible. In the middle of the 19th century, Pasteur, Lister and Semilwees change our ecological balance (and consequently the process of natural selection) by declaring war against the micro-organisms. The role of ecological evolution has changed from the ‘survival of the fittest’ to the survival of nearly everyone. Hippocratic medicine increased lifespan without adjusting reproduction and the result is population explosion. And human evolution, at least in the Western world, is almost over.5 Medicine isolated now in the fascinating transitional face to genetic and molecular medicine refuses to acknowledge the side-effects of medical progress. What can be done? Biological evolution created our species, characterized by a terrible mixture of humanity and inhumanity, a species sometime benevolent, sometimes evil. This reflects to the controversial and often paranoid human societies and human history. Both are characterized by the continuous swing from the most wonderful achievements in science, biology, technology and the arts, to the most terrible catastrophes, barbarism, wars and genocides.6–8 These characteristics are vividly expressed in the curve of the progress in the sciences and medicine which is rocket-like, while the curve of ethics, ethical values, spiritual awareness and related values remain flat throughout eons. Edward O Wilson characterized human species as an ecological aberration: ‘By every conceivable measure humanity is ecologically abnormal’.9 Another major problem is oblivion. Evolution predisposes us biologically (along with virtually the entirety of the living world) on the basis of immediate survival and short-term games. We don't think and we don't act perspectively.8,10 The human prospect is uncertain. The social and ecological crisis is deep and prolonged and is a historic crisis for it calls the basic premises, the basic presupposition upon which our culture is based, into question. This crisis calls for an interdisciplinary approach to guide us out of the impasse.2 ‘Medicine alone cannot heal a sick civilization,’ notes Antonio Damasio in his book Descartes' Error.11 And biology now plays the role of Cassandra. Only if we revise our concepts will biology play its role in the management of the planet including a new role for medicine. Medicine in a new role has to be applied at two levels. At the level of the population and the ecosystem healthcare would have biological directives with a primary aim of restoring our genetic material to health, bringing reproduction under control and intergrating homo sapiens into the optimized ecosystem. The study of human behaviour, predicated in part on neurophysiology, is a prerequisite. At the individual level Hippocratic medicine should be applied for the benefit of the individual. A political movement by enlightened physicians, scientists, anthropologists and politicians, biologically aware, aware of the pathology of the human mind and brain, with knowledge of human history diachronically, should attempt to redirect, however subtly, the course of events and stop the progress of a sixth mass extinction of life.12–14 This movement should first attempt to incorporate biological world view, to incorporate biological thinking, into the established political, economic, religious and philosophical world views. If this synthesis is achieved, it will create strong incentives for new social formations that will transform our civilization.15–18 The real difficulty is stressed by Albert Einstein: ‘The real problem is in the hearts and mind of man. It is not a problem of physics but of ethics. It is easier to denature plutonium than to denature the evil spirit of men.’ The risk of mass extinction of life is real and possibly imminent.19 Can the medical leadership, the medical thinkers, the medical establishment, remain apathetic?