Here’s the cover art for my book!
This is also logged on the Science of Human Perfection page in the title bar.
The biology of good and evil
In today’s New York Times, columnist David Brooks writes about the innate capacities for good and evil. Criticizing what he considers the prevailing worldview today, he writes that we believe that nature is fundamentally good, and hence, so we believe, are people. The Hitlers, the Idi Amins of this world are fundamentally warped. “This worldview,” he writes, “gives us an easy conscience, because we don’t have to contemplate the evil in ourselves. But when somebody who seems mostly good does something completely awful”–such as Robert Bales‘s recent massacre of 16 Afghan civilians, including children–“we’re rendered mute or confused.”
Brooks prefers an older view, in which humans are believed to be a mixture of good and evil. Thus, everyone possesses in some measure the capacity for atrocity. We should be concerned and shocked when such actions are committed, but not surprised. So far, I’m with him. I agree about the “easy conscience” that comes with the lack of hard introspection.
But Brooks then makes his argument biological. He cites the University of Texas evolutionary psychologist David Buss in support of his view. Buss studies human behavior such as jealousy, violence, and mating strategies in the context of Darwinism and especially sex differences. He is thus part of a long tradition of psychologists who seek to explain sexual and antisocial behavior in naturalistic terms, stretching back through Edward O. Wilson‘s sociobiology in the 1970s (here is the famous “Chapter 27” from his textbook, which defined the field) and 1980s, to Progressive-era researchers such as the feeblemindedness expert Henry Goddard, the founder of eugenics Francis Galton, and the Italian criminologist Cesare Lombroso. Such work inevitably sparks controversy because it claims that antisocial behavior is innate and therefore genetic.
Genetic determinism is often associated with a conservative and punitive worldview. If violent tendencies are inborn, there is little we can do about them. Those who display them must be locked up, so that the law-abiding can get on with their lives. Genetic determinism tends to ignore the environmental causes of violence, such as poverty and oppression. Historically, it has tended to align with the preference for criminalization over medicalization of antisocial behavior. That, however, may be changing. Perhaps it is possible to “cure” such behavior by tweaking our genes.
In “The Murderer Next Door: Why the Mind is Designed to Kill,” Buss argues that murderous tendencies have been selected for in evolution. By definition, that which can be selected for has not only a basis in our physical bodies, but therefore a basis in our genes. A necessary implication of this view, then, is that there are certain forms of certain genes that predispose us to violence. Buss’s work is the evil twin of works such as Matt Ridley’s The Origins of Virtue. Although the eugenics of the 1910s–1930s is easily mocked for its simplistic biologically determinist analyses of complex behaviors, now we have more complex biologically determinist analyses of complex behaviors. The problems raised by both are essentially the same.
If there are genes for good and evil, then we can find them. Genome-wide association studies are certainly capable of finding correlations between murder and certain passages in our DNA text. I believe they can find correlations between DNA and almost anything. It is only a matter of time before the “genes for” heinous acts such as Bales’s are found.
I believe those genes exist. There is no rational reason to doubt it. The problem is that the finding may well be meaningless. Something like criminal behavior is so complex that it will turn out to be influenced by hundreds if not thousands of genes. Those genes will interact in complex ways, both with each other and with the environment—and those interactions will themselves depend on other genes and other environmental factors. Finding genes associated with violence would be like finding a handful of sand and claiming that a cause of surfing has been discovered. Well yes, but so what?
Historically, finding that violence is “in the genes” has reinforced punitive models of behavior modification. “Innate” has equaled “immutable.” But biomedical research is moving rapidly toward being able to change the genes. In principle, the controlled environment of the laboratory is much more conducive to engineering than the messy world of populations, culture, and economics. Someday, we may wish for a trait to be found to be strongly heritable, for then it will be easy to alter–the way infectious diseases such as tuberculosis, which once were a death sentence, are now in the age of antibiotics easily treatable. In such a world, the ultimate arbiter of social behavior shifts from the justice system to the biomedical system.
Such a biomedical Brave New World would have enormous implications. I don’t see that we have begun to address the consequences of such a shift.
The Science of Human Perfection
I’ve started a new page–it will stay in the header bar above–for my forthcoming book, The Science of Human Perfection: How Genes Became the Heart of American Medicine, due this summer from Yale University Press. The book is a history of the promises of genetic medicine, from the late 19th through the late 20th centuries. It shows how genetics went from being a backwater of agricultural science to the core of biomedicine. Eugenics, I find, was not a hindrance to genetics going medical, but the vehicle by which it went medical.
I’ve posted a link to the Preface, and will post news about it there as it comes in. Enjoy!
Who’s Laughlin Now? Exclusive Interview with Expired Eugenicist Extraordinaire
Not long ago, Genotopia received a comment from Dr. Harry H. Laughlin, a noted eugenicist. This surprised us, because Laughlin died in 1943. Unsure whether he is visiting us from the spirit world or simply undead, we nevertheless fearlessly seized the opportunity to request an exclusive interview with him, which he kindly granted. Well, perhaps kindly isn’t quite the right word…
Harry Hamilton Laughlin was a principal architect of the American eugenics movement from 1910 to 1940[1]. Born in 1880 in Oskaloosa, Iowa, he worked as a high school teacher and principal before being tapped by Charles Davenport to run the new Eugenics Record Office, founded in 1910 at what is now Cold Spring Harbor Laboratory, on the north shore of New York’s Long Island. Laughlin built the ERO into the epicenter of American eugenics, training “fieldworkers,” collecting pedigrees and other family data, publishing articles both scientific and popular, and lobbying on behalf of the need to prevent the reproduction of the “unfit”—the diseased, the infirm, the antisocial and immoral, and especially the feebleminded, a broad term that could include all forms of subnormal intelligence but which was often applied to those of near-normal IQ. He was a staunch advocate of sterilization, institutionalization, and birth control as means of limiting the numbers of the socially undesirable. In 1922 he drafted a “model sterilization law” that became the basis for California’s sterilization law and which in turn informed the 1933 sterilization law in Nazi Germany. In 1936, Laughlin proudly accepted an honorary doctorate from the University of Heidelberg, a gesture of recognition by Hitler’s Germany of Laughlin’s contributions to eugenic health. Once an inspiration to eugenicists across the land, the ERO sank in reputation through the 1930s and became an embarrassment. The Carnegie Institution of Washington, which administered the Office, shut it down at the end of 1939, sending Laughlin into retirement. He died on Jan. 26, 1943, in Missouri, with his wife Patsy, but childless and with epilepsy. His thanatography will have to await future scholarship…
GT: In the first decades of the twentieth century, you made your reputation as perhaps the nation’s foremost opponent of feeblemindedness. Explain feeblemindedness for us, would you? Why did you see it as the root of so much social evil?
HL: The nation’s foremost opponent of feeblemindedness? Is anybody in their right mind a proponent of feeblemindedness? Let me make it simple for you – feeblemindedness is genetically determined low intelligence. With it comes all the social woes of the inferior classes and races. Inferior minds produce inferior morals, inferior habits, inferior looks, and feckless breeding. And the broods they produce – well, with your genetics background you should know that like produces like. It’s a menace to us all. Society just spirals down the porcelain canyon and flushes out into the Vale of Siddem. The solutions are simple – stop the feebleminded from breeding. You can’t fix their brains, but you can “fix” them other ways. And we must keep the inferior races out of the country so the Great Saxon Stock of this country is not overwhelmed. I don’t know why you can’t see that point, Genodopia. Any bright mind would.
GT: That’s –TOpia, ahem. Is feeblemindedness still a problem now, in the early twenty-first century? If so, how—and what should we be doing about it?
HL: Is it still a problem? Is that a serious question? This has become a country of immigrants from the lowest races – Africa, Asia, Mexico. Do you know that in a few decades, whites will be a minority? A MINORITY? Do you think that mass of defective germ plasm will be able to put a man on the Moon or make great medical discoveries? You can’t make great achievements when you aren’t smart enough for high school and spend your life collecting welfare checks.
We might still be able to reclaim this country if we are willing to take drastic measures, the same ones I proposed a hundred years ago. Strict immigration control – we only grant citizenship to the whitest and the brightest. We clear out the illegals who are already here. And for the rest, there is the Sharp Solution. Pay them to be sterilized. God bless Harry Sharp.[2]
GT: Ouch. Not long after your death, Sheldon Reed of the Dight Institute for Human Genetics in Minnesota coined the term “genetic counseling.”[3] He did so in part to differentiate “nondirective” genetic advice from the sometimes-coercive methods you and your colleagues employed in your eugenic program. In recent years, however, we have seen a backlash against nondirectiveness in genetic counseling. Do you see this as a positive development?
HH: Sounds like a bunch of double-talk to me. Reed was at heart a eugenicist. He just thought that if you laid out the facts for parents they would choose not to have a feebleminded kid. Nice Guy Eugenics. It was doomed to failure because Reed missed a basic point – feeble minds cannot understand complicated information. And even if they could, their unbridled enthusiasm for sexual intercourse would not let them refrain from producing broods. Reed was nudging, but successful eugenics calls for shoving. This is Genetic Warfare, my friend.
GT: That really is strikingly modern-sounding.
HL: And as I understand it, this nondirectiveness is just a bunch of psychology mumbo-jumbo. The backlash against it is the wrong kind of backlash. These new genetic counselors think that their patients have no responsibility to society, only to their own private lives. Well let me tell you, making babies is a very big public responsibility, and genetic counselors need to tell their clients that society does not need any more problems than it already has. That’s the right kind of backlash against nondirectiveness (what a ridiculous term!).
GT: Makes you wistful for the good old days before Nuremberg, doesn’t it? Where do you see hope for eugenics today? What’s going on in human genetics that gives you satisfaction?
HL: I sure wish we had this technology back in the day. The newspapers are filled with stories that link these genetic discoveries to crime, depression, alcoholism, political beliefs, moral failings.
GT: Even the gene for thalassophilia, which your boss was so ridiculed for after both your deaths, has been found.
HL: This is exactly what all the ERO pedigrees showed, but now there is hard biological proof. The DNA evidence is so overwhelming that people will have to see the eugenic light. And I understand that pretty soon we can all have our entire genetic blueprint scanned for a few well-spent dollars. We can start incorporating this genetic sequencing into every aspect of society – in marriage, in assigning children to the proper educational tracks so we don’t waste money trying to make gold out of lead, in deciding who can immigrate into the country, in getting people on the right career tracks, in tracking criminals before they commit crimes…. we have the possibility of a Galtonian Utopia within our grasp.
GT: An old saw of your day was that eugenics was “the self-direction of human evolution.” Are we closer to that goal now, in the early twenty-first century? Do you think we will ever truly achieve it?
HL: We can – we MUST – direct our evolution. Otherwise we face a genetic and evolutionary implosion, a return to a race of brutes cowering in caves, frightened of the dark. Nuclear nightmares look like pleasant dreams in comparison.
GT: You are a religious man, are you not? Isn’t playing God a game for atheists? How do you reconcile “playing God” with your God?
HL: God wants us to live to our full potential, to be more God-like, to be in his image. Do you think God looks like a Juke [4] or a Dugdale? That is why he gave us these great gifts of intelligence and wisdom and morals. Only with wise breeding can we be in God’s image. Eugenics is not “play”, my friend. It is a theological imperative.
[1] Philip K Wilson is working on a full-length biography of Laughlin. He has been a great help to me in framing the questions for this challenging interview. See “Harry Laughlin’s eugenic crusade…” for more insightful analysis of Laughlin. See also Dan Kevles’s In the Name of Eugenics
[2] See Elof Carlson’s and Jason Lantzer’s chapters in Paul Lombardo, ed., A Century of Eugenics in America (2011)
Childs Play
It’s February 29, the birthday of the great pediatrician and medical geneticist Barton Childs. Born in 1916, he would have had 24 candles on his cake today.
Childs was adopted as a baby. An irony for a medical geneticist, he told me, “Because I have no family history,” no pedigree to check for inherited traits. He graduated from Williams College and enrolled at Johns Hopkins medical school in 1938. He served in World War II and then returned to Hopkins, joining the medical faculty in pediatrics.
Pediatrics has a venerable place in the history of medical genetics. Childs was intrigued by young patients with congenital anomalies and began to read up on genetics. A formative moment in his career came in 1952, when he took a fellowship at the Galton Laboratory of Eugenics (later, Human Genetics), at University College London. There he studied under Lionel Penrose and worked with Harry Harris, two pioneers of the field. Penrose was a psychiatrist interested in mental deficiency—his 1938 Colchester Study was a landmark in the understanding of diseases such as phenylketonuria and Down syndrome. Harris was interested in genetic polymorphism. Newly available techniques, such as protein sequencing, electrophoresis, and chromatography enabled him to identify biochemical idiosyncrasies and variations. Both Penrose and Harris were devotees of Archibald Garrod, the English physician who developed the concepts of biochemical individuality and inborn errors of metabolism—two ideas central to genetic medicine today.
Harris and Penrose showed Childs the Garrodian light. He had a scientific temperament, and back in Baltimore he set up a Drosophila laboratory in the hospital to study genetic mechanisms. He contributed to early understanding of numerous genetic diseases, including G6PD deficiency, congenital adrenal hyperplasia and others. He took a particular interest in diseases of the X chromosome, which have a characteristic pattern on a pedigree. In the 1970s he participated in debates over genetic screening and counseling, arguing in favor of proceeding with caution and an eye toward respecting patients’ rights and autonomy.
But his most important contributions were his steady, articulate advocacy of the importance of genetics for medicine. Like his mentor Harris, Childs’s passion was variation. He was not interested in finding “the gene for” a disease; he wanted to understand how our genes contribute to variability in disease. What is it that makes us each biochemically and genetically unique? In particular, he was interested in bringing an understanding of the principles of genetics and evolution into medical education. He was fascinated by the challenge of molding physicians’ minds as the most potent way to improve medical care. By influencing how doctors think, he believed, one could have the largest possible effect on how patients are treated.
His 1999 book Genetic Medicine: A Logic of Disease is his magnum opus. In it, he frames disease as a deviation from the norm of health and asks, How did the normal become the norm? How and why do people vary? Can we identify a set of principles for understanding the mechanisms of disease, and can we develop a structured argument that can be taught to medical students? “To be comprehensible, a logic of disease requires a language common to biology, medicine, and other disciplines. In fact, there is such a language: that of the DNA.” Childs saw molecular genetics as the foundation of the life sciences, the principles on which all life is founded. Drawing on a mechanistic tradition reaching back to Claude Bernard, Childs articulated medicine as an expression of science. Science, in this view, describes the normal, and medicine the pathological, which is a deviation from the norm. Childs was not a simplistic genetic determinist, though. He understood that both health and disease result from the interplay of genetics and environment—an interplay that was unique to the individual and shifted through time. Though his intellect was austere and philosophical, his intent was always to improve medical care for the individual patient.
Childs’s commitment to theory as a guide to practice came from and contributed to a self-effacing personal style. He refused to discuss any personal matters with interviewers, insisting, for example, that nothing about his life was relevant to his ideas. This is a curious stance for a physician, whose first gesture with a new patient is to take a history. He could be gruff and curt, but his curmudgeonly exterior covered a gentle demeanor and a light ego. Seeking a portrait of him to use in my forthcoming book on medical genetics, I scoured the Chesney Medical Archives almost in vain. The only view of his face the archivists and I could find was a three-quarters view image of him talking with colleagues. I settled instead on a silhouette that for me evokes his independence and austerity.
His principal legacy is as he would have wanted it: in the medical curriculum. When Johns Hopkins reformed its curriculum in the 1990s, they grounded it on Childs’s biological approach to medical individuality. Administrators and faculty consulted with Childs, tooling up on his erudite and rich framing of medical education in genetic terms. The course “Genes to Society” is the keystone of the new curriculum, and is explicitly based on Childs’s “logic of disease.” In it, Garrodian individuality, polymorphism, and personalized medicine find pedagogical expression. They put molecular principles up front, using them to then characterize higher organ systems and environmental interactions. In contrast to traditional curricula, in which basic science is taught in the first two years and clinical exposure is in the last two years, the Genes to Society program introduces students to the clinic from the beginning, in an effort to convey the dynamic relationship between the normal and the pathological.
So raise a glass to Barton Childs on his twenty-fourth birthday—a fitting day for one so interested in human idiosyncrasy.
Selected bibliography:
Childs, Barton, and James B. Sidbury, Jr. “A Survey of Genetics as It Applies to Problems in Medicine.” Pediatrics 20, no. 1 (1957): 177-216.
Childs, Barton, and William J. Young. “Genetic Variations in Man.” American Journal of Medicine 34, no. May, 1963 (1963): 663-73.
Childs, Barton. “Sir Archibald Garrod’s Conception of Chemical Individuality: A Modern Appreciation.” N Engl J Med 282, no. 2 (1970): 71-77.
Childs, B., C. Scriver, and et al. Genetic Screening: Programs, Principles and Research. Washington, DC: National Academy of Sciences, 1975.
Childs, B. “Genetics in Medical Education.” Am J Hum Genet 52, no. 1 (1993): 225-7.
———. “A Logic of Disease.” Lipids 31 Suppl (1996): S3-6.
Childs, B., and R. S. Spielman. “Harry Harris (1919-94): In Memoriam.” Am J Hum Genet 58, no. 4 (1996): 896-8.
Childs, Barton. Genetic Medicine: A Logic of Disease. Baltimore: Johns Hopkins University Press, 1999.
Childs, B., C. Wiener, and D. Valle. “A Science of the Individual: Implications for a Medical School Curriculum.” Annu Rev Genomics Hum Genet 6 (2005): 313-30.
The genetic medicine bubble
“The medical world is holding its breath, waiting for the revolution. It will be here any minute. Definitely by the end of the decade. Or perhaps it will take a little longer than that, but seriously, it’s right around the corner. More or less.”
So begins Abigail Zuger’s review of three new pop genome books in yesterday’s New York Times. Zuger raises an interesting point about genetic medicine. The panting, bug-eyed enthusiasm for genetic medicine is ever-increasing, uncorrelated with therapeutic advance, and as obscurantist as a political speech. Which, if you believe economics and politics to be different teams playing the same game, it is.
Genetic medicine whips up support not for its results, but for its promise. It sells a vision of a medical future: one in which I will live forever, my doctor will know me personally, medical care will be tailored to me individually, and my diseases will be identified before they start—with treatment begun accordingly.
The promise is not without substance. Science and medical headlines are indeed full of examples of genomic data improving outcomes for one therapy or another and of cases of personalized high-tech medical care. Revolutions are built of many small steps, and it may well be that some time in the future we will understand ourselves sufficiently well at the DNA level to control much illness that currently confounds us and causes suffering. The scientific, mechanistic approach to human health and disease produces astonishing results that are indeed worth celebrating. Medicine is changing. It’s just that, as the doctor said to the achondroplastic dwarf, you’ll just have to be a little patient.
The hype over genomics and personalized medicine has little bearing on the real results coming out of real labs. The glare of the sunny future blasting from the headlines blinds one to the threats lurking in the shadows—the elitism of expensive, high-tech therapies for rare diseases, the risks of side effects from the increasing number of pharmaceuticals we ingest, the prospect of having our health managed from cradle to grave by a privatized, profit-driven medical establishment.
In both these promises and these threats, genomic medicine exposes its roots in biotechnology. In the 1970s and 1980s, recombinant DNA technology transformed biology—but it also transformed the stock market. Investors bought on the rumor and sold on the news, and so rumor became the most valued currency. Today’s genomic medicine grew out of those techniques of manipulating DNA—and it is driven by the same economic forces. The beauty of hype, from an investment standpoint, is that it fans optimism and masks risk. It is a dangerous model for healthcare.
Medical genetics has greatly advanced diagnosis but it has always struggled with therapeutics. Today’s genomic medicine claims to be at last breaking through the therapeutic wall: through understanding the molecular mechanisms of disease, the claim runs, researchers will develop new drugs. Personalized medicine, then, is pharmaceutical medicine. Every drug ever created has side effects, and they tend to be as potent as the main effects. Drug-based medicine treats side effects with more drugs—an antidepressant leads to weight gain, which is treated with an appetite-reducer, which leads to sleeplessness and high blood pressure,… This works out well for the pharmaceutical industry but turns the patient into a passive, chemically managed being. Medicine so dominated by drugs reduces patient autonomy— an ironic and dispiriting side effect of “personalized” medicine.
The books Zuger reviews are contributing to a healthcare bubble. Whatever the benefits that accrue to patients from genomic technology, they cannot possibly live up to the hype.
Dorkins DNA may reveal slaveholder gene
Prominent atheist and genome advocate Dick Dorkins is genetically hardwired to treat human beings as chattel, according to some interpretations of preliminary results from the amateur analysis of his genome.
The findings come from Project Dick, the widely publicized effort to sequence and analyze the Dorkins DNA. After initial setbacks, Project Dick has become one of the most over-hyped genomics efforts, which is saying something. While Project Dick started as a conventional private sequencing effort, in recent months it has become a group project. Dorkins approved the posting of DNA data online and solicited analyses from the online community—a type of public science made possible by “open-source” genome analysis programs. Like the popular online encyclopedia, content may be contributed by anyone, although it is subject to editorial approval before it goes live. So-called “genome bloggers” have contributed markedly to the analysis of the Dorkins genome. “It’s a Dorkipedia,” said one Project Dick spokesman.
A recent Dorkipedia post, contributed by the genome blogger “SnipDaddy” compared Dorkins’s DNA to that of 5 antebellum plantation owners and found a common set of single-nucleotide polymorphisms, or SNPs. SnipDaddy’s three roommates, none of whom own slaves, do not have the mutations. SnipDaddy concludes that the SNPs constitute a genetic signature for slaveholding. SnipDaddy concludes, “Dorkin grate grate grandad like wippin ppl—he lik wippin em 2. Its inz jeans.” Analysis of the post suggests that SnipDaddy is implying the existence of a slaveholding gene that is correlated with sadism.
The findings could be related to the recent discovery of a genetic predisposition to violent crime. Attention will be focused on finding any basis whatsoever to the claims.
The Master-of-the-Universe Gene
Jonah Lehrer has a new post in the Wall St. Journal on the applications of genetics to finance. For several years, two neuroscientists at Claremont Graduate University have been studying genetics, neurophysiology, and investor behavior. Their latest paper suggests that in the ever-elusive search to balance risk and reward, the sweet spot of maximum investor longevity (i.e., not going bankrupt) was predicted by their dopamine levels.
The paper is a masterpiece of handwaving. It illustrates beautifully how behavior genetics embraces the correlation-suggests-causation approach we like to condemn in those silly, bad old eugenicists from the Progressive Era. Kids, you couldn’t ask for a better example of genetic determinism. Here’s their abstract:
What determines success on Wall Street? This study examined if genes affecting dopamine levels of professional traders were associated with their career tenure. Sixty professional Wall Street traders were genotyped and compared to a control group who did not trade stocks. We found that distinct alleles of the dopamine receptor 4 promoter (DRD4P) and catecholamine-O-methyltransferase (COMT) that affect synaptic dopamine were predominant in traders. These alleles are associated with moderate, rather than very high or very low, levels of synaptic dopamine. The activity of these alleles correlated positively with years spent trading stocks on Wall Street. Differences in personality and trading behavior were also correlated with allelic variants. This evidence suggests there may be a genetic basis for the traits that make one a successful trader.
Of course there’s a genetic basis for it. The trick in finding it is in defining “trait” such that there is a genetic basis for it, and then you find it.
In a typical rhetorical move for overhyped scientistic explanations of fantastically complex behavior, both the scientists and Lehrer suggest a deterministic future by denying it. Let’s take the last three sentences one by one and translate them:
Dr. Zak notes that it’s far too soon to use his genetic assay as a hiring tool—the results still need to be replicated.
I.e., “We have no basis whatsoever for saying this, but…”
Still, it’s possible to imagine a future in which the financial sector requires less oversight because firms have found a way to hire more prudent employees.
“…Wall St. could hire people based on their DNA! If it works–and why shouldn’t it?–we could save so much money! And MAKE so much money!”
Given the massive amounts of money at stake, spending a few hundred dollars on a DNA kit might strike Wall Street as a particularly wise investment.
“What the hell? Go for it, data or no!”
Why so conservative? Since we already have one study–no one likes to do those boring “replication” studies anyway–why not just do away with resumes and job interviews and have would-be stockbrokers simply submit their genome profiles to potential employers? With minimum genetic standards for their mates, in a few generations we could have a race of genetically superior investors who would lead the market ever skyward!
Diseases as verbs
Last week I reread Owsei Temkin’s classic essay from 1963, “The scientific approach to disease: specific entity and individual illness,” for a course I am co-teaching on individuality and medicine. (I have not found the Temkin essay online. If you would like a copy of it, put a request in the comments section.) In it, Temkin distinguishes between the “ontological” and the “physiological” concepts of disease. An ontological approach treats diseases as specific entities—“things” that exist out in nature and befall humans and other creatures. The best example of an ontological approach to disease is the germ theory: the notion, developed by Pasteur, Koch, and others in the late 19th century, that many common diseases are caused by microbes. An ontological approach treats diseases as static; curing disease entails getting rid of the thing that causes it. An ontological approach gave us some of the greatest triumphs of twentieth century medicine: penicillin, the polio vaccine, the triple-drug AIDS therapy.
In contrast, a physiological disease concept treats illness as a process. Temkin also calls this a “biographical” or “historical” concept of disease. A physiological approach is individualized; it treats disease as a unique constellation of disease agent, heredity, experience, and local conditions. In its extreme form, it treats every case as different, because no two individuals have the exact same circumstances. Temkin shows how this approach characterized ancient Greek and Roman medicine, and illustrates how the two, ontological and physiological, have been in dynamic interplay down through the centuries.
Thinking about how to explain this distinction to my students, it occurred to me that ontological diseases are nouns, while physiological diseases are verbs. Objects versus processes; things versus actions. This is a little bit crude, but as a mnemonic it works well to remind one of the fundamental distinction Temkin makes. It’s important to remember that these are not properties of the diseases, but of one’s approach to disease.
Catching up on The Daily Show last night I saw an interview with USC professor David Agus, author of the new book, The End of Illness. Near the beginning of the interview, Agus uses exactly this concept. He says,
We look at diseases as one little factor…You have cancer. You have heart disease. Well to me, those diseases are verbs. You are cancering. You are heart diseasing. And I want to take you from a disease state, the other direction.
After a long and successful run in the twentieth century, the ontological approach to disease has recently ceded the limelight to the physiological disease concept. Genomic medicine is all about individualized or personalized medicine. It promises to end “one size fits all” medicine and treat patients as individuals once again. Individualized medicine is also about prevention—about identifying and stopping disease before it starts. Indeed, Agus segues immediately from diseases-as-verbs to prevention: “And I want to prevent illness.” The physiological approach to disease, individualized medicine, is intimately bound to this notion of disease prevention.
Prevention seems an unassailably benevolent goal; however, in this age of intensive medical management and a potent biochemical, pharmaceutical therapeutic style, prevention also means the erosion of the patient as a medical actor. We all become patients. Your health needs to be managed from birth to death, probably with an armamentarium of drugs designed to forestall a battery of diseases for which you have risk factors.
Agus seems to say that everyone should take a physiological approach, that all cancer and all heart disease, and perhaps even all diseases are verbs. But Temkin concludes his essay by insisting that neither the physiological nor the ontological approach is “correct.” Rather, one must treat a given disease ontologically or physiologically (or perhaps in some combination), depending on whether one is a patient, a doctor, a researcher, a public health worker, or what have you.
It is a marvelous example of how a historical approach to biomedicine—even from an essay half a century old—can deepen our understanding of current events in science, health, and disease.
References
Temkin, Owsei. “The Scientific Approach to Disease: Specific Entity and Individual Illness.” In Scientific Change: Historical Studies in the Intellectual, Social and Technical Conditions for Scientific Discovery and Technical Invention from Antiquity to the Present, edited by AC Crombie. 629-47. NY: Basic Books, 1963. Reprinted in The Double Face of Janus, Johns Hopkins, 1977.
See also Rosenberg, C. E. “What Is Disease? In Memory of Owsei Temkin.” Bull Hist Med 77, no. 3 (Fall 2003): 491-505
Interview with David B. Agus by Jon Stewart, http://www.thedailyshow.com/watch/thu-february-2-2012/david-agus
The continuing hunt for crime genes
“It is our hope that integrating behavioral genetic findings into mainstream criminological theories will elucidate the factors, both genetic and environmental, that ultimately lead to antisocial behavior.” (Barnes, JC, Kevin Beaver, and Brian B. Boutwell. “Examining the Genetic Underpinnings to Moffitt’s Developmental Taxonomy: A Behavioral Genetic Analysis.” Criminology 49, no. 4 (2011): 923-54. doi:0.1111/j.1745-9125.2011.00243.x.
The quote above is from a new study, getting media play over the last few days (“Is that a gun in your genes or are you just opportunistic?” it begins). It is an unselfconscious (i.e., not historically aware) contribution to a long and dangerous literature claiming to show the biological basis of crime.
Ten years ago, the historian of science Garland Allen published an article titled, “The biological basis of crime: an historical and methodological study” (History and Sociology of the Physical and Biological Sciences 31: 183-222). In it, he cited the recent spate of scientific studies purporting to show a strong genetic basis of crime. His focus was the 1992 “Violence initiative,” a federally funded program to help elucidate the genetic basis of crime and other antisocial behavior.
Allen pointed out the long tradition of finding the hereditary basis of crime, stretching back to the eugenic days of the Progressive era. Leading eugenicists such as Charles Davenport and the anthropologist Earnest A. Hooton claimed that criminal behavior was the result of a combination of genetic and environmental factors and that elucidating the genes involved in crime could be a significant social and economic benefit. Davenport, Allen wrote, “brought criminal behavior into the biological arena as an inherited defect of the central nervous system.” (Allen 2001: 188) Hooton, in works such as Crime and the Man (Cambridge, 1939) dissociated himself from the cruder and discredited 19th century anthropometric studies of Cesare Lombroso but borrowed the notion that physical “stigmata” could be reliable indicators of specific criminal tendencies.
These research traditions, Allen shows, have clear continuation into the era of modern genetics, with findings such as the (now discredited) notion that an extra Y chromosome predisposed its carrier to a life of crime, and Richard Herrnstein and James Q. Wilson’s 1985 book, Crime and Human Nature.
“That most eugenicists did not envision the ultimate outcome of their program and ideology is not surprising,” Allen wrote. “Scientists are not very accurate social critics.” (2001: 220)
One could mount a critique of the science in the paper: it has no candidate genes and is based simply on association. It has a broad and subjective definition of “crime” that allows in dozens of subjective, uncontrollable variables. I leave that critique to others.
My argument is simply this: science needs social critics, because its findings carry increasingly potent social impact.
(If any readers have difficulty obtaining any of the linked articles cited above, post a comment with your email address and I will send them to you.)
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