[1] This article inaugurates a column that will appear three or four times during the coming year. Its purpose is to review books addressing genetic engineering and its implications for the future of humanity. I’m using several criteria in selecting books to be discussed: 1) They will be directed to society at large, which means they will not be overly technical or directed primarily to the scientific community; 2) They will address cutting-edge developments in genetic engineering and related developments in reproductive technology that help the non-scientist to understand the nature of these developments; 3) They will engage ethical, philosophical, and/or theological issues that this technology raises for thoughtful readers; and 4) They will espouse a variety of philosophical and theological viewpoints.
[2] Why is the Journal of Lutheran Ethics giving particular attention in this way to genetics and not some other topic? Because there is little question that the biological and genetic frontier poses some of the most far-reaching and profoundly disturbing ethical issues that our society is facing. Kay Davies, professor of genetics at Oxford University, has made an astute observation which I think will be confirmed: “Biology is likely to dominate science for the next century.” My intent here is to provide interested readers – particularly those with a background in Christian ethics – with information gleaned from both books and articles being written on the subject, and to think along with them about the theological and ethical implications that follow from this new technology. Most of the books discussed will be fairly recent publications, including the last five years or so, but some earlier works may be included that are particularly worthy of our attention.
[3] My intent is to survey the author’s argument and then to engage it in conversation. My own viewpoint will become evident, of course, but I hope in a spirit of dialogue and with an effort to understand the grounds of the argument rather than to issue a summary judgment. What is certain is that we will be forced to grapple with some of the most intense and far-reaching issues conceivable, challenging our understanding of human nature and the human story. I look forward to bringing the resources of the Christian tradition to the consideration of these pressing issues. They concern us all, both as people of faith and as members of our society.
[4] A word on terminology. My interest here is in the nature of the human being and the future prospects for humanity in view of the likelihood of increased genetic interventions, or manipulation/modification of genetic material in the bodies of human beings. Since it is commonly employed and recognized, we use the term “genetic engineering” in our title as a way of describing this phenomenon. It includes such topics as somatic and germline gene therapy, embryonic stem cell research, cloning, and other technologies related to human reproduction. But there is other research and technology that also raises some of the same issues I’m addressing here (primarily that of the pharmaceutical industry), and I will have occasion to bring that into our discussion as well. The broader term, “biotechnology,” is often used in discussing these subjects, and I will use that term, particularly when the author under discussion is using it. But it is a broad term that includes much more subject matter than is included in our scope here.
[5] Since this column invites the response of interested readers, you are welcome to e-mail your reactions to me concerning any of the material I discuss (pjersild@mindspring.com). I will bring your reactions into the conversation as I see appropriate.
Works reviewed in this column:
Leon R. Kass, “Ageless Bodies, Happy Souls: Biotechnology and the Pursuit of Perfection,” The New Atlantis: A Journal of Technology & Society
Gregory Stock and John Campbell, eds., Engineering the Human Germline
Bryan Appleyard, Brave New Worlds
Ruth Hubbard and Elijah Wald, Exploding the Gene Myth
Leon R. Kass, “Ageless Bodies, Happy Souls: Biotechnology and the Pursuit of Perfection,” The New Atlantis: A Journal of Technology and Society, (Number 1, Spring, 2003, pp. 9-28.)
[6] I think it appropriate to begin with a recent article by one of the major figures in the current debates over biotechnology. In this lead article in the inaugural issue of The New Atlantis, Leon Kass provides a brief review of the issues that concern us in this column. Kass, chair of the President’s Council on Bioethics and currently on leave from the University of Chicago, is the Hertog Fellow in Social Thought at the American Enterprise Institute in Washington, D.C., a conservative think tank. I believe Kass is on target when he identifies the most seductive and “genuinely novel and worrisome” feature of the biotechnical revolution to be the belief that we can use it to “remake” or “perfect” the human condition. He maintains that with a more complete understanding of their biological basis, the human psyche and human behavior will be subjected to all the more heightened efforts to alter and improve them.
[7] While making the distinction between “therapy” and “enhancement” can highlight the problem, it is inadequate for moral analysis. Enhancement as a term is highly problematic, implying a norm or standards that will differ among us. Kass identifies the more basic issue as limitations that we all live with, and which now for the first time are being challenged by the extraordinary developments in biomedical technology. What used to be dreams or fantasies about human perfection are now being taken seriously, with the elimination of various limitations – related to physical or mental performance or to human longevity, for example – now being regarded as moral imperatives.
[8] In regard to biomedical technologies that go “beyond therapy,” Kass is not satisfied with the typical objections raised. He categorizes them in terms of dominant values in our society: health (expressed in the concern over safety), equality (some will be given unfair advantages), and liberty (the possibility of manipulating or coercing people according to the desires of those in power, whether parents or some group). This last value Kass sees as most significant, raising the specter of a society unduly subject to conformity or homogenization. All of these objections are consequential, with the full weight of their validity expressed in the cumulative effects of what they object to. For example, the prospect of adding three more decades of healthy life to the current life-span of an individual could be objected to, but not because it is inherently a bad idea or the wrong thing to do, but because the aggregated social effects would be disastrous.
[9] Thus Kass seeks a more basic moral standard in bringing judgment to biomedical enhancements. He appeals to what he calls “our disquiet” over individual uses of “performance-enhancing genetic engineering or mood-brightening drugs,” a disquiet that he perceives as an ethical reaction to the essence of the activity itself rather than its consequences. He then anchors this disquiet in our understanding of human nature. “If there is a case to be made against these activities – for individuals – we sense that it may have something to do with what is natural, or what is humanly dignified, or with the attitude that is properly respectful of what is naturally and dignifiedly human.” (17)
[10] He pursues this thesis by examining “the goodness of the ends, the fitness of the means, and the meaning of the overarching attitude of seeking to master, control, and even transform one’s own given nature.” Kass argues that human nature is a good that can be seen as both a given and a gift, a fact that would caution anyone who seeks to improve on it. He quotes from Michael Sandel’s working paper prepared for the President’s Council on Bioethics: “An appreciation of the giftedness of life constrains the Promethean project and conduces to a certain humility. It is, in part, a religious sensibility. But its resonance reaches beyond religion.” Kass’s argument, then, runs like this: Because human nature is good and worthy of respect, it gives a dignity to natural procreation, human finitude, the rise and fall of the human life cycle, and many other features of life that are “givens” that warrant being safeguarded. To ignore this is to succumb to a hubristic spirit, where we are enamored with our own creative powers and are willing to overlook our lack of knowledge and wisdom in addressing what it means to seriously tamper with the human condition.
[11] Turning to the means employed by biotechnology, Kass argues that they violate “the deep structure of natural human activity,” by which he means that efforts we make toward self-improvement involve an obvious connection with the goals we seek to attain. Through practice, training, or study, our performance is enhanced and we experience the reward. Biomedical interventions, in contrast, leave us entirely passive. We may feel their effects, but without grasping their meaning in human terms. Genetic or biochemical enhancements thus fail to affirm or authenticate the normal character of “human being-at-work-in-the-world,” leaving us without a sense of owning the transformations that have occurred because we have not experienced them as genuinely ours. This is not the primary reservation of Kass, but he sees it is as nonetheless significant and carrying unfortunate implications.
[12] But the more important issue is the ends themselves which biotechnology envisions, goals that Kass characterizes as “ageless bodies and happy souls.” Apart from population and intergenerational problems that would eventually occur if human longevity were appreciably increased, Kass argues that these goals would deflect us “from realizing more fully the aspirations to which our lives naturally point, from living well rather than merely staying alive.” (25) Moreover, he sees a society intent on improving its “agelessness” as one hostile to children and incapable of coming to terms with mortality. Our lives do in fact prepare us for the reality of death with the decrease in our flourishing over the passing of years; it would not be wise to change the trajectory and shape of that natural cycle.
[13] In regard to “happy souls,” we can indeed be thankful for the remarkable advances in pharmacology, but there is something misguided in the attempt to engineer bliss and to eliminate shame, guilt, and painful memories. Given the world in which we live there is reason to be disturbed in many ways, but what we lack inspires the drive to achieve, with deficiencies giving rise to aspirations to change things for the better. Human wisdom recognizes that being-at-work, fully engaged, and facing honestly one’s limitations, is the gift and goal of our humanity, rather than an ageless body or untroubled soul.
[14] The question between Kass and those members of the biotechnology establishment with whom he takes issue is in part a matter of definition. What are the genuine evils in human life that ought to be removed if at all possible? What pains and stress are ultimately destructive to the kind of life we would like to see actualized? One of the problems with such questions is that they raise all kinds of complications within the total, complex web of life, making it difficult to arrive at answers. I suspect that no one would want to argue the acceptability of every kind of pain or stress; at their destructive worse, they can be regarded as absolute evils. What Kass wants to repudiate is a society where people not only resist the genuine evils of life, but attempt to create a new human identity by overcoming those deficiencies and limitations (regarded as “evils”) which have defined the human condition. This is a subject which raises many difficult and contested areas; from other writings of Kass I would disagree with some of his own conclusions on where to draw the boundaries for “what is natural,” or acceptable human behavior. Indeed, this is one of the inherent difficulties to any argument of this kind. But he is right in defining the nature of the issue and in raising a serious caveat concerning the technology-driven desire to remove human limitations. In doing this he often reflects deeply and cogently about human nature and the human condition. He is an eloquent voice in today’s dialogue, and we will return often to theissues he addresses here.
Engineering the Human Germline: An Exploration of the Science and Ethics of Altering the Genes We Pass to Our Children Edited by Gregory Stock and John Campbell (New York: Oxford U. Press, 2000), 169pp.
[15] Gregory Stock and John Campbell teach at the UCLA School of Medicine, where Stock is Director of the Medicine, Technology and Society Program and Campbell is Professor of Neurobiology. Both men are convinced that genetic manipulation of eggs and sperm, called “germline engineering,” is on the horizon and needs to be carefully examined. In contrast to somatic gene therapy whose consequences are limited to the body of the individual being treated, modification of germ cells is intended to incorporate changes in succeeding generations. This book seeks to explore “both the prospects for, and the larger implications of, human germline engineering.”
[16] The book consists of three parts, the first consisting of seven essays by scientists in the field of genetics who assess the problems and possibilities of this technology. They range in viewpoint from W. French Anderson, who harbors serious reservations about any near-term use of this technology, to Lee Silver, an enthusiastic advocate of gaining “complete control” of our genetic destiny. Most of these writers tilt in the direction of Silver rather than Anderson, assuming the inevitability of our mastering this technology and exhibiting a basic confidence in its promise. The initial essay by the editors provides a helpful nuts-and-bolts description of the biology involved in this technology and the possibilities it raises.
[17] The second section is a free-wheeling conversation involving the seven contributors, plus James Watson (co-discoverer of the structure of DNA), ethicist John Fletcher, and a political scientist. This part widens the consideration of issues raised by germline technology, with Fletcher leading off the conversation by noting the predominantly conservative attitudes that religious people bring to the subject of genetic technologies, as well as making the point that the religious community must not be neglected in the public conversation on this topic.
[18] The third part consists of brief statements (2-3 pages) by a variety of writers from the United States and abroad, responding to a couple of questions designed to elicit their concerns and attitudes toward germline engineering. While concerns are expressed, most are confident that the technology can be developed and will eventually be utilized. At the close of their responses each writer is asked the same question: “If you could do so safely, would you use an artificial chromosome to extend the lifespan of your child?” Their responses to this question were often the most revealing, with some wondering how one could not respond affirmatively to such a possibility, and others (not as numerous) rejecting the possibility either for consequential reasons or on grounds of principle.
[19] One of the merits of this work is that it provides insight into the thinking of a cross section of geneticists and molecular biologists whose work directly relates to the questions raised by genetic engineering. Not surprisingly, most of them want to exploit whatever possibilities germline modification offers; indeed, to pursue those possibilities is seen as a moral imperative. While French Anderson raises a cautious reservation concerning the unknowns and unanticipated consequences of genetic engineering, James Watson advocates full-steam ahead: “Some people are going to have to have some guts and try germline therapy without completely knowing that it’s going to work….We’re always going to have to take chances.” (79)
[20] This book clearly conveys the sentiment that biotechnology is in the driver’s seat, and that its capacity to inspire us with its successes and its promise for the future is virtually unlimited. The belief is expressed by more than one writer that when the public is sufficiently informed and is capable of addressing germline intervention rationally and analytically rather than emotionally, a positive response will result. The questions and concerns raised by Kass are not on the radar screen of many of these geneticists. Any enhancement of one’s life through genetic interventions is regarded as an obvious good, for it goes without saying that “parents want to provide their children with improved opportunities to function more effectively within our society.”
[21] Thus the confidence of most of the contributors to this volume concerning the eventual widespread use of this technology tends to make irrelevant or even irresponsible any objection that might be raised (editor Stock’s more recent book, Redesigning Humans, which we will be addressing in a subsequent column, is one of the more enthusiastic expressions of what the new genetics can achieve). Their vision is indeed admirable, expressing the desire to humanize our lives by reducing if not eliminating the incidence of genetic disease. The question, again, is whether their vision involves too great a cost to the integrity of human life as we know it.
Brave New Worlds: Staying Human in the Genetic Future by Bryan Appleyard (New York: Penguin Putnam, 1998), 198pp.
[22] Bryan Appleyard is a freelance author who acknowledges up front that he is a “layman” when it comes to science and specifically genetics. As the title indicates, he writes on this topic because he is deeply apprehensive about the future promised by the revolution in genetics. This concern seems to be twofold: On the one hand, he is apprehensive about the consequences of the knowledge we are gaining through genetic investigations: “Is it possible that we can actually learn something that contradicts our most human instincts?” (6) On the other hand, it is not just what we learn but the ideology that governs and controls what we learn that also gives him pause. He calls this ideology “scientism,” which he describes as “belief in the absolute power and competence of science.” (155)
[23] Thus Appleyard’s book is moved by humanistic and philosophical concerns that lead him to confront the scientific establishment: “Since science is the most powerful and wealthiest orthodoxy the world has ever known, it must therefore be the target of the most rigorous skepticism.” (159) This skepticism is supported by the conviction that science is incapable of providing a complete understanding of ourselves and the world around us. Here the author reveals an appreciation of transcendence, though that concept is not well defined. His concern is to provide space for the element of mystery which he sees science (genetics) destroying in its unrelenting attempt to reduce all of life to molecular explanations.
[24] In reading Appleyard I was reminded of the ideological struggle in the social sciences going on during the seventies, when the behaviorism of B. F. Skinner (Beyond Freedom and Dignity) mounted a notable challenge to psychological theories that worked with a “self” that could not be reduced to empirical categories. Appleyard’s point is that genetics has moved this perennial debate to the next level, where our growing knowledge of genetics and biochemistry is now seen by many scientists as establishing their case. Personality and the mind become increasingly the objects of biochemical analysis, which poses as the definitive word in understanding these concepts. He cites an interesting remark of James Watson, who is not bashful about his atheism: “The end result of the human genome program on society will finally be to make people realize we are the products of evolution, not of a message from the sky. Finally they are going to find it impossible to ignore.” (150)
[25] Appleyard acknowledges that at the level of fundamental belief, the issue is how one interprets the findings of genetic explorations. He notes that Francis Collins, director of the Human Genome Project, is a devout believer who has not hesitated to make explicit his Christian convictions. He sees himself as standing somewhere between Watson and Collins, but particularly intent on repudiating the reductionism inherent to the prevailing scientism.
[26] Appleyard is also concerned about the eugenic impact of genetic technology. He quotes Bentley Glass, one-time president of the American Association for the Advancement of Science, who in 1971 argued for a eugenics approach that in the future would limit families to two offspring. This program, said Glass, would recognize “the right of every child to be born with a sound physical and mental constitution, based on a sound genotype. No parents will in that future time have a right to burden society with a malformed or mentally incompetent child.” (78) Since Glass’s time the procedures of genetic testing and screening have advanced dramatically, and as their use becomes near universal the pressure not to have a child who in any way is handicapped will become intense. This would be a kind of “market place eugenics,” where the perceptions and expectations of the majority in society enforce a drive toward normality and homogeneity.
[27] In regard to Glass’s statement, Appleyard repudiates as absurd the idea that we can apply the notion of “rights” to a sound genotype for the unborn. It’s “like saying I have the right to be Michael Jordan.” His strong reaction here reflects a justified impatience with the broad extension of “rights” language, in this case to an ideal picture of humanity that exists in the womb – the potentially perfect exemplar of the species. Whether it’s perfection or “normality” that one is seeking, it carries insidious consequences for those who do not measure up. Current data reveals that some nine out of ten couples who are informed that their offspring will be a Downs Syndrome, choose to abort.
[28] This concern of Appleyard gets at a central issue posed by what he calls “scientism.” In this view human beings are defined in terms of their genetic constitution, and because the knowledge and tools of biotechnology presumably carry the ability to change defective or undesirable genes, we are able to improve on human nature through genetic interventions. This constitutes a sufficiently fundamental transformation of who a person can be from what that person would have been, to inspire theological language. The notion of biological salvation has been used in reference to what we are describing here. This is certainly inflated language for a person of Christian faith, but it conveys the ultimate possibility within the worldview of scientism and thus is not inappropriate language. Salvation is to be found in deliverance from one’s own genome (a state of original sin, one might say), a deliverance made possible by science and technology. Indeed, the dimensions of deliverance that biotechnology can potentially achieve for us, according to some advocates, may include immortality or eternal life, a claim based on the discovery that some embryonic cells appear capable of reproducing themselves indefinitely.
[29] There are several other issues raised by Appleyard, but we conclude with brief reference to his principal argument. I find this book both interesting and significant because of its insistent raising of the philosophical question posed by a scientific worldview. Appleyard is saying that the most important issue raised by genetic technology is the definition of the human. Who are we, and what is our destiny? Scientific investigation itself is not supposed to answer this question; it prides itself on simply exercising a method of inquiry and letting the chips fall where they may on the question of truth. The naivete of this belief is by now fairly well recognized; there are governing assumptions created by scientific work, such as genetics, including the notion that final or “ultimate” truth concerning human beings is to be found at the molecular level. Appleyard, for one, finds this assumption overly restrictive in addressing the full realm of human experience. It too often is understood in a way that fails to comprehend, or allow for, dimensions of experience that many of us find essential to who we are as human beings. Thus, at the center of the conflict between science and the humanities, or science and faith, are the implications that people draw from scientific inquiry and how they shape the assumptions or beliefs that one brings to larger questions of meaning. The issue is not science as such, but “scientism.”
Exploding the Gene Myth: How Genetic Information Is Produced and Manipulated by Scientists, Physicians, Employers, Insurance Companies, Educators, and Law Enforcers
by Ruth Hubbard and Elijah Wald (Boston: Beacon Press, 1999), 225pp.
[30] This book expands considerably on the concerns raised by Appleyard. Ruth Hubbard brings impressive credentials to her task as professor emerita of biology at Harvard University, but she is also a feminist and social critic whose reservations about the impact of genetics include both scientific and social justice concerns. In a word, she believes the claims raised by genetic engineers are highly inflated, promising far more than is warranted. And her critique involves an effort to unmask the non-scientific factors – primarily the market place – that drive the genetic enterprise. “Amid the increasing genomania, we must have the necessary information to realistically assess market-driven promises of better health, a more fulfilling life, or greater security through genetics. That is what I hope this book can help provide.” (xxiii)
[31] Attacking the assumptions of geneticists and molecular biologists, Hubbard describes and would refute geneticization (the gene as controller and determiner of human life) and reductionism (reducing organisms to their smallest parts rather than looking at them as a whole). A gene is really a minute section of the DNA thread and constitutes a more complex concept than the usual notion of a discrete particle or entity, making any reference to specific genes (such as a Huntington gene or cystic fibrosis gene) an oversimplification. Genes must be understood as part of the overall functioning of cells and organisms, not as a controlling power that is calling the shots. Thus, “when molecular biologists speak of genes as ‘control centers’ or ‘blueprints,’ this is testimony to the hierarchical models they use rather than a description of the ways in which organisms function.” (64)
[32] Hubbard thus challenges the claims associated with the Human Genome Project (HGP) that mapping the human genome will result in the diagnosis and eventual cure of all sorts of genetic diseases. She laments the fact that the HGP has magnified the illusion that health is primarily a technical or genetic problem, when it is just as much a social and political problem that involves our relation to the environment. While inherited factors can have an impact on our health, their effects cannot be separated from a network of biological and ecological relationships. Hubbard maintains that except in rare cases, information at the level of DNA sequences is not all that useful at the level of cells, tissues, or whole organisms. This in turn means that except in rare cases, “predictive genetics” promises far more than it can deliver. Announcements concerning genes “for” manic-depression, schizophrenia, alcoholism, and smoking-related lung cancer, for example, have all subsequently been withdrawn.
[33] More than any other one factor, the pressures of a capitalist economy have directed the course of so-called genetic diseases. The development of genetic tests has proven quite lucrative for pharmaceutical companies and physicians, with new diseases being invented as fast as new diagnostic tools have become available that can spot or predict their occurrence. Hubbard cites as an example the case of Genentech, which is marketing a human growth hormone. When the supply was limited, it was used to treat only those children with pituitary dwarfism, but now with the supply unlimited, Genentech suggests that all children falling in the lowest three percent in terms of height are suitable prospects for their product. This would be a clientele of about 90,000 born each year, or a nine billion dollar market. Researchers have also suggested that giving growth hormone to old people who are basically healthy could slow the aging process. In our economy, expanding the market is the name of the game, which means expanding or inflating the “norm” for physical and mental well-being.
[34] Hubbard devotes a couple of chapters to inherited “tendencies,” both in regard to chronic conditions such as diabetes, high blood pressure, heart disease, strokes, and cancer, as well as to behaviors such as homosexuality, alcoholism, and criminality. In general she brings a skeptical attitude to attempts to establish a genetic origin for these conditions, believing in each case that it exemplifies the reductionist fallacy that fails to appreciate the complex nature of both physical and mental conditions. In discussing somatic gene therapy she takes exception to using the term “therapy,” maintaining it is a public relations term which on the basis of what has been achieved to this point is not warranted. She would prefer to use “treatment” as an appropriately neutral designation.
[35] As to germline gene therapy, Hubbard finds no justification for its use that could counteract its possibly “frightening” consequences. “In terms of curing or treating genetic conditions, germline manipulations are completely irrelevant. There are no sick people who will benefit, and there are other ways to avoid passing on specific genetic traits.” (114) It’s a good example of the technological imperative that would mandate the use of a technology if it is available. Hubbard cites as a lamentable example of this thinking the editor-in-chief of Science magazine, who advocates the improvement of a person’s IQ or physical potential or musical ability through gene manipulation.
[36] Hubbard devotes a chapter to the immense pressures exerted by the biotech industry in its efforts to exploit the financial potential of genetic research. To create a market, the pharmaceutical and biotechnical industries invest about a quarter of their income on marketing their products, including huge sums of money in the area of “predictive” diagnostic tests that are conducted on large numbers of healthy people. It’s quite likely that an atmosphere will be created where none of us feel safe until we submit to tests – even where there is but meager evidence of a hereditary component. One unfortunate aspect of this development, notes Hubbard, is the fact that all sorts of social and medical services place a more justifiable claim on society’s attention and financial resources, including malnutrition, preventable environmental toxins, accidents and violence, and infectious diseases.
[37] Another chapter is devoted to issues of discrimination in the way genetic testing is applied in the realms of education, employment, and insurance. Schools have developed long lists of diagnostic labels for a variety of learning problems, which Hubbard argues are often a diversion from carrying out the schools’ responsibilities in getting children up to minimum standards. It shifts the responsibility to the student for failures in the learning environment or in the larger society. The misuse of genetic testing on the part of employers and insurance companies is also addressed, as well as genetic privacy and civil liberties where the use of genetic information lacks appropriate restrictions and supervision. DNA-typing and banking are now very much a part of the mystique of scientific and technical progress, but Hubbard questions whether it merits that status.
[38] A critical issue raised by this book is one I’m not equipped to address. That is the scientific question raised by Hubbard concerning the role of genes and whether the model of “hierarchical control” that she ascribes to most geneticists is as inadequate as she contends. Her view on the applicability of DNA information at the level of organisms is also controvertible. Discussion of these differing viewpoints on the part of the scientific establishment is important, and particularly in a way that is open to the public and keeps people informed. The implications of such a discussion are so directly applicable to societal well-being in terms of the decisions we make concerning health care and genetic decisions, that it requires a high degree of openness and honesty in the biomedical establishment.
[39] Some will undoubtedly conclude that Hubbard is overstating her concerns and is too pessimistic about the prospects of genetic research. She acknowledges that she is more concerned to look at the dangers of biotechnology “because they are so frequently ignored, downplayed, or flatly denied.” My own sense is that we need people like Ruth Hubbard, who has the credentials and the courage to challenge the scientific establishment on its own turf. I believe she is on target when she sees a “genetic ideology” prevalent in society as well as a near obsession with medical aspects of life, from birth to death. It is an outlook, she says, that is more in the interest of the medical-industrial complex than of ourselves. It is particularly significant – and I think refreshing – when a scientist mounts this kind of challenge to her own peers; it is a sign of hope to the rest of us that a spirit of self-criticism is alive and well in the world of biomedical research.