Rick Carlson and Gary
Stimeling have written a book that purports to analyze the challenges the new
frontiers of genetic medicine set on the modern health-care in U.S. The
possibilities of genetic medicine promises are seen as enormous, yet the
authors concern is that given the status quo of health care, and medicine in
general, the promised goods are bound to be spoiled. The authors draw a bleak
picture of how the commercialized medicine, due to several contributing
factors, will misuse these possibilities to everyone’s loss. To quote (p. 46):
“In the future, the emphasis of medicine will shift toward more and better ways
to promote satisfaction of the upper-level needs. Genetics and biochemical
research will enable this shift; the profit motive will drive it.”

The book consists of three
parts. Part one “The Medical-Industrial Complex”, starts out by offering a
short introduction to the basics of genetics. This is followed up by a look at
the history of the health care system, along with some other processes, such as
general medicalization of human life. The contention is that the end result is
an inherently bad, profit-driven industry, that has ballooned up the costs (18
percent of U.S. GDP) while fewer and fewer patients are receiving adequate
care. The introduction of new genetic treatments is argued to make enforce the
social stratification already effected by the current situation, for the
overall costs of producing these techniques are huge. One of the main reasons
for this is the possibility to patent life forms, treated in chapter five.

Part two “Dangers of Biotech
Medicine”, treats various scenarios to which the development of genetic
medicine forces us to consider. Relevant issues include designer babies, gender
selection, cloning, and possible misuses of the new possibilities for political
ends, i.e., terrorism. Although these subjects are important, the nature of the
treatment may bother a reader looking to consider the problems analytically. In
several subchapters, the authors introduce a particular technique, e.g.
preimplantation genetic diagnosis (p. 157), but quickly lead the discussion via
a slippery slope to horrific consequences: “We may rightly worry that the
technique will be abused in the future […] perhaps leading to reservoirs of
girls in lands where only boys are valued.” (Ibid.) Blatantly immoral
consequences serve a function in moral discourse, but here the discussion is
dropped right after it is introduced. The assumption is that not only is
nothing being done to prevent such outcomes, but further, that there is nothing
we can do within the current economic system.

In Part three “Alternative Futures”, Carlson
and Stimeling note different options for arranging health care, e.g. a total
laissez-faire system, a centralized state-run system, and a hybrid (the current
U.S. system), and study some arguments for and against these options. They also
consider the role of medical insurance and cite as a positive instance of
medical planning the Orphan Drug Act, a law that was passed in 1983 to promote
the research and development of drugs for rare or ‘orphan’ diseases. This
twelfth chapter, “Medicine in Balance” is slightly more balanced in its view
than the earlier chapters, and presents some dialogue between different
positions. The final chapter “The Ends of Medicine” works towards a new
understanding of health that could serve as a humane basis for rearranging the
health sector. The authors contend that health is not a product of medicine,
but a product of self-knowledge and responsible living, social investment in
clean environment, tolerance and love, complemented with efficient health
system that works when called upon (p. 259). The book concludes with some
suggestions, which range from general ethical principles, such as making
“access to therapeutic medicine a right not a privilege” (p. 276), to more
definite policy proposals, such as “eliminate the secret branches of the United
States government, or at least prevent their access to genetic technology” (p.
277.).

The perspective taken in the
book is largely that of social sciences. The discussion on the ethical issues
involved is mostly left implicit, the horror scenarios displacing analytic
arguments. It can be suspected that an informed reader will not find much new
here, and the overall lack of argumentation for and against the claims made
diminishes the general usefulness of the book. In hurrying to cover a wealth of
examples of appalling mistakes and misconducts in medicine, the authors leave
much to hope for in terms of careful development of their ideas. On the
positive side, the authors have an extensive view of the field, and pose
serious questions. What are the hidden costs of the new biotechnology? How
should the rising medical costs be managed, while still distributing important
services fairly? Should we, as human beings, reconsider our ‘quick-fix’
relation to medicine? Read critically, The Terrible Gift might provoke
valuable discussions.

© 2002 Juho Ritola

Juho Ritola gives the following self-description:

I am Ph.D. student in the
philosophy department in the University of Turku, Finland. My dissertation is
in the field of argumentation theory, the title being ‘Begging the Question:
epistemic and dialectic approaches’. I
am currently working in a project ‘Who Owns Our Genes? Ethical and Social
Issues’. The project is funded by the
Finnish Academy of Sciences.

Categories: Genetics, Ethics