What Cigarettes Can Teach Us About the Risks of Breakthrough Technology
In cigarettes, we’ve invented a deadly vice that is immune to natural selection and our own reasoning. They’re not the only product we’ve built with those characteristics.
The series “Guidance Systems” discusses technologies that seem to improve our lives by offering us new choices, while in fact shaping or removing our ability to decide things for ourselves.
At the age of 14, Sean David imagined becoming a doctor. “I wanted to be Marcus Welby,” he remembers. So in the year after graduating college, he began to work in a hospital any way he could. He became an orderly, scrubbing out surgical theaters after each procedure.
“You go in, you pick up all the biological waste and dispose of it. You put this sudsy soap on the floor and mop and hose it down, go room to room,” he remembers. “The orthopedic cases were really rough, they use hammers and saws, they leave a lot of stuff behind.” But he was building his mental capacity for observing, up close, the failures of the human body, and he says the work was satisfying, in its way.
Then, in 1991, his supervisor found him as he was wheeling a bucket between rooms, and took him aside. “Your father is in the catheter wing,” he told David.
“My dad’s a banker, a VP of marketing, type A, he wore Brooks Brothers suits and smoked cigars and cigarettes and flew all over the world. He’s an intense guy,” says David. “I went into the waiting room, and there was my mother, and the president of the bank where my dad worked.”
Cigarettes had always been part of David’s memories of his father. “We’d go fishing and he’d be smoking cigarettes. I remember him putting bait on the line with a cigarette in his mouth. It wasn’t unusual in those days.”
But now his dad was lying pale and weak in a hospital. It was the first time David had ever seen him this way.
The cardiac surgeon told David and his mother that David’s father, who’d come in with chest pains, had a heart lesion that would require a bypass. And as the surgeon walked back into surgery to get started, David realized “I had just finished cleaning that room. That very room.”
David’s father survived the procedure. “I grew up and valued my father more than ever,” David says. “I never took a day for granted after that.”
And he had determined what he wanted to do with his medical training. “It became clear that smoking is life and death,” he says. “So many people don’t survive that first heart attack. So emotionally, I’m very driven by this.”
The admissions director at the University of Washington, where David applied for medical school, was that same cardiologist who operated on his father. And after medical school, David began a research career studying why it is that patients who show every outward sign of wanting to quit smoking simply cannot do it.
Ultimately, he says he believes there are a few basic facts of cigarette addiction that anyone hoping to fight it off must understand. The first is that it plays perfectly on our psychological frailties. “People consistently underestimate the risk of smoking,” he says. “It’s a 50% chance of premature death. That’s one in two. A one-in-six chance of lung cancer. The risks are huge, but somehow risk has become attractive.” Human beings simply lack whatever it is they need to truly internalize the danger, he says, and to avoid the deadly gamble altogether.
So avoiding tobacco, and fighting off the grip of addiction, needs to be sold, just as the cigarettes themselves are sold. “There has to be a key promise, something to get you out of smoking,” he argues. “We need formative research that finds out what motivates different audiences, because I haven’t seen a sustained public health campaign that resonates with every segment of the population. Maybe if we could talk about lung cancer — but the trouble is, there aren’t a lot of survivors, so there isn’t a good advocacy group out there.”
And finally, he believes that there is no natural mechanism that will simply cause humanity to stop smoking. “People live to reproductive age while smoking, so evolution can’t touch it, can’t wipe it out,” he says. In creating cigarettes — a consumer technology that delivers a consistently satisfying experience in a portable package — we’ve invented a deadly vice that is immune to natural selection.
This is the difficulty of the modern world. Scientific breakthroughs lead to new technologies upon which we build new businesses and, eventually, entire industries. And yet those technologies have outpaced our understanding of their risks and rewards. They often prey on our psychological frailties, excite us when they should revolt us, and evade our natural ability to improve our behavior over time. We push ahead into businesses with no clear understanding of just how completely they may serve to control the customers they serve, and how that manipulation may affect everyone else. These are what we’ll call guidance systems, and in the next few installments I’ll be exploring a few of them in depth.
We live in what Thomas Friedman calls the Age of Acceleration, when breakthroughs in fields like mathematics and computation are arriving every day, and entrepreneurs are just as quickly turning those breakthroughs into products.
At the same time, however, research is also beginning to reveal uncomfortable truths about the inner workings of our mind. New studies of human decision making shows that we’re prone to common mistakes of judgement and estimation, that we are allergic to uncertainty and will pay unreasonable sums of money to feel more reassured, that we misremember the past, that emotions often make our decisions for us. These are, in fact, cognitive gifts, part of an evolutionary inheritance that has worked wonderfully at keeping us alive for the vast majority of human history.
The trouble is that now we’re engineering products to appeal to those inner workings without fully understanding just how susceptible we are to being guided and manipulated, not to mention that the mental and physical health of entire generations could be at stake.
The entrepreneurs of right now, the ones that believe in the power of enlightened businesses to change the world for the better, need to understand just how deep this problem can go. My intention with this series is to help explain to those entrepreneurs a few of the deepest and most dangerous pitfalls science has uncovered in human psychology and sociology, and hopefully to establish the groundwork for a new conversation about the responsibility of business to help make up for those frailties, rather than taking destructive advantage of them.
Sean David — now a doctor at Stanford — is working on creating new ways to measure our addiction to cigarettes. He’s looking for biological indications of addiction and recovery. He’s already found a few potential genetic indications that may help addiction specialists tailor their treatments for particular patients. And in a new study, he’ll be putting ex-smokers inside an MRI scanner to look at their brain patterns while they’re shown reminders of cigarettes and smoking.
This is good work, made possible by the latest technology. And we need it. Because even now, when medical consensus has clearly determined the health threat posed by cigarettes, and the overwhelming addictiveness of smoking, medical science doesn’t even have a clear way of measuring the extent to which someone is addicted, nor their capacity to quit. We made cigarettes before we had any sense of how deadly they’d be. We certainly didn’t know how we’d measure whether people were addicted to them. Billions were made in that industry before those questions even came up. Dr. David points out that today we still don’t have a reliable way of measuring and treating cigarette addiction.
“It’s not as straightforward as treating something with an antibiotic,” Dr. David says. “Our models for care are wrong for this kind of thing. It needs to be very intensive. We’re not built for that.”
If it’s taken this long for researchers to hone in on a possible evaluation of smokers, it will be years before we have a clear sense of the ways in which social media, mobile devices, digital entertainment, chatbots and other new technologies guide our behavior and take away our ability to make rational decisions for ourselves. These guidance systems make for powerful, profitable businesses. But what will they do to us in the process?
Jacob Ward, the former editor-in-chief of Popular Science magazine, is a television correspondent for PBS, Discovery, National Geographic and Al Jazeera English, covering the intersection of technology and ethics. He’s host of the Complicated podcast on Audible, and his four-hour public television series on the science and social implications of bias and human decision making, Hacking Your Mind, airs in 2018.