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First, do no harm

What difference does it make when doctors turn from healing the sick to "enhancing" the healthy?

Those who say it makes no difference have to explain why most of us feel that there's something fundamentally different about a plastic surgeon who helps patients with congenital malformations or traumatic disfigurement, and one who sets up a clinic on Fifth Avenue to do botox injections and tummy-tucks. On one very basic level, the former is a healer, and the latter is a . . . ?

What? Still a doctor, yes, but not the same kind of doctor.

As the technology of genetic manipulation advances, it's very possible that we might not need the services of the healer anymore. All physicians will instead be "enhancers," wielders of the new technologies of immortality and beauty; salesmen for the 21st century biomedical-industrial complex.

Doctors are already getting a lot of practice with this latter role. The ads you see encouraging you to "ask your doctor" about Viagra and Celebrex have helped to reduce the physician from his old role as trusted counselor and healer to that of marketing representative for Pfizer. "Come on, Doc, gimme the pills I saw on TV and I'll walk out of here a satisfied customer."

Is this the kind of doctor who is capable of counseling us about the implications of designer babies? Upgrading your IQ? Modifying your genes in an attempt to achieve immortality?

Sherwin Nuland, a surgeon and frequent contributor to The American Scholar and other literary magazines, has a review of Shirley and David Rothman's new book, The Pursuit of Perfection: The Promise and Perils of Medical Enhancement. One of his suggestions is that we take a more rational approach to the new biomedical technologies, and that includes relying on a wider array of perspectives when considering the question, "is this good for us?"

I wonder whether it is true, as the Rothmans claim, that "there is no holding back the enterprise." It is just possibleŚnow for the first time in the history of modern scienceŚthat the moment has finally come when society might reconsider whether the curiosity and enthusiasm of scientists alone should determine the direction of research into certain technologies. As biomedical investigation moves into the forms of enhancement that will affect personality, intelligence, memory, organic structure, and longevity, perhaps we ought to make use of our experience with those strangers at the bedsides, and bid them visit not only the clinic but the laboratory too.

(Thanks again to Political Theory Daily Review.)


I don't think it's just the "enhancing the healthy" thing. For instance, we think it's legitimate (although surprisingly not done often) for doctors to advise quitting smoking, eating right, and wearing sun tan lotion. I think the question is "what do we feel weird about doctors modifying?" Making statements as to what we do with our behavior--okay. Making adjustments to genetic code so that behavior changes--not good.