The Price of Perfection

Contents

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Introduction

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pp. 1-5

Thanks to biomedical enhancement, in six months, you can be transformed. Your eyesight can become 20/5, so that you can see something from 20 feet away as clearly as a person with normal vision sees it at 5 feet. You can increase your muscle mass by 40 percent; improve your cognitive function so that you can remember better, solve harder problems, and cope better with emergencies; elevate your mood; ...

1. The Technological Horizon

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pp. 6-34

We can control biomedical enhancement only if we know to what the concept refers. Too broad a definition would sweep up and possibly discourage medical innovation. Too narrow a definition According to the dictionary, to enhance is to raise or lift up. A bio-medical enhancement, then, is something biomedical that raises a per-son up by improving performance, appearance, or capability. If only it ...

2. Self-Satisfaction

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pp. 35-48

The 2006 documentary film Wordplay is about people who like to do crossword puzzles. One of them is filmmaker Ken Burns, who explains: “I don’t drink coffee, smoke cigarettes, or need a drink at the end of the day. What I need to do is the New York Times crossword puzzle, in ink, every day.” For puzzle aficionados like Burns, it’s all about figuring out the clues to a difficult puzzle not only quickly but also de- ...

3. Social Reward

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pp. 49-78

When biomedical enhancements are used for self-satisfaction, users, if they can be said to be in competition, are competing against themselves. They are hoping to be faster, stronger, smarter, and more beautiful than they were before. But enhancements might enable them to be faster, stronger, smarter, or more beautiful than the next person too. The negative by-products of this one-upmanship are ...

4. The Hegemony of Meritocracy

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pp. 79-90

The concerns raised by the use of biomedical enhancement for social reward have to be understood in their social and historical context. So far the discussion of these concerns has been confined to sports. But the rewards made possible by biomedical enhancements would extend far beyond sports: to better houses, health care, vacations, toys, education, careers, and mates. Enhancement even could be ...

5. Access to Enhancements and the Challenge to Equality

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pp. 91-98

In our 1998 book Access to the Genome: The Challenge to Equality, my coauthor, Jeffrey Botkin, and I observed that the high price of new genetic technologies, including genetic enhancements, would place them beyond the means of many people, leading to a dangerous performance gap between the genetic haves and have-nots. We even invented a term to describe the new aristocracy, the well-off families who ...

6. Lack of Choice

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pp. 99-120

No biomedical intervention is risk-free, and, as we saw in chapter 2, enhancements are no exception. The twin ethical principles of beneficence (“do good”) and nonmaleficence (“do no harm”) prohibit health care professionals from providing products or services that do more harm than good. Originally, the professionals themselves weighed the risks and benefits of interventions and selected the ones ...

7. Enhancements in Sports

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pp. 121-144

Listening to the critics, you would think that the use of biomedical enhancement in sports was a recent phenomenon. Before the development of synthetic steroids, you would be led to believe, sports were “natural” and “clean.” As we saw in chapter 3, nowhere was this impression created more clearly than during the 2005 congressional hearings on steroid use in major league baseball, where Jim Bun-...

8. The Lessons from Sports

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pp. 145-174

The history of the antidoping war in sports and its link to the wider War on Drugs leads to the question of whether the antidoping policy in sports is the correct approach to take in controlling the use of biomedical enhancements outside of sports. If it is, then we should expect a full-fledged partnership of government and private entities aimed at preventing the use of a broad set of prohibited interventions. ...

9. The War on Enhancements

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pp. 175-184

Despite the tremendous tangible and intangible costs of trying to prevent people from using biomedical enhancements outside of sports, including the loss of substantial societal benefits to the extent that these efforts would have been successful had they proceeded unhindered, a campaign against enhancement use in general is in fact officially refuses to fund research on genetic engineering for enhance- ...

10. Promoting Safety, Efficacy, and Informed Decisionmaking

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pp. 185-210

Although the repressive stance of sports clearly is insupportable outside of sports, this does not mean that society should take a laissez-faire approach toward biomedical enhancement that permits people to manufacture and market enhancements without any government intervention and that leaves individuals entirely free to decide for themselves whether or not to use them. While this approach might appeal to ...

11. Protecting the Vulnerable

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pp. 211-217

Some individuals may not be in a position to make voluntary, informed choices for themselves about whether or not to use biomedical enhancements. The term that most bioethicists use to describe them is vulnerable. The concept of vulnerability is a bit tricky. Some bioethicists, such as Daniel Callahan, regard everybody as “vulnerable.” ¹ Chilean professor Michael Kottow, for example, describes it as the uni- ...

12. Access and Inequality

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pp. 218-226

As chapter 3 made clear, one of the most challenging problems created by biomedical enhancements is how they should be distributed. A main theme in my previous book, Wondergenes, was the unfairness that would result if access to highly effective biomedical enhancements were distributed as it is now, on the basis of ability to pay. Some enhancements, like caffeine and nicotine, are cheap enough to be ...

13. Abominations

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pp. 227-229

As the beginning chapters showed, biomedical enhancements cover a broad spectrum. At one end are familiar ones like caffeine and nose jobs. At the opposite extreme lie enhancements that transform people in such bizarre ways that they would induce in others powerful feelings of awe or revulsion. The future might see DNA from different species combined to produce a chimera, a creature that is part animal ...

14. Research on Enhancement

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pp. 230-253

Because by far the best way to ensure that biomedical enhancements promote the public good is to make them as safe and effective as possible, it is critical that good information be available about their risks and benefits. Good information includes knowledge about the chemical formulation of the drug or the electrical and mechanical design of the device, as well as data about the effects that the enhance- ...

Conclusion

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pp. 254-256

At the end of the introduction to this book, I asked three questions: should we stop biomedical enhancement, can we, and were we meant to? The answers to the first two questions are now clear. We cannot stop it, nor should we. Substantial benefits can be had by using the right kinds of enhancement for the right reasons, and the costs of trying to avert the wrong kind of enhancement altogether are too high. ...

Notes

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pp. 257-300

Index

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pp. 301-309