Better Than Well American Medicine Meets The American Dream

"Elliott's absorbing account will make readers think again about the ways that science shapes our personal identities."—American Scientist Americans have always been the world's most anxiously enthusiastic consumers of "enhancement technologies." Prozac, Viagra, and Botox injections are only the latest manifestations of a familiar pattern: enthusiastic adoption, public hand-wringing, an occasional congressional hearing, and calls for self-reliance. In a brilliant diagnosis of our reactions to self-improvement technologies, Carl Elliott asks questions that illuminate deep currents in the American character: Why do we feel uneasy about these drugs, procedures, and therapies even while we embrace them? Where do we draw the line between self and society? Why do we seek self-realization in ways so heavily influenced by cultural conformity?

At a time when clinical care and biomedical research generate as much angst as they offer cures, this volume provides valuable insight into how the practice of medicine has evolved, where it is going, and how lessons from history can improve its prognosis.--Thomas S. Huddle, M.D., Ph.D. "Journal of the History of Medicine"

Is it possible, through use of existing psychiatric medications or talk therapy, to treat someone who has become slightly to severely mentally ill, and not only eliminate symptoms of his illness but also leave him “better than well”? This is a question with which eminent American psychiatrist, Peter Kramer, grappled in his landmark 1993 book, Listening to Prozac. Kramer concluded, based largely on responses of his own patients to the then relatively new antidepressant Prozac, that “better than well” may indeed be attainable in some persons. Not surprisingly, this is a controversial conclusion that has been met with a large degree of skepticism, including in a number of books that have since appeared. The current book explores this issue in detail, including analysis of cutting edge neuroscience and psychiatric research, concluding that "better than well" may indeed be attainable in some individuals. If so, this phenomenon may have broad reaching implications for medicine and society in general.

A panoramic overview of biotechnologies that can endlessly boost human capabilities and the drastic changes these “superhuman” traits could trigger Biotechnology is moving fast. In the coming decades, advanced pharmaceuticals, bioelectronics, and genetic interventions will be used not only to heal the sick but to boost human physical and mental performance to unprecedented levels. People will have access to pills that make them stronger and faster, informatic devices will interface seamlessly with the human brain, and epigenetic modification may allow people to reshape their own physical and mental identities at will. Until recently, such major technological watersheds—like the development of metal tools or the industrialization of manufacturing—came about incrementally over centuries or longer. People and social systems had time to adapt: they gradually developed new values, norms, and habits to accommodate the transformed material conditions. But contemporary society is dangerously unprepared for the dramatic changes it is about to experience down this road on which it is already advancing at an accelerating pace. The results will no doubt be mixed. People will live longer, healthier lives, will fine-tune their own thought processes, and will generate staggeringly complex and subtle forms of knowledge and insight. But these technologies also threaten to widen the rift between rich and poor, to generate new forms of social and economic division, and to force people to engage in constant cycles of upgrades and boosts merely to keep up. Individuals who boost their traits beyond a certain threshold may acquire such extreme capabilities that they will no longer be recognized as unambiguously human. In this important and timely book, prize-winning historian Michael Bess provides a clear, nontechnical overview of cutting-edge biotechnology and paints a vivid portrait of a near-future society in which bioenhancement has become a part of everyday life. He surveys the ethical questions raised by the enhancement enterprise and explores the space for human agency in dealing with the challenges that these technologies will present. Headed your way over the coming decades: new biotechnologies that can powerfully alter your body and mind. The possibilities are tantalizing: • Rejuvenation therapies offering much longer lives (160 and even beyond) in full vigor and mental acuity • Cognitive enhancement through chemical or bioelectronic means (the rough equivalent of doubling or tripling IQ scores) • Epigenetic tools for altering some of your genetically influenced traits at any point in your lifetime (body shape, athletic ability, intelligence, personality) • Bioelectronic devices for modulating your own brain processes, including your “pleasure centers” (a potentially non-stop high) • Direct control of machines by thought, and perhaps direct communication with other people, brain-to-brain (a new dimension of sharing and intimacy) But some of the potential consequences are also alarming: • A growing rift between the biologically enhanced and those who can’t afford such modifications • A constant cycle of upgrades and boosts as the bar of “normal” rises ever higher—“Humans 95, Humans XP, Humans 8” • The fragmentation of humankind into rival “bioenhancement clusters” • A gradually blurring boundary between “person” and “product” • Extreme forms of self-modification, with some individuals no longer recognized as unambiguously human

Providing a clear and accessible guide to medical law, this work contains extracts from a wide variety of academic materials so that students can acquire a good understanding of a range of different perspectives.

Technologies such as direct-to-consumer genetic testing, pharmacogenetically developed therapies in cancer care, private umbilical cord blood banking, and neurocognitive enhancement claim to cater to an individual's specific biological character, and, in some cases, these technologies have shown powerful potential. Yet in others they have produced negligible or even negative results. Donna Dickenson examines the economic and political factors fueling the Me Medicine phenomenon and explores how, over time, this paradigm shift in how we approach our health might damage our individual and collective well-being. Drawing on the latest findings from leading scientists, social scientists, and political analysts, she critically examines four possible hypotheses driving the Me Medicine moment: a growing sense of threat; a wave of patient narcissism; corporate interests driving new niche markets; and the dominance of personal choice as a cultural value. She concludes with insights from political theory that emphasize a conception of the commons and the steps we can take to restore its value to modern biotechnology.

"It hurts to be beautiful" has been a cliche for centuries. What has been far less appreciated is how much it hurts not to be beautiful. The Beauty Bias explores our cultural preoccupation with attractiveness, the costs it imposes, and the responses it demands. Beauty may be only skin deep, but the damages associated with its absence go much deeper. Unattractive individuals are less likely to be hired and promoted, and are assumed less likely to have desirable traits, such as goodness, kindness, and honesty. Three quarters of women consider appearance important to their self image and over a third rank it as the most important factor. Although appearance can be a significant source of pleasure, its price can also be excessive, not only in time and money, but also in physical and psychological health. Our annual global investment in appearance totals close to $200 billion. Many individuals experience stigma, discrimination, and related difficulties, such as eating disorders, depression, and risky dieting and cosmetic procedures. Women bear a vastly disproportionate share of these costs, in part because they face standards more exacting than those for men, and pay greater penalties for falling short. The Beauty Bias explores the social, biological, market, and media forces that have contributed to appearance-related problems, as well as feminism's difficulties in confronting them. The book also reviews why it matters. Appearance-related bias infringes fundamental rights, compromises merit principles, reinforces debilitating stereotypes, and compounds the disadvantages of race, class, and gender. Yet only one state and a half dozen localities explicitly prohibit such discrimination. The Beauty Bias provides the first systematic survey of how appearance laws work in practice, and a compelling argument for extending their reach. The book offers case histories of invidious discrimination and a plausible legal and political strategy for addressing them. Our prejudices run deep, but we can do far more to promote realistic and healthy images of attractiveness, and to reduce the price of their pursuit.

By New Yorker and Atlantic writer Carl Elliott, a readable and even funny account of the serious business of medicine. A tongue-in-cheek account of the changes that have transformed medicine into big business. Physician and medical ethicist Carl Elliott tracks the new world of commercialized medicine from start to finish, introducing the professional guinea pigs, ghostwriters, thought leaders, drug reps, public relations pros, and even medical ethicists who use medicine for (sometimes huge) financial gain. Along the way, he uncovers the cost to patients lost in a health-care universe centered around consumerism.