Thursday, June 07, 2007

NEJM article on Genetic Medicine

The May 17th issue of NEJM has this interesting piece entitled "The Mixed Promise of Genetic Medicine" by Carl Elliott. Here is an excerpt:

In the early decades of the 20th century, most Americans considered cosmetic surgery to be just a few steps removed from quackery. Many observers saw the desire for cosmetic surgery as a mark of vanity, and physicians tended to believe that such surgery violated their ethical injunction to do no harm. Yet by the end of the century, cosmetic surgery had become a multibillion-dollar business, and it is now an accepted part of mainstream medicine, with its own professional journals and associations. Cosmetic-surgery clinics are sponsored by elite academic centers such as Stanford, Johns Hopkins, and the Mayo Clinic.

....The transformation of "enhancements" into "treatments" is now a familiar part of medicine, of course, and it has been accelerated by medicine's move into the consumer marketplace. Physicians today prescribe drugs to lengthen attention spans, strengthen erections, and smooth out wrinkled brows, even when they are not entirely convinced that what they are treating is a medical need rather than a consumer desire. Many others write prescriptions for conditions that blur the boundary between pathology and ordinary human variability: synthetic growth hormone for idiopathic short stature, antidepressants for social anxiety disorder, and hormone-replacement therapy for the effects of menopause. The line between what consumers want and what patients need has become very hard to draw.

It may become even more difficult with the advent of genetic medicine, which, according to its advocates, promises us even greater control over our own constitutions. Not only will we be able to eliminate genetic disorders, claim the advocates, but we will produce genetically superior people. With the new "liberal eugenics," the genetic lottery will be replaced by a genetic supermarket, and genetic choices will be orchestrated not by an authoritarian state, but by providers and consumers.