WHO'S IN YOUR GENES »
Inside the ancient Egyptian "Book of Coming Forth by Day" (usually called the Book of the Dead), one can find "spells" for transforming the body into other forms. Spell 77, for instance, offers an oration for "transformation into a falcon of gold". The next spell, number 78, takes it up a notch with transformation into a divine falcon. Then there is Spell 80 which offers "transformation into a God and giving light into darkness." If you read the actual spells you'll discover rather quickly that the symbol rich nature of Egyptian language defies our wont for literal interpretation. We can forgive our obtuse handling with Egyptian culture when we remember that even during their own time they were viewed as exotic and enigmatic by their neighbors. As per these three spells, Egypt seems to have viewed the human body as an accomplice to the workings of the divine world. They conceptualized the "Self" as having many separate and maybe even equal intersecting aspects; the human body being just one of them.
A leap from the Egyptian idea of the body to, say, the Christian one, establishes a timeline where the body seems to evolve (or devolve, depending on your persuasions) from something proximal to the sacred to something approaching the sinful. While the glorified Egyptian body required mummification, the sinful Christian body requires salvation. Further still up the timeline, arriving at today, we find a fully secularized body that demands perpetual youth through cosmetic surgery which is really just a type of mummification for the living. Our view of the Body largely determines our prescriptions for it. The Spiritualized Body of ancient times required spells, serums and salvation. The Emotional Body requires a great deal of therapy (or a hug). The Clinically Emotional Body requires psychotherapy. The Machine Body of today has no need of any of these things. Spells, serums, therapy or even a hug are either obsolete or optional. In their place we have surgery, pharmaceuticals and, of course, Hallmark® cards.
The Egyptians were right. The Body is capable of transformations, and over thousands of years it has seen many. The 19th Century saw the body completing its transformation into a machine. At the start of the 20th century we compared the machine body (specifically its brain) to cameras, phone switchboards, and today, the computer. This comparison means we are now transforming into the Cyber-Body. With each new transformation we are able to look back and laugh at the "unenlightened" transformations of the past. We are especially critical of the Spiritualized and even the Emotional Body. How foolish were we to ever believe that we could be something as ethereal as a spirit or as ambiguous as our emotions? Of course, our "enlightened" concepts of what the body could be were just as foolish at times.
Remember, the idea that the human body could be a Slave-Body, was once an enlightened conviction rationalized with "scientific" proof that slaves were only a few steps removed from animals. This was especially true in the United States, where even as late as 1970 we find a "scientific" ad disclaiming the equality of the races. Slaves as product and property are perhaps the earliest ancestors of Machines and, therefore, the Machine Body. Today, after much resistance, we have arrived at the neo-enlightened conclusion that a slave is, in fact, a human being which is why a human being should never be a slave. Besides, we don't need humans to be slaves anymore. We have machines. We can do other things with The Machine Body that do not violate human rights like, say, send it war.
War has a way of turning the Machine Body into a Medicalized Body. A body broken by battle requires fixing, and medical drugs had always been (and still is) a recurring element throughout the history of the wounded body. The baton for dominion over the damaged body passed through many hands, but in 1765, a decade before the start of the Revolutionary War, physician John Morgan succeeded in dividing this dominion into two competing parties: doctor and pharmacist. Whereas before the physician both prescribed and applied drug remedies, Morgan succeeded in establishing the latter to the role of the "druggist". The idea was to curb the problem of over-drugging. However, by 1778, with the Revolutionary War well under way, the scales tipped too far in the other direction when the need for large-scale drug manufacturing to support the Continental Army jump-started the emergence of an American pharmaceutical industry. By 1812 only the pharmacist was responsible for the production of medicine. By 1820 and 1847, respectively, the U.S. Pharmacopoeia and the American Medical Association emerged to begin expansion of the domain of the Medicalized Body.
However, at that time, most people claimed to know something about the body and practiced some form of at-home medicine. The advancement of folk medicine and the inevitable spin-off of "secret formulas" from quacks, compelled the creation of the American Pharmaceutical Association in 1853 to combat what they considered to be an adulteration of their products and an affront to their industry. The idea was to make knowledge of the body, its ailments and cures a specialized domain of physicians and pharmacists only. That Pharma now represents the fastest-growing segment of health-care expenditures clearly means that their battle for the Human Body was won. With this victory came the shape-shifting of the Machine Body to The Medicalized Body.
Today, the U.S. Pharmaceutical industry is made up of roughly 100 companies, with the top 10 largest companies accounting for over 60% of the industry's consumer sales. Pharma dominates the lion's share of the Medical Economy. That term -- Medical Economy -- describes where Medical Culture meshes with Marketing Culture. Medical knowledge has become a type of currency that determines the value of the products and services attached to it. One of these attachments is the Body itself. What have we been told about our bodies? What have we been sold for our bodies? These questions are the backdrop for today's Medicalized Body.
This was the case of Bipolar Disorder which was once a rare diagnosis for only 1% of the population (back then it was referred to as "Manic Depression"). By the 1990s new drugs for treating manic depression were discovered, coinciding (either by coincidence or design) with a new flexible criteria and diagnosis for Bipolar Disorder. The 1% manically depressed population suddenly expanded to 24%. Along with it grew the sales of anti-depressant medication. Joanna Moncrieff, in her book The Myth of the Chemical Cure, summarized it by writing: "What had once been a relatively rare disorder, for which there was considered to be only one very specific treatment, is now regarded as a widespread problem with an array of new drug treatments."
This is certainly not an adjudication that we are dealing with artificial knowledge or even artificial diseases. It calls into question whether or not we are witnessing the medical profession's improved ability to identify and treat existing problems; or instead witnessing the economic motivation for ideating new problems and annexing existing ones. As physician Jacalyn Duffin clarifies, "The word 'illness' is used to designate individual suffering; the word 'disease,' pertains to ideas about the illness." It is this territory of "ideas" that presents a great deal of flexibility that is useful to the marketplace of the human body. A diagnostic can be objective; but a diagnostic marketplace loses its medical objectivity as it responds to its own market needs. Consider the lawsuit by former-New York Attorney General Eliot Spitzer of GlaxoSmithKline for withholding clinical trial information of Paxil's anti-depressant results on children.
Pharma has enjoyed over 150 years of dominion over the Human Body, but the 21st Century has presented new challenges to its sovereignty. For one, their own drugs unwittingly belie the Man as Machine metaphor. Machines are uniform and we are quite confident that they can be fixed; which means as long as the body-as-machine metaphor endures we are equally confident that we too can be fixed. But it hasn't really panned out that way. The human body, if it is a machine at all, is a very individualistic one, especially when reacting to uniform pharmaceutical drugs. This fact remains the proverbial monkey wrench in Pharma's pursuit of massification of all of its drug products. The process of scaling-up a drug from small lab quantities to population volumes collides with the inevitable adverse reactions on the individual scale. Whether mechanized or medicalized, The Individual Body is not compatible with the urgencies of the marketplace. The problem of the individuated body is why it is so difficult to hit a home run with a new drug. The reputation of the drugs that do make it into the game at all have to next overcome public mistrust and suspicion. This is compounded by the revival of "body literacy" and folk medicine. The reappearance of both is largely attributed to the expansion of pop-science via the University of Google. Very much like the citizens of the 19th Century, a rising number of people are self-diagnosing and self-medicating with self-satisfying results. And, yes, similar to the 19th Century there is a great deal of quack products that exploit this trend. Pharma is back where it started.
The Pharma Economy has had only two saviors from public antipathy. Their first savior, ironically enough given the history between the two, is the physician. Very much like children's advertising, where commercials cast spells on kids sending them to demand that toys be bought by their parents, pharmaceutical ads employ the same formula; casting spells and then sending us on our way "to ask our doctor about..." Even the self-diagnosing citizen is, in the end, obeisant to the doctor's sovereign knowledge and acquiesces to his prescription. Physicians are their first savior, but Pharma's second savior arrived at the year 2000 with the completion of the Human Genome Project.
Initially, The Age of Biotech seemed to cloud the business models of pharmaceutical drugs. For one, traditional drugs are obtuse in their applications, especially when compared to the projected acute methods of treatment in personalized medicine. Whereas drugs don't actually cure anything at all, gene therapy seemed to promise not just a cure of the medicalized body, but can be "personalized" for the Individual Body. Pharma lucked up in that the Biotech Age has not yet lived up to our panacea expectations. It did, however, reboot, or rather re-mystify, the public's perception of scientific sovereignty. Peter Conrad, in his book The Medicalization of Society wrote, "The key to medicalization is definition. That is, a problem is defined in medical terms, described using medical language, understood through the adoption of a medical framework, or 'treated' with medical intervention." Physician Charles E. Rosenberg seconded this notion in his book Framing Disease. He calls disease "an elusive entity", stating that "a disease does not exist as a social phenomenon until we agree that it does -- until it is named." The 21st Century, and its Biotech Age, has ushered in a whole new vocabulary of names and terms that has returned stars in the eyes of futurists and a glaze-over in the eyes of the clueless.
There are over 300+ publicly traded biotech companies, and many more private ones. But this number fluctuates as these Biotechs are fast absorbed by larger pharmaceutical giants, resulting in what can only be called the BioPharmaceutical industry. The very title of the Genomics and Personalized Medicine Act of 2006, introduced by Barack Obama, demonstrates that the U.S. government is already preparing itself for this new industry and the "medicine" it is expected to create.
The public, on the other hand, will have to prepare not just for the types of medicine that will precipitate from BioPharma, but how this new medical knowledge will be packaged and sold. What new metaphors will be adopted to manage our awareness of the body? If the body was a Machine in the 19th Century, and a form of Medical Capital in the 20th century, what will it be in the Biotech Age? Who or what will we be (or become) in the mirror of biotechnology? In The Doctor's Dilemma, Louis Lasanga gave an enlightening response to what he anticipates to be our answers to these questions:
"In the beginning, there was Ignorance. And in the end, also, one can safely prophesy, when the last radioactive cloud settles over the hills and valleys of a dead world, some wise being looking down from another planet will roar with cosmic laughter at the stupid things earth people believed about their bodies and ailments."