Biomedical Engineering Reference
In-Depth Information
tions strongly resist such intervention, yet I consider the alternative—
supplying the missing enzyme somatically—far more dangerous. If our
technology ever breaks down—for instance, due to nuclear winter—
people dependent on somatic fixes will perish, and such people will be
numerous, as we have fixed the disease manifestations without fixing the
underlying heritable defect. I am undisturbed by the claim that this
smacks of eugenics, which is an ad hominem, guilt-by-association
argument.
At this point, we must engage a vexatious issue that emerges from
some of my own earlier work. The discussion thus far presupposes that
what counts as genetic diseases is self-evident; such diseases are in the
world. Yet in my own work, I have criticized the medical community for
treating diseases as if they were simply facts to be read off from the
world, self-evident defects in the body machine or mind machine. I have
argued (from a base established by Thomas Szasz) that the concepts of
disease, sickness, and illness all contain sociovaluational judgments as
well as empirical ones. For example, during the 1970s, textbooks of
internal medicine and pronouncements of the human medical commu-
nity began to trumpet obesity as the leading disease problem in the
United States. Conceptually, this raised two questions. First of all, while
obesity certainly leads to disease—from flatfeet to back problems to heart
disease—it is hard to see why it is itself a disease anymore than boxing
or football are, since they too lead to disease. Second, what counts as
obesity? One can say objectively and empirically of a person that he
weighs 250 pounds by putting him on a scale, but what is the objective
measure of obesity? Clearly, “too heavy,” “fat,” or “overweight” are in
part at least value judgments. It turns out, of course, that what is called
obesity is based on actuarial tables, coupled with the debatable valua-
tional assumption that longevity is the only value reasonably employed
to judge lifestyle. (A reasonable person could after all choose to be obese,
consume more and tastier food, and enjoy a shorter life.) Similarly, the
past few decades have seen child abuse, violence, and alcoholism all con-
fidently labeled diseases, as if that were a factual discovery and not a
partly valuational judgment.
I further argued that citizens should not allow the medical community
the authority to unilaterally decide what are diseases, but rather that the
acceptance of disease appellations should be openly discussed.
