The pursuit of perfection : the promise and perils of medical enhancement /

This is a fascinating critical analysis of a variety of medical therapies that began as cures but expanded--as risks were minimized and benefits amplified--to encompass human enhancement. Beginning with the development of hormonal therapies related to thyroid, pituitary, and reproductive disorders, the Rothmans (public health and history, respectively, Columbia Univ.) trace the evolution from the treatment of disorders to enhancement, e.g., moving from the treatment of facial deformities resulting from war injuries to plastic surgery aimed at improving the appearance of otherwise normal features. The book closes with an examination of the evolution of genetic engineering and its potential for benefit and misuse. Providing details of scientific discovery, the authors raise questions associated with safety, efficacy, profit making, and the use of medical therapies for the purposes of human enhancement. They identify the key players in this questionable pursuit of perfection: medicine, the pharmaceutical industry, the media, and consumers interested in cosmetic and functional improvements. ^BSumming Up: Recommended. General readers; upper-level undergraduates and graduate students; professionals and practitioners. N. I. Whitman Lynchburg College

The Rothmans ask what happens when science, medicine, and commerce combine to promise biological perfection, which, they say, while it is an attractive and seductive vision, is in reality far from pretty as a picture. Too often, risks and side effects associated with invasive procedures and pharmaceutical interventions done to perfect the organism are minimized or, worse, ignored, leading to severe illness and even death. Documenting what they report, the Rothmans blame--or credit--Darwin for fathering the concept that humans could improve upon nature's choices for them. Since the notion was bruited, medical science has descended a slippery slope from ovary removal (to treat nervousness, anxiety and an unwillingness to perform household duties ) to human growth hormone (a supposed anti-aging elixir) to possible gene manipulation (to control certain undesirable personality traits). This is worthy reading, for the Rothmans raise provocative questions: What price is too high for personal beauty? What happens when medicine merges with the free market? What is the line between cure and cosmetic? --Donna Chavez Copyright 2003 Booklist

This thoughtful but inconclusive book sends a mixed message as to whether it's the proper role of doctors to medicate or perform surgery on patients whose only medical complaint is unhappiness or inconvenience. Professors, respectively, of public health and of social medicine and history at Columbia University, Sheila Rothman and David Rothman consider the various uses of estrogen, testosterone, human growth hormone, liposuction and genetic manipulation, showing that these options have from the beginning blurred the line between cure and enhancement. Focusing heavily on how pharmaceutical corporations and physicians profit in the promotion of enhancement therapies, the authors argue that products were marketed to the public without due attention to their possible risks and that studies questioning their benefits and citing related health hazards have been consistently downplayed. At the same time, however, they acknowledge that consumers continue to demand enhancement therapies even when risks are known. Liposuction, for example, has become the most commonly performed plastic surgery, despite a "startling" mortality rate of one in 5,000. Since there is "no consensus on the meaning of enhancing the body" and because consumers perceive liposuction as easy and desirable, the procedure is here to stay. The prose is dry, and there's a shortage of interesting medical case histories, but the book ends with an intelligent exploration of how genetic research could lead to procedures that would double existing life spans. Admitting the serious ethical reservations such a possibility raises even among physicians themselves, the authors end on a disappointingly equivocal note: "Yes, there will be risks-but just imagine enjoying the benefits of an extra seventy years." Photos not seen by PW. (Nov. 4) (c) Copyright PWxyz, LLC. All rights reserved

The Rothmans (both medical historians and professors, Coll. of Physicians and Surgeons, Columbia Univ.) examine the history of medical enhancement to further our understanding of the current genetic engineering revolution. Central to their analysis is the blurring of the definitions of cure and enhancement by the medical and research communities and the industries that benefit from this confusion. At risk, they say, is the consumer-patient (most often a woman) sold therapies by a system that has historically underrepresented risks and ambiguous research results. The authors examine the development of hormone replacements (e.g., estrogen, testosterone, and growth hormone), plastic surgery, and the rise of the cosmetic and pharmaceutical industries, revealing a system out of balance; Viagra and herbal supplements are missing, even though they seem within the book's scope. The Rothmans conclude that enthusiastic patients, physicians, and marketing departments are likely to forge a similar path into the field of genetic engineering. Although academic in focus, this excellent distillation of the historical record-thorough but not overbearing in length-is well suited to larger public libraries.-Andy Wickens, King Cty. Lib. Syst., WA (c) Copyright 2010. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

A critical look at the historical record of medical enhancements as influenced by science, medicine, culture, and commerce, and the lessons to be learned from past experience. The Rothmans, both historians at Columbia, examine how what started out as cures have turned into enhancements. Beginning with the new science of endocrinology in the 19th century, they reveal how hormones came to be seen as offering a promise of reshaping lives. With the growing relationship of research and commerce in the 20th came a dramatic increase in the sale of prescription drugs, especially hormone preparations such as estrogen. Gynecologists and endocrinologists extolled their use, and many women demanded them, assured that they could, with estrogen's help, remain forever feminine. The assumed benefits long overshadowed the potential risks. Similarly, testosterone was promoted as the male equivalent, but, as the Rothmans report, it was the lack of patient demand, not the reluctance of physicians to prescribe it, that kept it from becoming a bestseller. The story of liposuction offers further evidence of how the allure of enhancements for some people and the potential for financial gain for some physicians has muted the attention paid to the risks involved. The use of human growth hormone for children of below-average height is a story of the turning of a socially undesirable or disadvantageous condition into a disease. Children have not been the only ones to be subjected to questionable interventions. Soon the use of human growth hormone products to enhance the physiques of adults was being promoted in anti-aging clinics, with the emphasis on benefits taking precedence over cautions about possible adverse side effects. The Rothmans argue that experience with such technologies demonstrates that routine oversight will not be adequate to protect consumers making decisions about the enhancements that genetic research will offer, nor will the advice of individual physicians, medical societies, or government regulatory agencies. What consumers need is to better understand the nature of the research and the reliability of the results. A loud and clear caveat emptor, backed up by undeniably disturbing facts regarding the risks and benefits of present-day procedures and future possibilities. Copyright ©Kirkus Reviews, used with permission.