What does it mean to live in a time when medical science can not only cure the human body but also reshape it? How should we as individuals and as a society respond to new drugs and genetic technologies? Sheila and David Rothman address these troubling questions with a singular blend of history and analysis, taking us behind the scenes to explain how scientific research, medical practice, drug company policies, and a quest for peak performance combine to exaggerate potential benefits and minimize risks. The Rothmans bring an authoritative clarity to a subject often obscured by rumor, commerce and inadequate reporting, revealing just what happens when physicians view patients' unhappiness and dissatisfaction with their bodies-short stature, thunder thighs, aging-as though they were diseases to be treated.

8220;The authors shrewdly look backward at the history of medical innovation over the past century. . . Their prescription for society is wise” --*The New York Times

• “Is being short a medical problem that warrants treatment? What about the diminished strength that accompanies lower testosterone levels in men as they age? . . . These are among the provocative questions that . . . a pair of eminent medical historians from Columbia University thoughtfully explore in their new book.” --*The Washington Post

• “A thoroughly documented and readable book. ‘What science creates medicine rapidly dispenses,’ [the Rothmans] warn, and this uncritical acceptance by both physician and consumer is precisely the problem.” --Sherwin Nuland, *The New York Review of Books

• “An important contribution to the debate about medical enhancement” —The New England Journal of *Medicine

Auteur

David Rothman & Sheila Rothman

Échantillon de lecture
Penetrating Nature

For the past 150 years, the biological sciences have been at war with nature, determined to penetrate its secrets in order to perfect it. Investigators are eager to intervene, tamper, modify, and revise the forms and substance of animal life and human life. They may share a grudging respect or even wholesale admiration for the complexity of a biological system or a particular organism, but their readiness to improve on it is not inhibited. The proposition that the natural represents what can be or should be is altogether alien. No matter how intricate the existing design, it may still be enhanced, even if the result might be unusual or unimagined. Biology has no fixed boundaries, only opportunities.

When confronting resistance from a secular or religious spokesmen, some biologists attempt to deflect criticism by conflating scientific methods with scientific goals. Since their methods are objective and neutral, their findings should be considered objective and neutral. Others emphasize the tangible benefits of the research, offering many examples of better and longer living through biology. To be sure, critics challenge their contentions, rejecting the idea of scientific neutrality or the premise that a longer life is a better life. Although their negativity may appear to represent a post-atomic age or post-genomic era response to science, its roots are much deeper. In 1818, Mary Shelley was asking whether Dr. Frankenstein ought to be plundering the graveyards of body parts in order to try to create a living being, and in 1896, H. G. Wells wondered whether Dr. Moreau ought to be transplanting body parts between animals so as to construct a more perfect beast. But however persistent the hostility, modern biology has not altered its fundamental approach to nature.

Its ambitious, even combative, attitude was articulated with particular brilliance and confidence by the pioneering figure in the field, Claude Bernard. Chair of the Department of Medicine at the Collège de France and a founder of the discipline of physiology, Bernard unabashedly defined nature as the enemy to be conquered. His 1856 book, An Introduction to the Study of Experimental Medicine, set forth a history of science and a method for future biological research.1 His predecessors, Bernard contended, had done little more than use their senses to observe biological processes. Early medical practitioners, for example, felt a patient's pulse, looked to see if the face was flushed, examined the urine, and listened to the chest. If they found a rapid pulse, they tried one remedy; if the urine was cloudy, they tried another. But they never actively intervened to understand the mechanisms responsible for one or another physical condition. In more modern times, biologists and physicians went one step further, observing nature through careful groupings of facts and testing of hypotheses. They treated patients with a drug, analyzed the results, and tried to evaluate its efficacy. But this approach, too, had only limited value, for the physician remained a mere observer of symptoms and outcomes.

Bernard championed a third and very different kind of biology, the "active observation" of nature. To characterize it, he quoted an aphorism from his French naturalist colleague Georges Cuvier: "The experimenter questions [nature] and forces her to unveil herself."2 As Bernard went on to explain: "Experimenters must be able to touch the body on which they act, whether by destroying it or by altering it, so as to learn the part which it plays in the phenomena of nature. . . . It is on this very possibility of acting, or not acting, on a body that the distinction will exclusively rest between sciences called sciences of observation and sciences called experimental."

Bernard's language demonstrates how aggressive experimental science sought to be. The investigator "touches" the body, not gently or respectfully but in ways that alter or even destroy it in order to learn about its functioning. Like a sexual predator, he forces nature to "unveil herself" so he may penetrate her mysteries and fathom her secrets. For Bernard, this very aggression differentiated an older and weaker science of observation from a newer and wiser science of experimentation.

This approach, Bernard predicted, would empower biology to transform nature. "Man becomes an inventor of phenomena, a real foreman of creation. . . . We cannot set limits to the power that he may gain over nature through future progress." Once a scientist made phenomena appear "under conditions of which he is the master," that is, in his laboratory, he would be able to "dominate nature . . . to conquer living nature, act upon vital phenomena and regulate and modify them."6 Bernard was acutely aware of a cultural resistance to the idea of scientist as foreman of creation. But rather than compromise his position, he urged colleagues to ignore popular opinion. Since "it is impossible for men, judging facts by such different ideas, ever to agree . . . , a man of science should attend only to the opinion of men of science who understand him."7

Bernard's vision for biology won over the discipline not only because it promised to unleash the power of science but because it fit so well with the new and powerful framework that Charles Darwin provided to order the natural world. Biological change, as Darwin explained, was inevitable and seemingly ungovernable. On the Origin of Species made clear that the static, hierarchical, and fixed vision of nature that marked earlier thinking had to be replaced, really swept away, by a far more fluid vision consistent with the dynamics of evolution. Darwin, as his biographer E. Janet Browne observes, was inviting people to "believe in a world run by irregular, unpredictable contingencies." A particular species appeared at one stage, adapted itself at another, and become extinct at still another. The mechanisms responsible for these changes were "natural," that is, the result of a non-human (and non-divine) process of selection that no one could con…