This thoughtful but inconclusive book sends a mixed message as to whether it's the proper role of doctors to medicate or perform surgery on patients whose only medical complaint is unhappiness or inconvenience. Professors, respectively, of public health and of social medicine and history at Columbia University, Sheila Rothman and David Rothman consider the various uses of estrogen, testosterone, human growth hormone, liposuction and genetic manipulation, showing that these options have from the beginning blurred the line between cure and enhancement. Focusing heavily on how pharmaceutical corporations and physicians profit in the promotion of enhancement therapies, the authors argue that products were marketed to the public without due attention to their possible risks and that studies questioning their benefits and citing related health hazards have been consistently downplayed. At the same time, however, they acknowledge that consumers continue to demand enhancement therapies even when risks are known. Liposuction, for example, has become the most commonly performed plastic surgery, despite a "startling" mortality rate of one in 5,000. Since there is "no consensus on the meaning of enhancing the body" and because consumers perceive liposuction as easy and desirable, the procedure is here to stay. The prose is dry, and there's a shortage of interesting medical case histories, but the book ends with an intelligent exploration of how genetic research could lead to procedures that would double existing life spans. Admitting the serious ethical reservations such a possibility raises even among physicians themselves, the authors end on a disappointingly equivocal note: "Yes, there will be risks-but just imagine enjoying the benefits of an extra seventy years." Photos not seen by PW.
Copyright 2003 Reed Business Information, Inc.
From The New England Journal of Medicine
Many new medical interventions raise important questions about the goals of medicine and the moral legitimacy of medical enhancement. Most interventions that cure, treat, or prevent diseases can also enhance or change human beings. Plastic surgery can repair a child's cleft palate and reduce the size of a person's nose. Viagra can help a man overcome sexual dysfunction and allow a man with normal sexual function to improve his sexual performance. Preimplantation genetic diagnosis can help a couple prevent the birth of a child with a devastating genetic disease and help a couple choose the sex of their child. Even if we could agree that one should not use medical technology to enhance human beings, we would still need to find a way to distinguish between enhancement and therapy. The difference, according to many people, depends on the definition of disease. Medical therapies cure, prevent, or treat diseases, whereas medical enhancements do something different. According to a common theory, a disease is a harmful deviation from the normal range of human variation with respect to a particular trait. For example, a person with congestive heart failure cannot pump blood normally, and a person with type 1 diabetes cannot produce insulin. What is considered normal in one society or culture, however, may be considered abnormal in another. An 11-year-old who is 4 ft tall might be considered a dwarf in the United States but normal in another country. In ancient Rome or Palestine, a person who heard voices inside his head might have been regarded as a prophet. Today, schizophrenia might be diagnosed in someone with that trait. The Pursuit of Perfection, by Sheila Rothman and David Rothman, provides valuable insights into the debate about medical enhancement by exploring the recent history of medicine, including hormone-replacement therapy for women and men, plastic surgery, liposuction, the use of human growth hormone for short children, and research to promote longevity and prevent aging. The authors examine the social, economic, and cultural factors that have contributed to the debate about enhancement. They show that pharmaceutical companies, physicians, and surgeons have profited from selling patients medical products and services that are designed to enhance normal functioning, and that patients have sought and demanded these medical interventions in their pursuit of youthful vigor, femininity, virility, beauty, or happiness. The authors also provide some useful insight into the conflicting attitudes of the medical profession toward enhancement by showing that some physicians have condemned various forms of enhancement as contrary to the goals of medicine, whereas others have promoted enhancement as a way of helping patients realize their goals and achieve happiness. The book is an important contribution to the debate about medical enhancement and should interest clinicians, scientists, policy analysts, and scholars. The book's most important message is that it will be very difficult for society to set boundaries between therapy and enhancement and to regulate enhancement. David B. Resnik, J.D., Ph.D.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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