In recent years the Indian Journal of Medical Ethics has been to the forefront in grappling with tricky issues in medical ethics and politics – topics that the best known medical journals and authorities should deal with but steer clear of.
One of us (DH) had a growing awareness of IJME’s lead on tricky issues, but became even more aware of it at the time of the Cochrane crisis last year, when the editor Amar Jesani approached me for a comment. There was no steer as to what was wanted and no editing of what was said just a genuine interest it seemed to get some important issues into wider circulation and get a debate rolling – a debate that Cochrane wanted to close down.
A few weeks ago, IJME asked me to write a review of Love is the Drug – a new book, certain to sell well and perhaps a book that might even help create a new field of relationship-modification drugs (EQ) to complement the smart drug (IQ) scene and a booming Wellness market.
Again I was free to write whatever I wanted. There were some welcome suggestions from IJME about points to clarify and a general steer toward making it shorter and tighter but no effort to interfere with how I chose to handle some sensitive issues.
The journal was even happy to try and get the review published for St Patrick’s Day – St Patrick being the guy who eliminated snakes from Ireland. This is HERE.
The tricky problems relationship modifying drugs throw up in Love is the Drug are not centred on the efforts of pharma to market sex drugs for women with supposed hypoactive sexual desire disorders or other efforts to commodify women and men’s sexual functioning.
There is almost no mention of marketing here.
The authors seem to assume the scurvy knaves of the pharmaceutical industry, who were causing us all problems some years back, have been clapped in irons by evidence based medicine and regulators and we can all now get back to more innocent days – romance filled days of Listening to Prozac when we were all about to be transformed into an entirely new species and could walk the earth with fresh-faced wonder.
There is in fact very little biochemical or pharmacological detail in here and some of what there is is wrong – statins do not inhibit sex.
This lack of detail produces a screen onto which bioethical fantasies are projected. The broader fantasy is that we need a work around for our primitive biological machinery, which where sex is concerned centres on procreation. In the progressive future hurtling towards us, we can’t be held back by our biology.
We will be liberated by “smart” chemicals.
The trouble with this vision is that its our ancient biology that had the smarts to tame and incorporate some beyond-dumb chemicals. Taking these chemicals out of biological systems, figuring that’s where the biological smarts lie, is a dumb move.
Cabbages are a good example of why this is. At the last count cabbages contained something like 47 different pesticides, many of which would not be approved by FDA if they were extracted and submitted for licensing.
But cabbages have the “brains” to use these pesticides effectively, although smart though they clearly are they couldn’t anticipate all eventualities – such as the evolution of a species that would like pesticides. Some of us humans find pesticides tasty (these are what give cabbage its taste and some of us a brassica problem after indulging our tastes).
Testosterone and Estrogen are similarly poisonous but equally can almost irresistibly contribute to the “taste” of other humans. Extracting them, however, figuring they contain the smarts of what it means to be feminine or masculine doesn’t always work out.
Estrogen and Testosterone are a pair of dumb chemicals. It is the biological systems that are smart – smarter often than the individuals they support, even some who write books.
Extracting these poisons and giving testosterone back to men with apparent Low T can cause suicide, dependence and withdrawal problems – yes withdrawal.
Giving estrogen to women with normal estrogen levels can cause addictive cravings, dependence, and withdrawal problems in some women and can also make other women emotionally labile and suicidal.
Even giving thyroid hormone to people with thyroid deficiencies can cause problems – as one of the early posts on RxISK Weight Gain on Thyroxine brings out. Everyone in healthcare knows that one of the signs of underactive thyroids is weight gain and thyroid hormone replacement therapy (THRT) can help people to lose the weight gained.
This underpins a thriving Wellness market niche that pushes thyroid hormones for weight loss – most thyroid hormone prescribing these days is probably for people who have nothing wrong with their thyroid glands. Trouble is that even in cases of genuine thyroid problems, the replacement hormones can do just the opposite to what you’d expect – causing weight gain as the post with its over 200 endorsing comments brings out.
All chemicals, both natural and unnatural ones, can do the opposite to what people expect – a drug that slows your heart rate may increase mine. This is because the chemicals are being chucked into systems that may be wired up in opposite ways but still achieve the right functional goal. The function lies in the system not the chemical. Left handers manage to live in a right handed world
And to add another layer of complexity, biologically there is no such thing as an individual. Our systems, and hormones and everything else in us are shaped by the other systems in the group in which we live.
Love is the Drug ends up twisting itself into a pretzel over some very important points. The authors envisage a future where we will have the chemical capabilities to convert anyone who is homosexual to a heteronormative state and where there might therefore be pressure to convert. They quite rightly say that we need to avoid this.
A few pages later, they tack the opposite way saying that people who are seeking to transition (convert) to the right them need to have a full panoply of smart chemicals available to enable them to be the real and authentic them. Their ancient biological machinery (the author’s words not mine) cannot be let get in the way.
The book finishes on a note of
chemicals change chemicals and thinking changes chemicals and because of this none of us are in a position to decide whether there is an authentic way to achieve authenticity.
To be continued next week with Snakes in a Love Drug 2 .
‘Thinking changes chemicals’
Thinking can change ANYTHING, it’s down to the individual. ‘In the 1960s John
Basmajian, a professor of medicine at McMaster University in Ontario and a specialist in rehabilitative science, began training people with spinal-chord injuries use EMG feedback to regain control over single cells in their spinal chords’ Another psychologist called Elmer Green at the Menninger Institute used biofeedback as a form of therapy to make migraines go away.
Very useful to know that ‘thinking’ can do anything, but ONLY when linked with the power of intention. Where just now the world seems lost in the confusion of the coronavirus, it’s good to know that it’s been scientifically proven that every single cell appears to be within an individual’s control. Read ‘The Intention Experiment’ by Lynne McTaggart if you want to know how the science works. Chapter Nine, ‘Mental Blueprints’ particularly good. Very empowering as we face coronavirus.
I can see where the confusion comes from but my point was almost the opposite. Thinking doesn’t change chemicals reliably in the sense I think you suggest.
The issue is about authenticity. Our general sense is that authenticity comes from a struggle. Great insights and peace can come from a psychedelic drug. (Ditto with alternate treatments or anything done to us). But my bottom line experience is that those who get their insights from psychedelics are the least likely to stand up to the powers that harm us when it counts. They won’t take on Roche for instance
Yes, sorry, I was trying to say that if ‘thinking’ is employed in our authentic state, and can, if done in a controlled and directed positive way, bring about any desired result, then no one needs to find escape from struggle, discontent, ennui by turning to a drug to chemically enhance their life. For, as Annie so clearly states, once that chemical gets inside you, it can change you, probably irrevocably and your authenticity is lost.
Giving someone a hormone like those contained in the contraceptive pill, can cause certain individuals such disruption to their natural personal hormone balance that depression can be the result. So, you prevent the conception of a baby but you at the same time throw that person’s mind into chaos. If 100 different effects can come from a chemical, and no one knows which ones will manifest in any one of us, it’s terrifying to imagine how blithely some of us trust a pill to bring us what we think we want but feel we lack.
I was interested in the way athletes can achieve their best results by using their minds to imagine every step of the race, match, whatever, in detail, over and over again, from their armchair long before the race. If the authentic mind can instruct the body to perform at its best level of achievement, and if this is proven to be the case (most athletes apparently incorporate this in their training now) surely this can apply to any aspect of life, enhance relationships, remove ennui etc. You just have to be clear about what you really want, and then think your way to achieving it, within reason of course. So, who needs to hand control over to a drug, which can trigger all kinds of unwanted side effects, when we already have a means of self change/achievement in ourselves, to be used effectively and safely if we understand how to go about it, and it can be done simply, without involving anyone or anything else. And it costs nothing, and causes us no damage because we are focussed and in control. Not a pesky drug.
I don’t think this is an ‘alternative’ treatment. It’s just trying to use, or tap into, one’s authentic mind to its fullest capacity, and I don’t think most of us have any conception of the vastness of its capabilities. Some might term it self hypnosis but I think it’s not exactly that.
Most athletes figure steroids beat these amazing mental powers hands down but the rest of us at the moment figure perhaps so but the performance is not authentic. And this is before we get into the tricky areas of transitioning males competing in female sports. As Suzanne points out Julian Savulescu has pushed the post-human boat out – saying we need to use all these techniques or we are doomed for extinction but when it comes to relating, while chemicals can play a part …
Surely there is some sort of ethical dilemma between people who want to change themselves and those who would prefer not to.
All the drugs developed change people.
The ‘Chemical’ Romance, here.
How naïve and stupid, taking Seroxat, and not realising that it would change me.
Let alone all the other drugs foisted on me to relieve the effects and me not knowing that that they would change me even more. And given out with such hostility; those doctors sure know how to put the prescriptions in…
We were all born authentic.
We knew who we were.
We were strong, upbeat and successful.
But along came all these drugs and before you knew it, the change had happened.
Ethical questions need to be answered. PSSD people are clawing for answers.
If this review does nothing else, it should draw attention as to what do people actually want.
A supposed romantic pill giving euphoria, a god-given right to explore alternatives to hapless lives or a market -driven machine hell bent on tapping in to people’s insecurities of life, love and all that, life and all that …
As medication has progressed and we all swallow the propaganda delivered de facto so we need to think about how the ‘snake oil salesman’ will always be wanted?
We need many more conversations about the Ethics of Changing People and we need to talk about Who, are happy to do so …
I don’t know how a philosopher is defined and often self defined as a philosopher but whatever I find Julian Savulescu and his ideas deeply offensive. And worryingly ignorant of the drugs he defines in his lecture. (on vimeo below). He took over the editorship of the british journal of medical ethics some years ago – thereafter contributions which would have been accepted and encouraged by Raanan Gillon (pred ed) were refused.
Julian Savulescu coined the phrase procreative beneficence. It is the controversial putative moral obligation of parents in a position to select their children, for instance through preimplantation genetic diagnosis (PGD), to favor those expected to have the best life. An argument in favor of this principle is that traits (such as empathy, memory, etc.) are “all-purpose means” in the sense of being instrumental in realizing whatever life plans the child may come to have.
In some of his publications he has argued for the following: that parents have a responsibility to select the best children they could have, given all of the relevant genetic information available to them, a principle that he extends to the use of in-vitro fertilization (IVF) and preimplantation genetic diagnoses (PGD) in order to determine the intelligence of embryos and possible children; and that stem cell research is justifiable even if one accepts the view of the embryo as a person.
Julian Savulescu also justifies the destruction of embryos and fetuses as a source of organs and tissue for transplantation to adults. In his abstract he argues, “The most publicly justifiable application of human cloning, if there is one at all, is to provide self-compatible cells or tissues for medical use, especially transplantation. Some have argued that this raises no new ethical issues above those raised by any form of embryo experimentation. I argue that this research is less morally problematic than other embryo research. Indeed, it is not merely morally permissible but morally required that we employ cloning to produce embryos or fetuses for the sake of providing cells, tissues or even organs for therapy, followed by abortion of the embryo or fetus.” He argues that if it is permissible to destroy fetuses, for social reasons, or no reasons at all, it must be justifiable to destroy them to save lives.
As editor of the Journal of Medical Ethics, he published, in 2012, an article by two Italian academics which stated that a new-born baby is effectively no different from a foetus, is not a “person” and, morally, could be killed at the decision of the parents etc.
Along with neuro-ethicist Guy Kahane, Savulescu’s article “Brain Damage and the Moral Significance of Consciousness” appears to be the first mainstream publication to argue that increased evidence of consciousness in patients diagnosed with being in persistent vegetative state actually supports withdrawing or withholding care.
In 2009, Professor Savulescu presented a paper at the ’Festival of Dangerous Ideas,’ held at the Sydney Opera House in October 2009, entitled “Unfit for Life: Genetically Enhance Humanity or Face Extinction,” which can be seen on Vimeo. Savulescu argues that humanity is on the brink of disappearing in a metaphorical ‘Bermuda Triangle’ unless humans are willing to undergo ‘moral enhancement’.
Pills that improve morality: Julian Savulescu at TEDxBarcelona
15,653 views•23 Jul 2013
Oh dear. Looks like another book by another two armchair academics. The spiel ends in the Amazon review with: “Love Drugs (sic) arms us with the latest scientific knowledge…” But does it really?
In bookshops, I’ve leafed through a number of seemingly interesting books like this. Very often they don’t included bibliographies enabling the reader to read the actual ‘science’ of which the writer is ‘synthesising’ into layman’s terms for its reader (although there are often, many a footnote saying “Read my other books xyz for more information”). When properly cited references do appear, the actual science papers often turn out to be either misinterpreted, used out of context or poor science and in some cases all three together. Think much of this is done out of naïveté. For whilst they may have had their own papers published in journals, I’ve discovered for myself, that many professionals only ‘think’ they know how to make sense of a science paper.
This hardly amounts to equipping the reader of such books with enough insight to start forming meaningful, enlightened opinions. Also knowledge itself should not (must not) be confused with wisdom. This appears to be a plank in the eyes of as many modern day ethicists as in the past. One only has to consider how often they contradict each other. From having read a lot of history, I get the impression that their ‘thinking’ goes a full rotation along a helix (its seldom an exact repeating ‘circle’) about every 70 years.
Therefore, I’ll refrain from commenting on the subject matter of the book itself, especially as DH has read it and I have not.
Hear all about it then ask how someone as ignorant of vaccines was asked on the show.Vaccines at 6.36
Jeremy Vine – 20/07/2020 – BBC Sounds
Released On: 20 Jul 2020Available for 29 days
Savelescu drivels on at 6.36 on the bar Slip sliding all over the place eg amongs other things he said and changed his mind when caught out was that he had been tested and so has anitbodies to the Covid virus – then back tracked when told that would not guarantee protection for more than a few months, so hey if compulsory he would then have a vaccination. In One sentence he thinks vaccine should be compulsory then back tracked again in a total muddle. It tooks a couple of people to phone in and inform him of potential serious reactions to the iingredients’ of the vaccines. He knows zilch about medicine. Or ethics. Common sense at least would tell him not to accept invitations to shows where he lacks competence.Who does he know at the BBC ? there can’t be any good reason for inviting him – unless the connection being vaccines are being produced at Oxford and he works in a non medical capacity there.