Once defined as the science of human improvement through better breeding, eugenics has roared back into the headlines in recent weeks in both Mr. Hyde and Dr. Jekyll personae. The close observer may well wonder which will prevail. The snarling Mr. Hyde is the state control over reproduction. Although this idea may evoke visions of Nazi genocide, the U.S. itself has a long, unsavory eugenic history, peaking between 1910 and the mid-thirties but tailing out through the 20th century. And now into the 21st: theby the Center for Investigative Reporting, which showed that between 2006 and 2010 nearly 150 pregnant prisoners had been sterilized against their will in California, was a stunning reminder that traces of the old eugenics remain in our own time.
Another recent storya polemical but informativeon the continued efforts of a private organization begun in 1997 that pays poor and drug-addicted women to be sterilizedhighlights some of the complexities of reproductive rights. Payment of the poor or incarcerated has long been acknowledged as a form of coercion; yet some such women genuinely welcome the opportunity to simultaneously forgo children they can ill afford without becoming celibate. Sorting out these issues has been a problem at least since , begun in the 1940s, which sterilized thousands through the 1950s and 1960s, with the express approval of the state. A dabbing of eyes and collective sigh of closure accompanied the news this month that thepay a total of $10 million to the programs victims, or, as they were known at the time, patients.
Eugenics critics are still the vocal majority, spanning the political spectrum. But in recent years, a growing constituency of Drs. Jekyll within the biomedical community has sought to resurrect eugenics as a practice that, if done correctly, can be beneficent. The key to the new eugenics, they say, is individualitya word with complex resonances ranging from individualized medicine to individualism, a cherished American value. Indeed, the new eugenics is sometimes called individual eugenics. A recent article by Jon Entine, of the Center for Genetic Literacy at George Mason University, exemplified this push for eugenicists to come back . Prenatal genetic diagnosis is eugenics, Entine says, because it is controlled by individuals, not governments. This sparked a lively debate on both his blog and mine. The question then is whether individuality can save the soul of eugenics.
Individuality is one of the oldest and newest terms in medicine. The Hippocratic physicians diagnosed each patient in terms of their unique constellation of heredity, environment, and experience (although individualized treatment was, as today, reserved for those who could afford it). In the second century A.D., Rufus of Ephesus stressed the importance of interrogating the patient as to habits, preferences, experiences, and congenital diseases as an aid to diagnosis. The development of the case-study method in the Early Modern period signaled new attention to individual; each case came to be understood as a unique manifestation of disease.
This trend toward individualized treatment halted in the 19th century, with one of the greatest transformations in medicinethe concept of specific disease, caused by a specific disease agent such as the cholera vibrio or the tubercle bacillus. Increasingly, physicians treated the disease rather than the patient. Although this development led to enormous gains in the potency of medical therapy, some have rued the disappearance of the sick man. The current fad for individualized or personalized medicine is, among other things, the latest call for a return to patient-centered medicine. Increasingly, the physician interrogates the patients genome, learning far more from the sub-microscopic ticker-tape of DNA in her cells than Rufuss wildest dreams could conjure.
But some question whether this new technology really puts the person back into medicine. Critics point out that personalized medicine often seems to concern profit more than health. Indeed, tech business sites show that personalized medicine is one of the healthcare industrys biggest growth areas. Qui bono? Here is where individuality meets individualismthe libertarian swing that has captured much of American culture in recent decades. Events as disparate as the stock-market bubble, gay marriage, legalization of marijuana, and right-to-carry laws illustrate the resurgence of this quinetessential American value.
Individualism, of course, runs deep in the American identity, but not since the Gilded Age have the individualist mythos and free-market economics enjoyed such dominance. Indeed, the main arguments in domestic politics today seem to concern how and how fast to cut costs and disempower the government. Individualized medicine can also be seen as individualist:stress that the new medicine must be participatory, meaning that the patient has increased responsibility for their own care. Modern individualism means everyone looks out for their own interestsfrom biotech CEOs to hospitals to patients.
The old eugenics was top-down and collectivist. Francis Galton proposed eugenics in Victorian England, as a humane alternative to the ruggedly individualist but misleadingly named social Darwinism. (More accurate though less sonorous would have been social Spencerism, after Herbert Spencer.) Rather than letting the weak kill off themselves and each other, Galton proposed a system of tax incentives and education programs he thought would lead the poor, sick, and stupid to voluntarily have fewer childrenand the healthy, wealthy, and wise to voluntarily breed like rabbits. Human evolution could thus be gently directed toward perfection with much less suffering. Galton counted on evolutions losers to unselect themselves, for the greater good.
After 1900, eugenics became yet more collectivist and much more potent, particularly in Progressive-era America. Progressivism was, fundamentally, a reaction to the exploitative practices of what Mark Twain called the Gilded Agethe industrial boom of the 19th century. Americans were fed up with the selfish greed and worker exploitation of Andrew Carnegie (an avid social Spencerist), Cornelius Vanderbilt, JP Morgan, and other Robber Barons. (The fact that this narrative oversimplifies the history of American industrialism doesnt discount public perception at the time.) Progressives counted on Government as the only social entity powerful enough to stand up to industry, but even many who did not identify with the Progressive Party valued personal sacrifice for the greater good.
The first part of the twentieth century was, by American standards, a moment of profound shift toward collectivism. However, progressivism was also about science. The rediscovery of Mendels principles in 1900 seemed to do for heredity what Marie Curies radium and Rutherfords splitting of the atom did for physics: crack open the secrets of nature, providing hitherto unknown power to harness natural forces for the good of humanity.Harry Laughlin