A critical look at the historical record of medical enhancements as influenced by science, medicine, culture, and commerce, and the lessons to be learned from past experience.
The Rothmans, both historians at Columbia, examine how what started out as cures have turned into enhancements. Beginning with the new science of endocrinology in the 19th century, they reveal how hormones came to be seen as offering a promise of reshaping lives. With the growing relationship of research and commerce in the 20th came a dramatic increase in the sale of prescription drugs, especially hormone preparations such as estrogen. Gynecologists and endocrinologists extolled their use, and many women demanded them, assured that they could, with estrogen’s help, remain forever feminine. The assumed benefits long overshadowed the potential risks. Similarly, testosterone was promoted as the male equivalent, but, as the Rothmans report, it was the lack of patient demand, not the reluctance of physicians to prescribe it, that kept it from becoming a bestseller. The story of liposuction offers further evidence of how the allure of enhancements for some people and the potential for financial gain for some physicians has muted the attention paid to the risks involved. The use of human growth hormone for children of below-average height is a story of the turning of a socially undesirable or disadvantageous condition into a disease. Children have not been the only ones to be subjected to questionable interventions. Soon the use of human growth hormone products to enhance the physiques of adults was being promoted in anti-aging clinics, with the emphasis on benefits taking precedence over cautions about possible adverse side effects. The Rothmans argue that experience with such technologies demonstrates that routine oversight will not be adequate to protect consumers making decisions about the enhancements that genetic research will offer, nor will the advice of individual physicians, medical societies, or government regulatory agencies. What consumers need is to better understand the nature of the research and the reliability of the results.
A loud and clear caveat emptor, backed up by undeniably disturbing facts regarding the risks and benefits of present-day procedures and future possibilities.