Saturday, June 15, 2013

Donna Dickenson's "Me Medicine vs. We Medicine"

Donna Dickenson was born and educated in New England. After an appointment as associate in research at Yale University, she held professorships at several U.K. universities. She is now professor emerita of medical ethics at the University of London and research associate at the Centre for Health, Law, and Emerging Technologies at the University of Oxford. Her book Body Shopping: Converting Body Parts to Profit was called “essential reading” by The Lancet and “ambitious and thoughtful” by New Scientist. In 2006, Dickenson was awarded the prestigious International Spinoza Lens award for her contribution to public debate on ethics, becoming the first and only woman to win the prize.

She applied the “Page 99 Test” to her new book, Me Medicine vs. We Medicine: Reclaiming Biotechnology for the Common Good, and reported the following:
Even in the highly individualized American medical system, influential advocates of “personalized medicine” claim that our healthcare just isn’t individualized enough. What I call “Me Medicine” ranges from personalized cancer therapy regimes—which can definitely do good in some cases—through highly speculative notions such as neurocognitive enhancement—creating the “best me I can possibly be”-- and on to one form of individualized care that can actually do harm.

If you opened Me Medicine at page 99, that’s the technique you’d find being discussed: private umbilical cord blood banking, where a portion of the blood that would normally flow from the placenta to the baby is diverted during delivery. Instead it’s stored—at a charge-- as a private “spare parts kit” for the child’s later use, if stem cell technologies ever get to that point. But that means that public cord blood banks, open to all regardless of ability to pay, lose out on that contribution—and the procedure may increase the risk of jaundice or anemia for the baby. It’s an emblematic example of the potential harms in individualized medicine.

In another way, however, page 99 isn’t at all typical of the wider sweep of the book’s argument: that we risk losing sight of the common good in biotechnology—what I call “We Medicine”—in our haste to embrace personalized healthcare. To set this debate in a wider political and economic context, I examine four possible reasons for the rise of Me Medicine: a sense of threat, the rise of narcissism, corporate interests backed by neo-liberal government policy, and the sacredness of personal choice. I’m primarily a political theorist and medical ethicist: the book ends with an extended development of the notion of the public good and the commons in biomedicine.

In each chapter on one of the new techniques, however, I undertake a crucial reality check of the scientific research base, for and against. At page 99, you’d land smack in the middle of what might appear an arcane obstetric debate about whether early clamping of the cord and diversion of blood harm the baby. In fact, however, that debate is crucial to establish scientific credibility and to give you the necessary factual base, so that you can make up your own mind about Me Medicine vs. We Medicine.
Learn more about the book and author at Donna Dickenson's website.

--Marshal Zeringue