The Noble Lie

Gary Greenberg

Description

Is drug addiction really a disease? Is sexuality inborn and fixed or mutable? Science is where we often turn when we can't achieve moral clarity. In The Noble Lie, acclaimed and controversial science writer Gary Greenberg shows how scientists try to use their findings to resolve the dilemmas raised by some of the most hotly contested issues of our time, from gay rights to euthanasia and the drug war. He reveals how their answers often turn out to be more fiction than science—and explores whether they cause more harm than good.

Sujets

• Philosophie
• Éthique et morale
• Moral Philosophy
• Philosophie et théologie
• Noble lie
• Philosophy
• Ethics
• Ethique et morale

Informations

• Publié par: Turner Publishing Company
• Date de parution: 01 septembre 2008
• Nombre de lectures: 0
• EAN13: 9781620458648
• Langue: English

Extrait

The Noble Lie
The Noble Lie
When Scientists Give the Right Answers for the Wrong Reasons
Gary Greenberg

John Wiley Sons, Inc.
Copyright 2008 by Gary Greenberg. All rights reserved
Published by John Wiley Sons, Inc., Hoboken, New Jersey
Published simultaneously in Canada
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Library of Congress Cataloging-in-Publication Data:
Greenberg, Gary, date.
The noble lie : when scientists give the right answers for the wrong reasons / Gary Greenberg.
p. cm.
Includes index.
ISBN 978-0-470-07277-6 (cloth)
1. Science-Moral and ethical aspects. 2. Science-Social aspects. I. Title.
Q175.35.G74 2008
174 .95-dc22
2008003759
Printed in the United States of America
10 9 8 7 6 5 4 3 2 1
C ONTENTS
Acknowledgments
Introduction
1 Addiction: Visions of Healing
2 Depression: In the Magic Factory
3 Sexual Orientation: Gay Science
4 Schizophrenia: In the Kingdom of the Unabomber
5 Brain Death: As Good as Dead
6 Persistent Vegetative State: Back from the Dead
7 Mortality: We ll All Wake Up Together
Afterword
Notes
Index
A CKNOWLEDGMENTS
This book wouldn t exist if not for its editor, Eric Nelson, who noticed the theme of the noble lie in my reporting and then plied me with caffeine until I saw it, too. He s an old-fashioned literary guy-a sensitive reader and a great believer in the power of books, that is-and I am grateful to him.
Many of the chapters that follow began their lives as magazine articles and owe much to their editors. When you stumble into journalism in mid-career, you re even more dependent on editors than you might be otherwise, and I ve been fortunate to work with some of the best: Dave Eggers at McSweeney s , John Bennet and Amy Davidson at the New Yorker, Clara Jeffery at Mother Jones, Jennifer Szalai at Harper s , and Nick Thompson at Wired. I owe them all for encouraging and nurturing me and for saving me from embarrassment on the page. I owe special thanks to Dave and John for taking me on when I was soaking wet behind the ears and teaching me a thing or two.
The stories in this book have all benefited greatly from the careful reading and the thoughtful comments of Bill Musgrave, Jeff Singer, Michael Silverstone, and Rand Cooper. A writer couldn t ask for a smarter, funnier, and sweeter group with whom to take risks. They ve egged me on in all the right ways. My breakfast conversations with Glenn Cheney, himself no slouch of a writer, gave many a day s writing a good start.
My production editor, Kimberly Monroe-Hill, ably shepherded the manuscript through the sausage factory. Crackerjack editorial assistant Ellen Wright fielded calls, directed traffic, and provided much needed translation services. I owe special thanks to my mother, Ruth Savin Greenberg, for her sharp-eyed copyediting and for refraining from scolding me for going out on a boat in the rain.
I understand why my psychotherapy clients open up to me: they expect (and sometimes get) something back-support, perhaps, or insight or even something transformative. But I m still not sure why the people featured in this book let me hang out with them and ask impertinent questions, let alone why they answered them thoughtfully and honestly and for the record. I just know that it was mighty generous of them, and I m grateful for that.
And to Susan and Joel, wife and son, who put up with my absences and preoccupations, my early morning coffee grinding, and my cantankerousness at the end of a long day spent inserting and removing commas . . . well, here s a truth that is certain: none of this would have been possible without their indulgence and forbearance and love.
I NTRODUCTION
In the Winter of 1816, Ren -Th ophile-Hyacinthe Laennec, a house physician at a small hospital on the outskirts of Paris, found himself in a delicate position. His patient, a young woman, was complaining of a heart problem, but she was so fat that thumping her chest and listening for changes in resonance, the standard method of diagnostic assessment at the time, was useless for detecting her trouble. The only other method available to him was immediate auscultation , the laying of his ear upon her chest with, at most, a silk handkerchief between her bare skin and his. Faced with the equally unpalatable options of ignorance and immodesty, Laennec improvised: he rolled a sheaf of paper from her bedside into a tube, pushed one end through the folds of her flesh until it reached solid ground, and placed his ear on the other. To his great satisfaction, he could now hear her heart clearly.
Laennec, who credited his invention to a couple of schoolboys whom he had seen in the courtyard of the Louvre using a wooden beam to send the sound of a scratching pin from one to the other, never said what became of his patient, perhaps because he had greater ambitions. An amateur woodworker, Laennec soon perfected a wooden version of what he named simply the cylinder and began to use it to catalog the sounds of the chest, to which he gave names such as pectoriloquy and rales and fremitus . Thanks to the primitive state of early-nineteenth-century medicine, Laennec was often able to correlate what he heard at the bedside with what he would soon see on the autopsy table. Slowly, the body s inchoate murmurings revealed their meanings, and Laennec was eventually able to use his ear to distinguish pleurisy from emphysema, abscesses from emboli, tubercles from blood clots.
In 1819, Laennec published De l auscultation m diate , a glossary of the thoracic language, and it became a classic text for doctors in training. By the 1830s, other doctors were experimenting with improvements on the device, and in 1851, an American doctor shortened the cylinder and connected it through flexible tubing to a pair of curved metal tubes topped by ivory earpieces, thus allowing him to listen through both ears, not to mention to avoid the indignity of bending over his patients. In this form, Laennec s device has become such a familiar sign of medical authority that a stethoscope slung over the shoulders is a virtual identity card in any hospital and a status symbol in any crowd.
And with good reason. The stethoscope was the first in a long line of devices-X-ray machines, CT scanners, ultrasound detectors-that allow doctors to fulfill the oldest dream of Western medicine: that by using nothing more than their senses (amplified, if necessary) and logic, they can plumb the murky recesses of the body and explain and heal our suffering. Doctors have been pursuing this dream of a purely empirical medicine since Hippocrates (or the group of ancient doctors from Kos who were responsible for the Hippocratic corpus) first insisted that a good doctor must pay exquisitely close attention to the patient,
to his habits, regimens and pursuits; to his conversation, manners, taciturnity, thoughts, sleep or absence of sleep, and sometimes his dreams; to his picking and scratching; to his tears; to the alvine discharges [i.e., feces], urine, sputa, and vomitings . . . to the sweat, coldness, rigor, cough, sneezing, hiccup, respiration, eructation, flatulence, whether passed silently or with a noise; to hemorrhages and hemorrhoids.
The Hippocratic doctors used their own bodies unsparingly to make this examination, smelling the stools, tasting the urine and the earwax, feeling the skin s temperature and looking at its color, listening carefully to the flatulence. But even this low-tech approach was enough to wrest the understanding of illness from the priests, to kick the gods out of the clinic, and to replace divination and prayer with close observation and reason.
At the heart of this enterprise, which should be familiar to anyone who has ever visited a doctor, is a special kind of knowledge: diagnosis, the determination of the truth about our suffering. The ability to examine patients, assess their symptoms, and then reveal what lies behind them is perhaps the most critical skill for good doctoring, the one that makes physicians more than mere technicians of the body. Your doctor knows that your palpitations are atrial fibrillation caused by cardiomyopathy , that your malaise and thirst are the result of diabetes , that your aching back indic