Bioethics/Introduction
Joanna Zylinska
Bioethical Mutations in the Age of Capital
Bioethics is a serious business, in every sense of the word. A sub-domain of philosophy which deals with issues concerning life and health, it has to arbitrate not only over practical matters regarding patient care and medical experiments, but also over the very ontology of ‘life’: its manufacturing, patenting and redefinition in and by the biotech industry. Since bioethics functions as a node in the complex nexus of social, political and economic forces, it is perhaps not surprising that technocapitalism does not want to leave it just to philosophers. Instead, it mobilises a whole army of ‘experts’: morality salespeople, ethics technicians, value mathematicians, to help us decide on the price of life. Consequently, bioethics increasingly abandons its more daring ambitions and responsibilities -- such as exploring the metaphysics of life or the politics of everyday survival -- to serve instead as just a ‘technical discourse about values clarification and choice’ (Haraway, 2007: 109). Its methods of working are thus principally procedural, akin to ‘facts and hypothesis testing’ in science (Haraway, 2007: 109). Feminist thinker Donna Haraway points out that medical ethics ‘is now a literal industry, funded directly by the new developments in technoscience. Ethics experts have become an indispensable part of the apparatus of technoscience-production’ (2007: 109). To put it crudely, bioethics’ role is often to get biotech corporations off the hook -- although, of course, it has the potential to be much more than that. Indeed, in its engagement with life in both a metaphysical and material sense, bioethics is potentially one of the most exciting areas of philosophical interrogation and artistic experimentation today.
Designed as a supplement to my 2009 book, Bioethics in the Age of New Media -- which explores and experiments with some alternatives within bioethics -- this living book, Bioethics™: Life, Politics, Economics, is to act as a warning against the foreclosure of the aforementioned potential by casting light on this increasing marketisation of both life and bioethics under late capitalism. Performed as a form of ‘mutation’, the introduction to Bioethics™ proposes an academic-artistic method for reading and writing as genetic recombination, which can perhaps be seen as a biotech-era take on Roland Barthes’ ‘From Work to Text’. The text below is thus a product of the cross-fertilisation of all the sources that feature in the Bioethics™ book: between one and four sentences have been taken from each article and spliced to form a unified whole. The structure of individual sentences has been retained most of the time, and indication has been given whenever sentences have been split. No foreign material has been added to the mix. Phenotypically resembling a standard academic essay, yet referenced in a less conventional way by a series of direct links (although a full page of Attributions is also available here), the text below is an experiment in textual and conceptual hybridisation. Its main function is to foreground the questions of crossing over, intellectual property, political economy and the ethics and politics of academic research that are the topic of this particular living book, and of the Living Books project as a whole -- but it may also of course develop a life of its own...
Today, the pharmaceutical industry has settled comfortably into its place as the most profitable business in America. The media hoopla surrounding the sequencing of Watson’s genome has already had some commentators worrying that genome sequencing could become the next must-have for the rich and privileged.... However, beyond the publicity, it is only a matter of time until genome sequencing will be affordable for most people. Once it becomes commonplace, it will generate an enormous quantity of sequence data from a wide range of humans that could benefit biomedical research and drug development. More importantly, a ‘thousand-dollar genome’ could become an important tool to realize personalized medicine: perfectly tailoring diagnostics and treatments to a patient’s genetic make-up. The emergence of an autonomous health industry establishes a potential structural problem for capitalism: insofar as the growth of the health industry depends on ‘people becoming more sick,’ its growth seems to be in tension with the growth of other sectors of the economy. The solution to this structural problem is the creation of ‘surplus health,’ or that ‘proportion of health unnecessary for maintaining one’s capacity as a worker’... . Preventive medicine is especially well suited for the creation of surplus health, for by enabling the diagnostic identification, and pharmaceutical management, of ‘risk factors’ for diseases, rather than simply the diseases themselves, it becomes possible to expand markets for diagnostics and medication, without at the same time reducing an individual’s capacity for labor.
Over the past half-century, American doctors have begun to use the tools of medicine not merely to make sick people better but to make well people better than well. But does making small normal children bigger also make them better? That is the fundamental and simplistic question underpinning the use of GH growth hormone in ‘idiopathic’ short stature. Just when it seemed that eugenics could not return to the forefront of the social arena, it appears once again, although its spectacle has been modified to suit the times. Eugenics, at least on the surface, is only implicitly attached to issues of race improvement or gene pool cleansing. Now it hides under the authority of medical progress and the decoding of nature.
The pharmaceutical industry influences psychiatrists to prescribe psychoactive drugs even for categories of patients in whom the drugs have not been found safe and effective. What should be of greatest concern for Americans is the astonishing rise in the diagnosis and treatment of mental illness in children, sometimes as young as two years old. These children are often treated with drugs that were never approved by the FDA for use in this age group and have serious side effects.... Ten percent of ten-year-old boys now take daily stimulants for ADHD -- ‘attention deficit/hyperactivity disorder’ -- and 500,000 children take antipsychotic drugs. industry uses ghostwriters to insert marketing messages into articles published in medical journals. open-ended activities such as ‘unrestricted’ research grants, ‘educational’ grants, membership in speakers’ bureaus and advisory panels, consultancies, and stock-holding could be of greater concern, through an insidious blurring of professional boundaries and obligations. There is evidence that these types of ties are common among specialist physicians.
The true purpose of a drug trial is not always obvious. Medical trials are not always conducted to test the drug -- sometimes it’s to seed the market. research on humans has become a commercial enterprise. Most clinical trials have moved from academic settings to specialized contract research organizations (CROs), which contract with the pharmaceutical and biotechnology industries. Reports suggest finder’s fees ranging between $2,000 and $5,000 per patient are common, although it is not always easy to distinguish the reward for the recruitment of patients from remuneration for clinical activities that are part of the research. Few would argue that patients in trials should be treated as commodities, but patients have become de facto market products, while ‘market controls’ are neither clear nor sufficiently stringent.
In North America today..., where medical research happily converges with consumer capitalism, even bioethicists believe that the market ultimately works for justice. Ethical issues are a growing concern for companies, in the wake of a series of corporate governance scandals and the accompanying sharp decline in societal and investor trust in firms. Some companies have responded to these concerns by creating internal ethics programs. ethics is an asset that firms can trade upon. Firms are considering ethics as central not only to their research activities and the dissemination of their products to consumers, but also to the reputation and branding of the company itself. manufacturers were reported to demonstrate awareness of existing regulations and engage in strategic behaviors to work around them (e.g., by giving employees lectures about the regulatory environment that were understood to be a smokescreen) or to mask their violations of the law (e.g., by encouraging employees to not enter off-label marketing calls in their logs).
References
Barthes, R. (1977) ‘From Work to Text’, Image - Music - Text. Trans. S. Heath. London: Fontana Press.
Haraway, D. J. (1997) Modest_Witness@Second_Millennium. FemaleMan©_Meets_OncoMouse™. New York and London: Routledge.
Zylinska, J. (2009) Bioethics in the Age of New Media. Cambridge, MA: The MIT Press.