Better Than Well:
American Medicine Meets
The American Dream
by Carl Elliott
Norton 357 pp $26.95
Reviewed by Shannon Brownlee
| 1 | In the late 1960s, the pharmaceutical company Sandoz introduced Serentil, a new | |
| tranquilizer. Serentil, according to the ad, could ease the “anxiety that comes from not | ||
| fitting in,” a feeling that practically every person on the planet has undoubtedly | ||
| experienced. But Sandoz was prevented from tapping this potentially enormous market | ||
| by the U.S. Food and Drug Administration, which forced the company to withdraw the | ||
| drug and issue a statement to the effect that Serentil was not intended for use in | ||
| everyday, anxiety-provoking situations. | ||
| 2 | Thirty years after Serentil flopped, GlaxoSmithKline launched its own ad campaign | |
| for Paxil, an antidepressant that could also be used to treat “social phobia.” The | ||
| company sent out press releases describing the disease, provided reporters with lists of | ||
| sufferers willing to speak about their condition, and papered bus shelters with posters | ||
| and the slogan “Imagine Being Allergic to People.” The promotional campaign hardly | ||
| mentioned the drug, let alone the manufacturer, notes author Carl Elliott, because | ||
| pharmaceutical companies have learned the lesson of Serentil: if they want to sell a drug | ||
| that will “take the edge off some sharply uncomfortable aspect of American social life,” | ||
| as Elliott puts it, they first need to persuade Americans that their discomfort is due to a | ||
| bona fide medical problem. “SmithKline does not need to sell Paxil,” he writes. “What | ||
| they need to sell is social phobia.” | ||
| 3 | That, in a nutshell, is the pattern of America’s obsession with enhancement | |
| technology: drugs and procedures that are supposed to make us more contented, calmer, | ||
| sexier. In a word, better. “Doctors begin using a new drug or surgical procedure that | ||
| looks as much like cosmetic intervention … as a proper medical treatment,” Elliott | ||
| writes. The technology triggers a heated debate. But in the end, the technology is | ||
| accepted as a part of ordinary American life. | ||
| 4 | The acceptance of enhancement has been aided, says Elliot, by the American devotion | |
| to the self. “We tend to see ourselves as the managers of life projects,” writes Elliott, | ||
| managers who must search for ways to make our lives better, richer, more | ||
| psychologically healthy. But this notion of life as a project leads to a degree of moral | ||
| uncertainty, and to the belief that we are solely responsible for the outcome of our | ||
| endeavors. To that end, we have drafted medicine and technology into the service of | ||
| having good lives rather than being good people. | ||
| 5 | Better Than Well is a superbly crafted book. Lucidly written, often funny, it offers a | |
| penetrating look at our self-obsessed, over-medicalized, enhancement-addicted society. | ||
| But Elliott goes further than this. Better Than Well also prepares the ground for | ||
| thinking about the difficult and contentious issues surrounding gene therapy and genetic | ||
| engineering. | ||
| 6 | Bioethicists draw a line between so-called therapeutic technologies, which are | |
| deemed moral, and enhancement technologies, which are not. Thus genetic therapy that | ||
| can cure a disease such as cystic fibrosis is good, but genetic engineering to give a child | ||
| greater intelligence is bad. The problem with this construction, as Elliott makes clear, is | ||
| that the distinction between treatment and enhancement gets a little blurry in a society | ||
| that has become adept at turning many aspects of ordinary life into medical problems. Is | ||
| it enhancement to give growth hormone to increase the stature of boys who will achieve | ||
| below-average height? Or therapy to protect their egos? And once biotechnologists find | ||
| the genes for stature, will we want to ensure that all our sons are above average and all | ||
| our daughters do not grow too tall? | ||
| 7 | The ability to alter the genes in embryos is coming soon to a culture that sees selfexpression | |
| and identity as commodities that can be purchased. The implication of this | ||
| eloquent, disturbing book is that it will be very difficult to stop genetic enhancement, or | ||
| even slow it down. | ||
| The Washington Post |