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The Humanitas Project A CENTER FOR BIOETHICS EDUCATION |
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Living in the Biotech Century News, Resources, and Commentary |
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May 6, 2004
What is the purpose of medicine? Is Ugliness a Disease? by Carl Elliott
New medical treatments for ‘conditions’ such as short stature or anxiety are sweeping America. But it's society, not the patient, which is ill.
“Something strange is happening in American medicine. No longer is it being used merely to cure illness. Medicine is now being used in the pursuit of happiness. In America, we take Viagra at bedtime and Ritalin before work. We inject Botox into ourwrinkled brows and rub Rogaine on our balding heads. We swallow Paxil for shyness, Prozac for grief, and Buspar for anxiety. For stage fright we use beta blockers; for excessive blushing and sweating, we get endoscopic surgery. We ask surgeons to trim down our noses, suck fat from our thighs, transform us from men to women, even amputate our healthy arms and legs in the pursuit of what some people believe to be their true selves. Twenty years ago, most doctors said no. Now many have changed their minds.
“Not all of this is new, of course. Cosmetic surgeons were setting up shop as far back as the 1930s, and antidepressants and anxiety drugs have been around for more than 50 years. Nor are all these so-called ‘enhancement technologies’ merely enhancements. Antidepressants can be used to treat severe depression as well as to make well people ‘better than well.’ Yet at no time in history have Americans been such enthusiastic consumers of these technologies….
“This is not simply a matter of the industry creating illnesses out of thin air. The suffering these interventions treat is often genuine. But much of it differs sharply from the kind of suffering that comes from ordinary medical conditions. Often (though not always) it is social in nature. If you have diabetes or heart disease, you suffer regardless of who is watching you or how they perceive you. But the suffering that comes from being too short, too shy or too small-breasted is bound up with the way these characteristics are seen by other people. Yet once social problems can be treated by medical technologies, they come to be seen as medical problems. Then doctors are much more comfortable treating them….”
The Guardian – August 26, 2003: http://www.guardian.co.uk/health/story/0,3605,1029279,00.html.
The recent development of “enhancements,” procedures designed to make people “better than well,” as a significant part of American medicine is discussed more fully in Carl Elliott’s book, Better than Well: American Medicine Meets the American Dream (W. W. Norton & Company, 2003).
Just when would you get the “disease” of aging? Is Aging a Disease? It's Debatable
“Aging can make your skin sag, your joints hurt and increase your risk of disease.
“That's just for starters.
“Here's another wrinkle: Aging itself may be a disease.
“That theory drew attention recently when it emerged as the topic of a live debate and Webcast sponsored by SAGE Crossroads, a Washington, D.C.-based online forum for issues on human aging.
“Proclaiming aging a disease makes good sense, says Arthur Caplan, a former director of the Center for Bioethics at the University of Minnesota.
“‘The changes of aging are like disease. They have all kinds of symptoms and problems that lead to disorders, malfunctions and difficulties for us,’ says the nationally known ethicist who heads the University of Pennsylvania’s Center for Bioethics.
“Aging hasn’t been defined as disease because it’s considered universal and natural, he explains. He disputes both. ‘It isn’t always universal, because it happens to different people at different rates.’ And it isn’t natural but rather a process that ‘just got designed into us,’ he says.
“Harry ‘Rick’ Moody, Caplan’s opponent in the Webcast debate, calls the age-as-disease theory ‘a terrible idea.’ It’s more important to focus on older people’s well-being than their physical decline, says the director of the Institute for Human Values in Aging, affiliated with the New York-based International Longevity Center.
“More people age 65 and older are alive today than ever, he points out. ‘The worst thing we can do under those circumstances is tell them, “‘And by the way, you’ve got a disease,’” he says. ‘Instead we should begin to celebrate growing older and looking for the assets, not just the deficits.’…”
Knight Ridder Newspapers/azcentral.com (requires free registration) – February 25, 2004: Please click on the following link for the rest of this article: http://www.azcentral.com/health/wellness/articles/0225aging-disease-ON.html.
To read the transcript of the debate between Caplan and Moody, click on http://www.sagecrossroads.org/. Next, click on “Webcasts” and then on “Video Archive.” Scroll down until you find “Is Aging a Disease?”
Have we also made childbirth a disease? Too Posh to Push?
“It’s becoming known as the ‘too posh to push’ phenomenon thanks to recent media stories, but the reality is, the rate of caesarean births (C-section) in industrialized countries is rising. In Canada, there has been ‘a jump of almost three per cent in the last two years,’ said Dr. Jan Christilaw, an obstetrician at B.C. Women’s Hospital in Vancouver….
“At the moment, SOGC [Society of Obstetricians and Gynecologists of Canada] says that vaginal birth is the preferred option for most women and that C-section births are reserved for medical reasons. ‘Health-care professionals strive for the lowest possible risk to the pregnant woman and as such, patient-physician discussion and informed consent are extremely important in order for patients to understand the risks of such an operation,’ SOGC said in a release in early March….
“Some, but definitely not all, experts feel the risks and benefits for health are the same for either method, and hospitals say the costs to the health-care system are about equal. Cesarean rates in Canada fell from 20 per cent of live births in 1986 to 15 per cent in 1994, but rose again to 19.6 per cent in 1997. In the United States, the rate of caesarean delivery reached an all-time high of 26.1 per cent in 2002.
“The World Health Organization stated that a caesarean section rate of over 15 per cent indicates ‘inappropriate usage.’ The International Caesarean Awareness Network lists caesarean rates in Brazil at 40 per cent (1999), Australia at 21.1 (1998) per cent and Bolivia at five per cent (1997)….”
Editor’s Note: This article concludes with a good “risks/benefits” analysis of caesarean section.
CBC News Online – March 4, 2004: http://www.cbc.ca/news/background/csection_births/.
Perhaps, his genes made him write a book called the “Blank Slate”.... Pinker Says It’s Nature, Not Nurture
Genes, instincts determine thoughts, feelings, behavior.
“According to Steven Pinker, every human exclamation, every chuckle, every expression of love stems not from life experience, but from millions of years of human development.
“The best-selling author and Harvard professor argues that evolution, more than environment, has shaped the human mind – echoing Charles Darwin’s famous contention that natural development, occurring over centuries, altered the makeup of the human body.
“In his latest book, ‘The Blank Slate,’ Pinker takes aim at the theory that people are born with minds that are blank, to be filled by experiences and lessons. Instead, he contends, many human behaviors are the product of genes and, thus, innate.
“‘During the past century the doctrine of the blank slate has set the agenda for much of the social sciences and humanities,’ Pinker writes. ‘... [P]sychology has sought to explain all thought, feeling, and behavior with a few simple mechanisms of learning.’…”
CNN – April 19, 2004: For the rest of the article, click on this link: http://www.cnn.com/2004/WORLD/americas/04/16/pinker/.
Proposing another way to use stem cells....
Scientists Plan Teeth that Regrow
False teeth could become a thing of the past thanks to stem cell technology, scientists at London University say.
“Successful tests on mice show the technology may let people grow their own replacement teeth.
“The London team at Kings College have been awarded £500,000 ($887,500) to further their research and have set up a private company, Odontis, to develop their plans.
“The scientists say the technology will allow those with missing teeth to fill the gaps in their mouth without having to resort to false teeth, bridges or synthetic implants.
“The technology works by taking stem cells – ‘master’ cells that can be programmed to make different kinds of tissue – from the patient which are treated and cultured in the lab.
“They are then re-implanted in the patient's jaw under the gum where the tooth is missing.
“Prof. Paul Sharpe, the genetic research scientist behind the technique, told the UK’s Press Association that it was hoped the tooth would then grow into a fully-formed, live tooth in around two months.
“He said the technique had been tested in mice and they hoped to move on to trials in humans in the next two years….”
CNN.com/International – May 3, 2004: http://edition.cnn.com/2004/WORLD/europe/05/03/teeth.replace/.
The President’s Council on Bioethics makes recommendations on reproductive biotechnologies...but does the council get it right?
The Politics of Bioethics, by Eric Cohen and William Kristol
“‘Nothing illustrates this administration’s anti-science attitude better than George Bush’s cynical decision to limit research on embryonic stem cells,’ declared John Kerry in a December 2003 campaign speech. He was referring to the president’s August 9, 2001, decision to permit federal funding for existing embryonic stem cell lines, where the embryos in question had already been destroyed, but to deny funding for research involving further embryo destruction….
“Since the president announced his stem cell policy in August 2001, the science of the brave new world has continued apace—not just the destruction of human embryos on a growing scale, but the manipulation of human reproduction in radical new ways. In its latest report, Reproduction and Responsibility, the President’s Council on Bioethics finds that the practice of assisted reproduction technology (ART) is largely unregulated. New baby-making technologies are introduced willy-nilly into clinical practice, with little research regarding their effects on the children produced with their aid. Because so many embryos are implanted all at once, nearly half the children born using ART are twins or triplets with disproportionately and often dangerously low birth weights. Some ART clinics already advertise cosmetic baby-making services—such as preimplantation genetic screening to choose the sex of one's child—and these services only promise to increase as our genetic knowledge expands. And it is the ART clinics and their patients that produce thousands of ‘excess’ embryos each year—embryos that are frozen indefinitely or destroyed for research….
Editor’s Note: This essay is an outstanding overview of the current status of the debate about assisted reproductive technologies. It deserves a close and thoughtful reading, especially by those of us who worry that the President’s Council on Bioethics may have given too much away in their proposal.
The Weekly Standard – 05/10/2004, Volume 009, Issue 33: This article is available free (for a limited time) at this address: http://www.weeklystandard.com/Content/Public/Articles/000/000/004/038fujkx.asp.
Could science make men unnecessary? Mouse Created Without Father
Scientists turn egg cell into surrogate sperm.
“From time immemorial, making a mammalian baby has involved two essential ingredients: eggs and sperm. Now Japanese scientists have written men out of the reproduction rule-book, and created fatherless mice.
“The team made the animals by combining the nucleus of one female’s egg with that of another, essentially creating a mouse with two mothers. ‘It is a bit of a surprise,’ says evolutionary biologist David Haig of Harvard University, Boston.
“After nearly 460 attempts at growing embryos, ten live pups were born and just one of those survived to adulthood. Christened Kaguya, from the story of a girl discovered in a bamboo stump, the mouse is now 14 months old and has babies of her own. She is ‘very healthy’, says team leader Tomohiro Kono of Tokyo University of Agriculture.
“Some might say that Kaguya is living proof of men’s futility, in the baby-making stakes at least. But scientists maintain it is premature for chaps to step aside in human reproduction: there are significant obstacles to transferring the technique to the fertility clinic.
“Like human reproductive cloning, which is thought unsafe, it is not known whether the animals produced are entirely healthy and normal. The technique is also hugely laborious, has a high failure rate and would involve genetically engineering a human egg, which is generally considered to be ethically unacceptable….”
Nature – April 22, 2004: http://www.nature.com/nsu/040419/040419-8.html.
Growing skin on a bandage....
‘Living Bandages’ Heal Burns with Patient’s Cells
“British scientists have developed ‘living bandages,’ made from a patient’s own cells, which speed healing for burns and diabetes sufferers.
“The biological bandages, launched at the British Burns Association meeting on Tuesday, have been used successfully on patients with severe burns and diabetics with chronic wounds.
“‘It is a convenient way of using the patient’s own cells to heal wounds,’ Professor Sheila MacNeil, of the University of Sheffield, said in an interview.
“‘This is a simple dressing to take laboratory-expanded cells and deliver them back to the patient’s wounds.’
“MacNeil, who developed the bandages called Myskin with her Sheffield colleague Professor Robert Short, said the bandages can be placed on wounds five to seven days after a sample of cells has been taken from the patient and grown on specialized discs in the laboratory.
“After the bandage has been applied to the wound, the discs release the cells and prompt new layers of skin to grow in the damaged areas. The bandage is removed after the cells have migrated to the wound….”
Reuters – April 26, 2004: http://www.reuters.com/newsArticle.jhtml?type=healthNews&storyID=4945853.
The unintended consequences of technology.... Study Links Dental X-Rays during Pregnancy to Smaller Babies
“Pregnant women are advised to avoid having medical x-rays taken to avoid harming the developing fetus. Now a study published by the Journal of the American Medical Association links dental x-rays administered during pregnancy to low birthweight babies.
“Philippe P. Hujoel of the University of Washington and his colleagues studied the records of thousands of women who received dental treatments between 1993 and 2000 in Washington State. The team compared the list to birth certificate records and found that 1,117 of the patients for whom they were able to obtain dental records had delivered low birthweight infants. According to the report, expectant mothers who underwent dental radiography were three times more likely to have a full-term baby weighing in at under five pounds, eight ounces than were women who had not had dental x-rays. ‘We were surprised by the finding, but it does bear out previous studies that found that other types of diagnostic radiation, such as diagnostic radiation for spine problems, also were associated with low birthweight,’ Hujoel says….”
ScientificAmerican.com – April 28, 2004: http://www.sciam.com/article.cfm?chanID=sa003&articleID=000AFD6E-C03C-108E-803C83414B7F0102.
Using biological computers to produce “smart drugs”.... DNA Computer Could Fight Cancer
“New computers made of biological molecules that react to DNA hold the promise to diagnose and treat diseases such as cancer by operating like doctors inside the body, Israeli scientists said.
“The devices, used in test-tube experiments, already have demonstrated the ability to identify and then destroy prostate and lung cancer cells, but their creators cautioned it could be decades before such biological computers find their way into medicine.
“‘The hope is that someday this direction will help lead to a new concept of “smart drugs,”’ said researcher Ehud Shapiro, a computer scientist at the Weizmann Institute of Science in Rehovat, Israel.
“‘Today’s drugs are like carpet bombing – you take a large amount of drug molecules and they go all over the body,’ Shapiro told United Press International from Brussels. ‘A smart drug would only operate where the condition of disease holds.’
“Shapiro and colleagues have created a series of biological computers in the past five years – several trillion of which can fit in a drop of water. Their software is made of DNA, while the hardware is made of DNA-manipulating enzymes.
“The computers work on genetic material, specifically ribonucleic acid or RNA, the smaller cousin of DNA. The body uses RNA often to transmit messages in the cell. Strands of DNA and RNA can bind if the sequences of molecules that make both up match.
“Diseases such as cancer leave their own chemical fingerprint in the body, including over-producing or under-producing specific RNA sequences. The computer’s enzyme hardware chops up the RNA it finds. If those bits bind to a computer’s DNA software – which is encoded to look for cancer sequences – the computer then can release a drug….”
UPI/SpaceDaily.com – Apr 29, 2004: http://www.spacedaily.com/news/spacemedicine-04r.html.
Worth considering....
“The first concrete project for citizens who live in hope is to insist that we name things accurately and appropriately. Why is this so vital? One extraordinary sign of our times is a process of radical alteration in language, understanding, and meaning. Of course, many changes in language are not only benign but embody a linguistic advance in that our descriptive powers are enhanced and our capacity to pierce closer to the reality of that which we would understand is expanded. But, on the other side, we are painfully aware of what happened when totalitarian regimes had the power to control language and to cover mass murder with the rhetoric of ‘improvement of the race’ and even ‘mercy and compassion.’…”
“The deterioration, manipulation, and distortion of language works in a similar fashion [to the destruction of neighborhoods]. Once one acquiesces in euphemisms like… ‘compassion’ for killing helpless, imperfect human beings; or ‘choice’ for a nigh-unlimited ‘right’ to withdraw the boundary of moral concern from unborn children at any stage of fetal development; or ‘liberation’ as our freedom from any socially or ethically sanctioned relations or commitments…one is on a fast track to the radical loss of meaning that so characterizes our age….”
Who Are We? Critical Reflections and Hopeful Possibilities, by Jean Bethke Elshtain (William B. Eerdmans Publishing Company, 2000). Excerpt is from the essay, “Living in Hope,” pp. 127-8, 132.
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