The Pursuit of Perfection

THE PURSUIT OF PERFECTION: The Promise and Perils of

Medical Enhancement. By Sheila M. Rothman and

David J. Rothman.

Pantheon. 292 pp. $25

When did we become a nation dedicated to the proposition that all men created equal shouldn’t have to stay that way? Columbia University professors Sheila and David Rothman show that Western medicine has been walking the slippery slope of medical enhancement for nearly a century. As far back as the 1920s, drug companies were aggressively marketing new treatments to the medical community, endowing research chairs, funding university laboratories, and exploiting individual doctors to advance their claims. These days, Genentech, the largest manufacturer of human growth hormone, routinely doles out re­search grants to the doctors who prescribe it. Plus ça change, the Rothmans would say.

Ludicrous medical practices have always gotten a warm reception in this country. In the 1930s, wealthy Americans raced to Europe for “sexual rejuvenation” by the Viennese doctor Eugen Steinach, who used x-rays to stimulate the ovaries and claimed to increase testosterone production via vasectomy. Researchers in St. Louis figured out how to create synthetic estrogen from the urine of sows and pregnant women, and soon gynecologists seeking to prevent miscarriages were freely dispensing DES, an estrogen compound later discovered to cause vaginal cancer in the daughters of its recipients. For the past half-century, despite reports of associated cancers, menopausal women have taken estrogen supplements to forestall normal aging.

Plastic surgery, which began as reconstructive work on World War I soldiers, came of age at midcentury, when such traits as a “Jewish” nose or small breasts were deemed especially undesirable. In the 1970s, a French doctor developed a method of removing fatty deposits from the body using gynecological instruments, and soon men and women were rushing for liposuction to correct genetically ordained fat distributions. Nowadays, plastic surgery is just another middle-class blood sport, albeit one fueled by self-loathing. At the opening of each episode of Nip/Tuck, the FX series about plastic surgeons in Miami, one of the doctors asks a new client: “Tell us what you don’t like about yourself.” Where to begin?

Though quackery abounds, the Rothmans argue that the field of medical enhancement represents serious science, promising to make us not just better looking but better behaved and longer lived. “We do not believe that enhancement will necessarily violate nature, subvert our humanity and dignity, or undermine social order,” they write. But “what the technologies do represent is a test of the outer limits of allowing science to set its own agenda, of allowing happiness to drive clinical care, of allowing profit motives almost unbounded license, and allowing individuals to exercise autonomy and choice.” Botoxer, beware.

—A. J. Hewat