Getting in Nature’s Way

Scientifically advanced nations, most notably the US, seem on the verge of a new situation in which the traditional goals of doctors and others concerned with health care will be radically altered. The changes will be the result of increased understanding of the basic molecular mechanisms shared by all living things and a widened ability to devise technological methods by which those processes may be manipulated. More than a few observers of the biomedical scene believe that we are about to enter an age in which the improvement of human bodies and minds will become a primary goal in research and clinical treatment. Some of these observers are hopeful; some point to the possibilities of inherent and unforeseeable danger.

Until little more than a century ago, the only aims of medical care were the cure of disease and the relief of human suffering. But the definition of “human suffering” has gradually changed. We now find ourselves faced with the reality that it is no longer sufficient to prevent or treat sickness of the body or mind, but that physicians are expected to address increasing attention—and society’s dollars—to the millions who are dissatisfied with what nature and their own DNA have given them. Whether for rhinoplasty, botox injections, or a prescription for sex hormones, thousands of men and women daily make their way to doctors’ offices, intent on improving themselves. Not sick in any usual definition of the word, such discontented people would like to be better than they are, better than merely well. Even “better” may not be enough. That is why Sheila and David Rothman have called their cautionary new book The Pursuit of Perfection.

If the pronouncements of some futurists are to be believed, enhancements of human appearance and function will soon be so effective and commonplace that many will wonder in coming years why some critics scoffed when Gregory Stock, director of the Program on Medicine, Technology and Society at UCLA, called his book Redesigning Humans: Our Inevitable Genetic Future.1 The title of Stock’s opening chapter was “The Last Human,” by which he meant those few remaining whose bodies and minds have been formed by nature and nurture alone. As they age to more than double the biblical three score years and ten, the contented beneficiaries of the coming technologies may look back with scorn at the bioethicists and others who criticized William Haseltine, the biotech entrepreneur and CEO of Human Genome Sciences Incorporated, when he proclaimed to a New York Times reporter, “I believe our generation is the first to be able to map a possible route to individual immortality.”2

These are the outcomes envisioned by the pioneers who believe a biogenetic gold rush will soon take place. But every new technology carries the possibility of introducing unacceptable risk as well, which is why the subtitle of the Rothmans’ book is “The Promise and Perils of Medical Enhancement.” The Rothmans deal not with the future, but with such recently popular treatments as hormone replacement…

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