medical-technology1

There are many complex factors driving up the cost of healthcare, but one major factor is increasing medical technology. Often new expensive technologies provide incremental, or even questionable, additional benefits but can dramatically increase the cost of health care. This is especially true of in-hospital treatments.

There are also, of course, medical technologies that provide significant benefits, and others that improve our ability to make diagnoses. The public clearly wants and expects the latest and greatest medical technology when it comes to their health care or that of their loved-ones.

From this perspective the culture is definitely very pro-medical technology. Nothing is too invasive or heroic if it might save a loved-one. In fact, access to the latest medical miracles is considered a right, and even the suggestion that such technology might be futile is often met with hostility and anger.

At the same time, there is substantial fear in the culture toward some medical technologies, depending on context. A recent Pew survey found:

A majority of Americans would be ‘very’ or ‘somewhat’ worried about gene editing (68%); brain chips (69%); and synthetic blood (63%), while no more than half say they would be enthusiastic about each of these developments. While some people say they would be both enthusiastic and worried, overall, concern outpaces excitement.

People are both excited and worried at the same time.

Competing narratives

It seems that there are two basic narratives at play here, and people will tend to adopt one or the other, but can flip between them depending on context.

The pro-technology narrative I think is more straightforward. People expect technology to make their lives progressively better. They have been sold on the “miracles of modern medicine” and want it. If something is broken about their body, they want it fixed.

There is a distinction to be made, however, between fixing a problem and enhancing human function. In general people are far more accepting of technology that is used to cure or treat a disease, or to fix or compensate for a missing or malfunctioning body part. I don’t think there would be much of an outcry if we were able to give patients completely bionic limbs to replace those that are lost or paralyzed.

If, however, you want to implant devices to enhance an otherwise completely healthy person, that is “meddling with nature.”

That brings us to the other narrative, one we discuss at SBM frequently, the appeal to nature narrative (or fallacy, depending on your perspective). People have a sense of what is “natural,” even if they cannot specifically define it, and they feel that anything that violates nature beyond some arbitrary and fuzzy point is morally wrong.

There appears to be some emotional calculus going on, with disgust at anything “unnatural” on one side of the equation, and appropriate health benefit on the other side. That sense of disgust is often translated into a moral position.

Messing with the brain, our genes, and our blood provokes these feelings in a majority of the public (at least according to this one survey). I don’t think such feelings are limited to these areas, however. Remember the girl with the baboon heart? People objected to transplanting animal organs, or even just animal protein, into a human (as if we are not animals).

This sense of disgust extends to our food, as is evidenced by popular objections to genetically modified food.

Nature is amoral

While people are free to have whatever values and beliefs they wish, I am an unapologetic supporter of the notion that what is “natural” has no moral implications. I do think this is merely a manifestation of the emotion of disgust misplaced on technology.

There is also a strange combination of mutually incompatible beliefs at work. On the one hand, humans are viewed as part of nature and therefore we should not violate our nature – beyond some arbitrary point and depending on the purpose and details of the violation. In this view we should not alter our genes, or implant technology.

On the other hand, there is an implicit view that humans are somehow separate from nature. We are pure in some sense, and should not be contaminated with “animal proteins.” Some people would have less of a problem putting a mechanical heart into a patient than a baboon heart.

I don’t think any of these objections to medical or biological technology has a rational basis, or at least I have never heard one. There are often cost-benefit and risk-benefit issues with new technologies, and those are legitimate concerns, but they are rarely the basis for the actual objections. They are sometimes used as proxy issues, but are never the true cause of objections to the new technology.

The fact is, it is human nature to mess with nature. The primary adaptation of the human brain is that we use it to adapt our environment (nature) to us. Almost all of the food we eat has been altered beyond recognition to make it more palatable and nutritious for us. We can replace organs, swap out your blood, filter your blood, give you manufactured chemicals that bind to your cell’s receptors, remove diseased body parts, enhance your body’s defenses with germ-killing drugs, and replace body parts with artificial parts.

There is nothing “natural” about health care. What is natural is for humans to live short and brutal lives.

Technology advances

Despite the appeal to nature fallacy and the Luddites, acceptance of new technology slowly advances. Some people will object to the latest extension of our ability to alter, fix, and enhance our bodies, but then those technologies are quickly accepted as it becomes clear that there are no Frankenstein’s monsters or horrible consequences.

The classic example of this is in-vitro fertilization. There was a great deal of objection to “test-tube babies” when the technology was introduced, and now it is generally accepted without a thought (there are always some religious holdouts, but that is a separate issue).

The fact is – humans are animals, and our bodies are just complex biological machines. We all want long, healthy lives with good quality of life. We eventually will accept any technology that fulfills that desire, in fact we demand it. What was viewed previously as unacceptable meddling with nature will soon be seen as an inherent right of every person. Just try to deny IVF to a couple who want a baby, or talk to a family whose loved-one is in critical condition.

Posted by Steven Novella

Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the president and co-founder of the New England Skeptical Society, the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also contributes every Sunday to The Rogues Gallery, the official blog of the SGU.