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by Rick J. Carlson and Gary Stimeling
PublicAffairs, 2002
Review by Juho Ritola on Dec 12th 2002

The Terrible Gift

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.