Chapter 7 21st Century Enhancements

Western cultures no longer look with favor on the word 'eugenics.' But some of the goals that are central to the eugenics movement-improving individuals, improving populations-remain objectives of contemporary societies. The fashionable word for describing human improvements is 'enhancements.'

Among the most contentious issues relating to the concept of enhancement are these: who should decide what constitutes an enhancement, which enhancements are, in fact, desirable, and would enhancements ultimately limit the richness of human variability? Sometimes the distinction between a treatment (for a disease or condition) and an enhancement (something aimed at making 'good' into 'better' and 'better' into 'best') is not obvious, and often the two are linked by a precariously slippery slope.

Kids take cello and swimming lessons, work with tutors so they can ace difficult exams, and have 'nose jobs.' Few people object to these commonly employed strategies for enhancing musical talent, athletic prowess, brain power, and even physical appearance, although access to them is not equally available to all. Thus, enhancements tend to further stretch the already broad divide that separates the 'haves' in a society from the 'have nots.'

In addition to the enhancements that are rendered through enriched environments and cosmetic surgery, others can be delivered with medicinal drugs. The drugs in most cases were originally designed to serve as treatments or cures for specific conditions and only later were applied to enhancing a trait or a characteristic. For example, the antidepressant Prozac was first used by people who were seriously depressed; human growth hormone was first injected into children who did not produce enough growth hormone on their own to attain a reasonable adult stature. Now the use of each of these drugs has expanded to include at least one enhancing application. Some people who want to feel 'better than well' pop Prozac, and some people with aspirations for becoming basketball players ask for growth hormone treatments.

Sometime in the future, enhancements may be brought about through tinkering with a person's genes. Perhaps an individual can be injected with an extra height gene, so that the basketball dream can come true. Such 'genetic enhancements' would use the technologies of gene engineering that scientists are trying to develop for fixing or replacing defective genes that cause diseases (see Chapter 6). Researchers and the media have made many claims of cures and benefits resulting from gene therapy, but, to date, not a single gene therapy experiment has been successful. The media 'hype' has led to widespread public misunderstanding of both the availability and the promise of gene therapy technology.

How close to eugenics are enhancements? How close would gene therapy be if it were actually to work? Who should make decisions about which genes need fixing, should be fixed, or MUST be fixed? Who should decide whose traits and characteristics should be fixed? What policies should our society consider now and put into place so that future societies will benefit, not suffer, from enhancements and the engineering of genes?

Included References

Science, 10 March 2000, 287:1751.
British Medical Journal, 1999, 319:1284-1285.
Science, 26 March 1999, 283:2023-2024.

Additional Resources

Website of the Human Genome Project's Ethical, Legal and Social Issues: http:www.ornl.gov/hgmis/resource/elsi.html
The Chronicle of Higher Education, June 11, 1999, A52.

Aims

Students should understand the following:

Enhancements can be brought about by enriching environments, drugs and surgeries, and (perhaps in the future) genetic engineering
Access to opportunities for enhancement is not equal for all individuals
Concepts of beauty, health, human worth, and so on are different for different cultures and different individuals
Now is the time to consider how enhancements should be used and regulated in the future

Topics for Discussion/Written Assessment

Researchers and the media contribute to public misunderstanding about the benefits and even the promise of gene therapy. To date, many claims of cures and benefits have been made, but not a single gene therapy experiment has been successful. What are the motivations of researchers who promote their research and the promise that it holds? Why do journalists 'hype' stories? How might journalists better balance their needs to produce 'news' with their obligations to tell the truth?
What is different about enhancements that improve populations and those that improve individuals? Discuss how the involvement of third parties (doctors, governments, institutions, insurers, others) affects each of these.
One argument against giving growth hormone to children is that the child will come to believe, on the basis of the extraordinary effort involved, that tall stature is truly an important goal. How accurate is this expectation? What psychological harms might come to the child who fails to grow as tall as anticipated?
The main consumers of growth hormone in the United States today are white males. Women and African American men are underrepresented in the group. What does this indicate about height in American culture? Why do some men think it is important to be tall? Why do women not value tall stature for themselves? Why might whites use hormone therapy more than blacks? What social, cultural, economic, and political factors contribute to these differences?
Who should decide which children should have access to enhancement technologies?
Enhancement of genes in the germline-those genes that are passed from generation to generation, thereby affecting future generations-is considered unacceptable by most people, because such changes would subject future generations to manipulations that are based on today's values. In addition, the future individual has no way to give informed consent to the change. Why are these two objections so important socially, biologically, ethically, and politically?
Most ethicists currently hold that it is morally acceptable to use sex selection in only one circumstance: to avoid transmission of a sex-linked inherited disease. Why is this situation acceptable? What is accomplished by this form of sex selection? What diseases fall into this category?
Is it appropriate for a person of normal height to take human growth hormone in order to try to become super tall? Should people who are not clinically depressed take Prozac to try to be super happy? How would you decide when to use a drug to enhance an average trait or condition? What criteria would you use to make the decision?
Does vaccination 'enhance' the normal functioning of the immune system or is it a 'treatment' for preventing disease? In developing your answer, consider specific factors that lie along the slippery slope between enhancements and treatments.
In his book Listening to Prozac, Peter Kramer notes that the drug makes people feel "better than well." Should people who are not depressed take this drug? What are the reasons for doing it? What are the potential problems?
How does a person make decisions about the sort of person s/he wants to be? How does a society make decisions about the sorts of people it wants to include? How do individuals respond to societal and familial pressures of this sort?

Extension Questions for Additional Research

New technologies can have intended and unintended consequences. The unintended consequences of growth hormone therapy are still unknown. One drug for which the unintended consequences were disastrous was thalidomide. Find out what happened when thalidomide was given to ease pain of pregnancy during the 1960s. Why has thalidomide come back into use today? Has it redeemed itself as a useful drug in this new application?
Some say that the 'stature problem' is a societal one and not an individual one. That is, the society, rather than the individual, should be changed. Why and how are Americans, as a society, prejudiced against those who are short? How do the structures of and standards for furniture, cars, kitchens, and so on make life difficult for people of extremely short or extremely tall stature? Propose some policies and steps that could be taken to bring about a changed society rather than changed individuals.
Should a society permit the expenditure of federal money on enhancements when not all of its children are free of disease? Where do enhancements fit into the priority lists for the allocation of limited resources for health care?
Enhancing height with growth hormones first became a reality in 1958, when the first crude extracts of hormones were made from the pituitary glands of human cadavers. But some children who received these extracts developed Creutzfeldt-Jakob syndrome. What is this syndrome? What problems does it create? What is its relationship to Mad Cow disease?
Human gene therapy with the gene that encodes human growth hormone is not yet on the horizon. Studies carried out in swine show that, even when a "transgene" for growth hormone is expressed in swine, the swine do not grow bigger. What are transgenes? What are the steps involved in the expression of genes in host animals?
One group interested in using human growth hormone includes people who are short but do not produce low levels of the hormone. The likelihood that hormone therapy will help them to grow taller is unclear. For example, their situation may be comparable to that of a subset of people who have diabetes and who produce enough hormone (insulin) but lack receptors for carrying the insulin inside cells where it can work. Find out what data are available from studies of people in this category. How well is hormone therapy working for them?
Another group interested in growth hormone therapy are those who want to get an 'edge' on others in societies in which height is associated with greater achievement, wealth, popularity, success, and so on. How valid is their assumption? How legitimate is it for these people to receive the hormone? How likely is it that hormone therapy will cause them to grow to very tall statures?

Topics for Teacher Preparation

Enhancements can be brought about through surgery, drugs, environment, and genes
Enhancement is a tricky concept, one that is culturally constructed
Policies can be put in place to limit or expand the use of enhancements
Human Genome Project
Gene therapy