Better Than Human: The Promise and Perils of Enhancing Ourselves by Allen Buchanan. Oxford, 2011. 208 pages.

In sports, it has become unfortunately common for athletes to use anabolic steroids and other drugs to improve their abilities. But in the workplace, what if your coworkers were using cognitive-enhancing pharmaceuticals and, as a result, your boss was considering firing you for poor performance? Further complicating the matter, what if you then felt compelled to take these medications but were distressed about potentially devastating side effects?

These are some of the ethical dilemmas raised by the growing use of enhancements, which are drugs and devices that can lift a user's capabilities above normal human levels. Studies in healthy volunteers have demonstrated that various medications can impart cognitive benefits. When adult participants were kept awake for two consecutive nights, the sleep-disorder drug modafinil (brand name Provigil) significantly increased alertness and performance on cognitive tests.

In numerous studies, methylphenidate (Ritalin)—a treatment for attention deficit hyperactivity disorder (ADHD)—improved aspects of working memory, which people use to solve problems. Each year roughly 5 to 10 percent of college students take Ritalin or a related ADHD therapy, Adderall, to enhance their alertness and concentration. Two recent reader polls, in the journal Nature and magazine New Scientist, found that 20 to 40 percent of readers had used cognition-boosting drugs. They are becoming commonplace.

In the future, new technologies may radically extend human abilities. Early-stage research, including work conducted at Duke, has shown that primates can control robotic arms with their minds. In other work, researchers are developing prototypes of electronic contact lenses that might one day provide telescopic zooming, night vision, and in-vision displays. Such innovations are still on the horizon. But their potential widespread use could have profound social, medical, legal, political, and philosophical implications.

Allen Buchanan, a prominent bioethicist and James B. Duke Professor of philosophy, introduces readers to the ethical dilemmas of enhancements in Better Than Human. The problem areas include inequality (what if only the rich can access abilityboosting technologies?), safety risks (what are the side effects in healthy people?), coercion (what if institutional policies or peer pressure compels people to enhance?), corruption of character (what if we become lazy?), and loss of human nature (what would that mean?).

One key concern is that enhancements may widen alreadyexpanding inequality gaps. Buchanan explains that some people assume that these technologies will be expensive; only the rich might afford them. As enhanced people become smarter and more productive—and use their privileged access to knowledge and connections—they might accumulate wealth and political power at even faster rates.

Buchanan reasons, however, that the fear of increasing inequality may be unrealistic. It presumes that enhancement prices will not fall over time, as have the prices of technologies like cell phones and computers. It also assumes that governments will not intervene to improve access. Governments might subsidize innovations that increase productivity (leading to more business growth, jobs, and tax revenue) or reduce criminal behavior (leading to less spending on court fees, rehabilitation, or imprisonment).

The concern over safety may be more significant: The long-term risks of ability- boosting medications in healthy people are unknown. Currently the U.S. Food and Drug Administration regulates only treatments and diagnostics for disease (though Congress could expand the FDA's scope and resources). As a result, drug companies are not required to conduct long-term trials of enhancement efficacy and safety in healthy people, nor are they liable for severe side effects. People acquire enhancements from physicians' off-label prescriptions, Internet prescriptions, or the black market.

Future enhancements also may impart devastating and novel side effects beyond those of typical therapies. Some potential risks are purely medical: A brain implant could malfunction and cause irreparable brain damage or even death. Other risks carry a social element: What if some humans became so altered that they could no longer relate to un-enhanced humans?

Buchanan, who also holds an appointment in the law school, provides guidelines for managing these risks. To help in avoiding unintended harmful consequences, he argues that enhancements should be reversible. This will be easier to achieve for pharmaceuticals and external devices than for interventions like gene therapy and implanted devices. He also asserts that a newly heightened ability should not surpass that of the highest- achieving person in an un-enhanced population, though Buchanan would allow exceptions for some extremely beneficial innovations. A general limit to radical improvements, he contends, would give society time to adjust.

The central achievement of Better Than Human is that it introduces important ethical questions to a broad audience. Written with a cautiously optimistic outlook, the book is a good primer on the ethics of enhancements.

—Andrew McKee

McKee B.S.E. '00, M.D. '05 is a freelance writer based in San Francisco.

Ruhlman's Twenty by Michael Ruhlman '85

Ruhlman's Twenty by Michael Ruhlman '85. Chronicle Books, 2011. 368 pages.

Ruhlman knows food. His credits include nine books (Charcuterie, Soul of a Chef) and seven coauthored cookbooks (The French Laundry Cookbook). He's a New York Times and Los Angeles Times contributor and a judge on shows such as Iron Chef America and Cooking Under Fire. In his latest book, the Culinary Institute of America graduate identifies the ingredients, techniques, and approaches essential to mastering cooking. Each of the twenty sections includes photographs of specific techniques and recipes, ranging from classics such as coq au vin and deviled eggs to braised pork belly with caramel miso glaze and chipotle corn fritters with cilantro-lime dipping sauce.



Loving Animals: Toward a New Animal Advocacy by Kathy Rudy

Loving Animals: Toward a New Animal Advocacy by Kathy Rudy. University of Minnesota Press 2011. 288 pages.

An associate professor of ethics and women's studies at Duke, Rudy contends that in order to achieve such goals as ending animal testing and factory farming, activists need to be better attuned to the emotional and spiritual attachment that many people have with the animals in their lives. The book explores the five realms in which humans use animals—as pets, for food, in entertainment, in scientific research, and for clothing—to broaden support for animal advocacy and societal change.


Lucky Girl by Sharon Hammond McAlister with Charles B. Hammond M.D. '61

Lucky Girl by Sharon Hammond McAlister with Charles B. Hammond M.D. '61. Authorhouse, 2011. 176 pages.

Charles Hammond, who chaired Duke's ob-gyn department for twenty-two years and has published more than 400 scientific articles and books, completed this book after his daughter died in 2009. The book chronicles Sharon's diagnosis and treatment of Stage III breast cancer at the age of fortytwo, and her husband's battle with and death from Lou Gehrig's disease, and includes reflections from her father.


The Vietnam War from the Rear Echelon: An Intelligence Officer's Memoir, 1972-1973 by Timothy Lomperis A.M. '78, Ph.D. '81

The Vietnam War from the Rear Echelon: An Intelligence Officer's Memoir, 1972-1973 by Timothy Lomperis A.M. '78, Ph.D. '81. University Press of Kansas, 2011. 272 pages.

An intelligence officer in Vietnam, Lomperis was part of a command tasked with carrying out the political imperatives of Washington while the military situation on the ground was deteriorating. In his third book about Vietnam, he describes his own moral conundrum as the son of missionaries and an initial Cold War advocate who undergoes gradual disillusionment. Lomperis is a Bronze Star veteran and professor of political science at Saint Louis University.


An Engineer's Alphabet: Gleanings From the Softer Side of a Profession by Henry Petroski

An Engineer's Alphabet: Gleanings From the Softer Side of a Profession by Henry Petroski. Cambridge University Press, 2011. 368 pages.

Petroski's latest general-interest book about engineering includes a selection of thoughts, quotations, anecdotes, facts, trivia, and arcana relating to the practice, history, culture, and traditions of his profession. Petroski is the Aleksandar S. Vesic Professor of civil engineering and a professor of history.





To Free a Family: The Journey of Mary Walker by Sydney Nathans

To Free a Family: The Journey of Mary Walker by Sydney Nathans. Harvard University Press, 2011. 346 pages.

Duke professor emeritus of history Nathans re-creates the efforts of Mary Walker, who escaped from slavery in 1848 and spent the next seventeen years trying to be reunited with the family she was forced to leave behind. Nearly twenty-five years since Nathans first came across the letter that would spark his interest in Walker's case, he has written a book that weaves together historical events, such as John Brown's raid on Harpers Ferry and Reconstruction, with personal details drawn from letters and diaries.

Global Climate Change: A Primer by Orrin H. Pilkey and Keith C. Pilkey

Global Climate Change: A Primer by Orrin H. Pilkey and Keith C. Pilkey. Duke University Press, 2011. 160 pages.

An internationally recognized expert on the geology of barrier islands, Orrin Pilkey—James B. Duke Professor Emeritus of geology and of earth and ocean sciences at the Nicholas School of the Environment— explains the science of global change and its effects. Pilkey and his son, Keith, a lawyer with a longstanding interest in geo-engineering and corporate influence on science policy, describe the greenhouse effect and the damage it is causing, and confront and rebut arguments typically advanced by climate-change deniers and the fossil-fuel industry. Complementing the discussion are batik illustrations by Mary Edna Fraser depicting the large-scale arenas where climate change plays out. Dear Jay, Love Dad: Bud

Dear Jay, Love Dad: Bud Wilkinson's Letters to His Son by Jay Wilkinson '64

Dear Jay, Love Dad: Bud Wilkinson's Letters to His Son by Jay Wilkinson '64. University of Oklahoma Press, 2012. 232 pages.

Bud Wilkinson made history as the football coach of the University of Oklahoma, winning fourteen conference titles and three national championships and setting an NCAA record of forty-seven consecutive wins. This compilation of letters between the legend and his son, who excelled as a varsity football player at Duke, provides a more intimate look at the enduring life lessons he embraced.


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