Meliorism and the Medical Model

THE OPEN MIND
Host: Richard D. Heffner
Guest: Gerald Weissman
Title: “Meliorism and the Medical Model”
VTR: 9/26/1995

HEFFNER: I’m Richard Heffner, your host on THE OPEN MIND. Last week my guest and I discussed the medicine of unreason. Today, enough of the alternative medicine he likes to dismiss as sentimental, new age fancies with their new age toe-ticklers. Instead, let me now ask Dr. Gerald Weissman, Professor of Medicine and Head of the Division of Rheumatology at the New York University Medical Center what he sees as the best of Medical Meliorism, asking him first to define, and then to evaluate meliorism in medicine. Is that a fair enough request?

WEISSMAN: Sure. Meliorism…meliorism is a term that was coined by George Elliot, a novelist, in the 1870s, about the time of the Second Reform Law in Britain, and is meant that it is a function of humankind in a democratic society to change things for the better through reason, not sentiment alone. An analogy is that an altruist who is sentimental will feed the becker, but a meliorist will not only feed the becker but will also vaccinate the children. That distinction, mainly that one can do good through reason, or by reason, in slow, progressive steps, led to a wide movement in the countries of the West. The word meliorism explains that movement, which pretty much came out of both the Puritan idea of doing God’s work on Earth, and doing it rationally; it was joined by the Abolitionists of the…, and then led to such things as the Settlement House movement, child labor laws, the Progressive Party, and then the liberal views of the New Deal. It’s a long, slow march with many ups and downs, many enemies, much opposition. But it is by and large a true thrust to do good through reason, by understanding the world by what George Eliot called “The Serene Light of Science”.

HEFFNER: And if one took “The Serene Light of Science” and talked about “The Serene Light of Politics”, would you make the concession to me, optimist though you are, that we seem to have reversed our field in the question of meliorism?

WEISSMAN: Oh, I think, I think we’re in massive retreat from some of the more generous motives in this country. And one of the reasons I’ve written this book, Democracy and DNA, is to remind us of how good people have been in this country with…not only with motive, but also with heart and mind. The book relates to anti-bellum, mainly before the Civil War, ideas of Abolitionism and social justice, to post-bellum war, post-Civil War ideas of what an industrial society owed to its citizens. And then how medicine, at least, stayed true to the liberal imagination of Arnold…whereas many short of political institutions have taken flight.

HEFFNER: Do you think medicine can stay outside of the general patterns of the country and that the retreat from meliorism must not in time, in turn turn…

WEISSMAN: Well, to the degree that the medicine I know and love best has been hijacked by accountants and pen-pushers, I’d say that it’s not immune. But willy-nilly, whatever the troubles are that corporate practice in medicine, or for-profit in medicine or advertising by hospitals, all that junk that is messing up what physicians do for patients – however that is being changed to hijack the course of medicine, there is a major scientific thrust, and mainly day by day, literally, new discoveries are made that however how they are applied in practice, are going to do good things for the body, if not necessarily for the mind, of humankind.

HEFFNER: Now, I was going to say, would you say that again…

WEISSMAN: (Laughter)

HEFFNER: …but I’ve heard very well what you’ve said. I wondered if…would you strike me down if I say is that a television posture? Is that a public posture, that optimism? Do you really feel that right down to your bones?

WEISSMAN: I’m struck by the fact that…when I was eight years old, it seemed very possible that Fascism, National Socialism, would come to rule the world, that democracies were not armed, that the brown shirts, the black shirts would run the place. That the Japanese oligarchs who had invaded Manchuria and China would win in the Pacific and that Germany would continue to sit over Paris. That didn’t happen because people took arms and did something. The generation that won the Civil War and made abolition a fact is a generation that I spend much of my time discussing in this book because the motives are identical. And if one reads the accounts of Dr. Samuel Gridley Howe, one of the great medical pioneers of the United States, and the husband of Julia Ward Howe – when one reads the despairing of letters of Frederick Law Olmstead, not only one of the designers of Central Park, but also a journalist who visited the Cotton Kingdom – when you read the despairing letters of the men of the North and the Abolitionists of what would ever happen if the South were to win – the dark days of the Civil War when Oliver Wendell Holmes and John Lothrop Motley were commiserating with each other – that when Oliver Wendell Holmes said “If we do not see freedom in my time, maybe my children will see it”…Those episodes remind me that trend is not destiny.

HEFFNER: I like that, that “trend is not destiny”.

WEISSMAN: That’s Louis Mumford.

HEFFNER: But is not destiny the way we are going? Right?

WEISSMAN: Yes.

HEFFNER: It’s not enough to say trend is not destiny. We may be whistling in the dark.

WEISSMAN: Well, that’s why…another of my favorite meliorists, the late Sir Peter Medawar said that, and I agree with him “I admit of being of a sanguine temperament, and this is usually confused with a shallow optimism”. Nevertheless, I believe in finding out what is wrong with the world and trying to put it right by reason.

HEFFNER: Well, you say if we’re lucky, we can have “Democracy and DNA”. Two questions: What do you mean, number one; and two, will we be so lucky? I know now that your answer is that it won’t be luck. We will do it. But what do you mean that we can have “Democracy and DNA”?

WEISSMAN: Well, the two nouns are shortcuts for what is perceived to be conflict. Namely, democracy suggests a consensus, or perhaps even a majority view with great respect for the views of a minority in political agreements and arrangements, in the ethics, as it were, of social relations. At the present time our democracy has been challenged by a wide variety of fundamentalisms; fundamentalisms at the simplest levels of technology; fundamentalisms of the most archaic of religions and political paleontological views, the Limbaughs and the Gingriches. On the other hand, DNA represents that there is this remarkable new thing we’ve gotten in the last two centuries in Western science. It is possible, that if the oligarchs, the Fascists take over, that this will be badly misused. It is frequently felt by my friends of the political left that science is their enemy. On the contrary, without it they’re nowhere. It is a fact that human beings can live in a technologically advanced society and can have access to the goods that they’re entitled to and can have, that makes the democracy work. The problem is, of course, that you wind up having détente television.

HEFFNER: Just so, to whatever extent, that Lord Acton was right, that power intends to corrupt, and that absolute power intends to corrupt absolutely, you’re talking in terms of the DNA Revolution, about power undreamed of before in areas undreamed of before. Only the poets thought of exercising the kind of power you scientists will be able to exercise over creating humankind. Now, doesn’t that give you pause?

WEISSMAN: Yes, but countered Lord Acton was Emerson’s marvelous enthusiasm for the new age. After he left his transcendental mode, Ralph Waldo Emerson was thrilled not only by the undersea cable, but he was sure that something would happen in biology. And he said “I don’t think I’d feel uncomfortable if I saw a chemist taking his hydrogen and his oxygen and his nitrogen and mixing them all together and making…in the test tube” (or in the dish at the time). “I would only think that is was the work of an advancing race, an advancing consciousness behind it”. Well, it turns out he was right. Because of the horrors of World War II and the camps and the misuse of science by the eugenicists and the Nazis, at the same time that we had the power to play with DNA, the morals in the scientific community arose together with it. The Selmar Conference, held by scientists who knew that this might present a problem, the regulation and thought about competent DNA, and yet with the enthusiastic enlistment of the community in both the moral and the scientific quest, that dream has become a reality. At the same time the human genome project was set up there was a group of ethicists and ethical considerations were part of it. I think that by and large, the scientific community, dealing with the ethical problems of DNA, competent DNA, the creation of the species, has been remarkably responsive, and has listened to people will all kinds of backgrounds; politicians, social scientists, theologians, etc., to receive their views and to proceed in a socially useful and acceptable sense. So I think the idea of the mad doctor, the mad doctor Caligari or Magusa or Strangelove, these fantasies which have been present in the minds of the literate since time immemorial, since Lucifer, have been assuaged, at least to my thinking, by the fact that the morals have merged together with the science.

HEFFNER: Well, I’m glad you brought Lucifer into this. Because it seems to me that what you’re describing, activities by enlightened scientists, activities I would applaud as you applaud them…but the question remains: In the long history of mankind, do we have so many examples of this kind of power over the stuff of human beings that can be used, can be used without doing the kind of damage that I would bet you are concerned about?

WEISSMAN: I’m concerned about a conscription of humans into an army to be killed at the whim of a general. That’s manipulating human beings…in unheard of…gunpowder, that’s another one of these, electricity…the idea that technological advance per se is…leads to appropriate fears, but I think if one has a structured moral system and a moral system to which all can repair, one can handle these difficulties.

HEFFNER: That’s a big “if”.

WEISSMAN: Yup.

HEFFNER: Today in particular.

WEISSMAN: I think that more people have been killed by mad politicians or by religious zealotry than be killed or possibly be harmed by anything science can do. I would suggest, Sir that anything you could imagine has already been done in the absence of science. The Crusades, the Inquisitions, the Holocaust were put together before one DNA molecule has ever been isolated.

HEFFNER: Of course Oppenheimer was very concerned that the scientific community had provided the political and the military with the vices that could go still further. Look, I’m not a…well, maybe I am, but I’m not that bad. Let me ask you what you anticipate, what you foresee as the uses that will be made from the DNA Revolution.

WEISSMAN: Well, in my book I discuss the fact that John Keats, who was a member of the Guild of Apothecaries, was actually a surgeon and a dresser…

HEFFNER: We don’t really remember him as…

WEISSMAN: …well, he worked in Guy’s Hospital and then decided to write a parable of what medicine might be all about and what learning might be all about in this marvelous poem “La Mer”. In “La Mer” he describes a marvelous example of genetic recompetency in which “La Mer” was both snake and woman and a creature of knowledge and power. It becomes transformed before our very eyes. We can now do this kind of recompetency in the dish and in fact, an embryo. The uses to which this will be put will be determined entirely by the ethical matrixes of the society that has that power. And to the degree that we contribute to that ethical matrix, science has a lot to contribute, but is will go on willy-nilly.

HEFFNER: But now you will have created the kind of power, never mind willy-nilly, the kind of power that hasn’t existed before. What do you anticipate? Now, I know you’re going to have to say that that will depend upon the ethical considerations of those in the future, but in terms of the crystal ball (that’s not alternative medicine), in terms of your willingness to look into the future as a student of the past, and you are, what do you see?

WEISSMAN: My guess would be that we’re going to do very well with this. We’re very young. As Lewis Thomas kept pointing out in his many books, and pointed out in his last book, This Fragile Species, we’re a very young species. We’re just beginning to fly, as it were, without the wings of support and futile beliefs and fancies. The Enlightenment and the Renaissance are just behind us in real geologic time. I think we’re going to work out a way that we can handle this power of doing modern molecular biology with no great problem, and no great problem that can’t be handled by the societies we erect. If we have a nasty, horrible, Fascist society creeping in on the Western Democratic front to the degree that we have another problem in the world, then DNA will be the least of our worries. I would suggest most of our problems are political.

HEFFNER: In the five years that remain in this century, what do you think? Where will the DNA Revolution take us? What will be done, in terms…not making judgments…

WEISSMAN: Well, it takes a long time to move something that is feasible to something that is practical. And the cautions we set in place, both economic and scientific are not a hindrance, but a proper break, I should have thought…I think we are beginning to see the first glimpse of hope with gene replacement for genetic diseases…(?)Deficiency…(?)Disease…these are diseases you rarely have heard of. But the hope is there for things like obesity, hypertension; tumor repressive genes have been isolated; we can splice them and do their work without their intricate devices that we don’t understand yet. But if we can go along, within five years we should be further along in gene replacement therapy. And that will be a major triumph, like the first antibiotic. And the fact is that there are some signs that that’s already happened. Slowly, step by step, we are not only going to be able to change the course of genetic diseases, but non-genetic diseases such as heart attacks, and for that matter, AIDS, by putting in genes that counter the intricate machinery and mischief that something like the HIV virus or the tumor viruses or the…can produce themselves. So that’s on the rise and it will come.

HEFFNER: And the creation of human beings, which is always the bugaboo?

WEISSMAN: I don’t…first of all most people aren’t really interested in that, in terms of the “Brave New World” cloning of individuals. That is probably more a fantasy of the arts than of the sciences. But then again, the arts are the explosion of our inner feelings.

HEFFNER: Indeed.

WEISSMAN: So consequently, somebody may want to do this. We’ll see. I don’t see this as a problem. I see it as a bugaboo.

HEFFNER: Indeed, the beauty of Democracy and DNA is that you take your cue from people who are in medicine. People who are artists, who are poets, so it is that liberal imagination or illiberal imagination as it may become…

WEISSMAN: The book is about American dreams. We have had some marvelous dreamers in this country who are also quite practical. I don’t refer to the big names I write about, Oliver Wendell Holmes, Sr., the physician and Dean of Harvard Medical School, rather than his good friend Ralph Waldo Emerson. I write about Thomas Wentworth Higginson, the account of the army life of the Black Regimen, rather than more famous soldiers such as Sherman or Grant. And I write about Alice James rather than her famous brothers Henry and William.

HEFFNER: You know, a question I want to ask you is where…at what level, where will the decisions be made as to the future course of the scientific endeavor? We’re focusing again on the DNA – at what level?

WEISSMAN: Well, I think that now the focus on DNA extends from the courts, as we all know, to the bench. And that’s a broad range of concern. I think that so far the best thing that’s happened out of recompetent DNA in the…area in the legal system that it’s gotten a lot of guilty people off, which just recently happened in New York, among the suspects in the Central Park Jogger case. What use is made is determined by our legal system, which is again, a reflection of our political system, which I think is basically a reflection of our culture.

HEFFNER: You say that with a smile?

WEISSMAN: Well, I think that to a large degree the culture we create, whether it be literary, television, or rock music, that is the culture in which we live, and it’s, to a large degree, the mother link, as it were, to which these institutions precipitate.

HEFFNER: You know, it’s so fascinating to me that on the one hand, you’re quite critical of the political manifestations of our times. Then you say the use we make of DNA, or what we’ve come to learn about DNA will be determined by our culture, which is a reflection of our politics, or our politics, a reflection of our culture. Where in the world does that optimism come from?

WEISSMAN: I should have thought that it’s the experience of someone our age. To quote Steven Sondheim, we’ve been through Herbert and J. Edgar Hoover and we’ve come through. The idea that things are the most gloomy that they’ve ever been is a classic millennial view. In mid-century if we were to come to this kind of pessimism or what Jimmy Carter calls a “malaise of the soul” which was his, or Bill Clinton calls a “funk”, which again is his, if we succumb to this we’re in trouble. In far more troubling times we’ve managed to throw up leaders that got away it.

HEFFNER: Wait a minute. We’ve just got a couple of minutes left. Are you saying that “malaise” was Carter’s and the “funk” was Clinton’s?

WEISSMAN: No, I think that by and large the function of a political leader is not to tell the people you’re in a funk. I think that is just bizarre. And I think that with a little bit more knowledge of what’s terrific in the present time, among which is not only the capacity to understand each other, but to throw up such urges as DNA and to do something about the environment and human health. That’s splendid. That kind of optimism, which extends from space to you’re getting to the moon, and opening up DNA, is a tremendous cultural achievement as much as a scientific achievement. We’ve done that in our time. How can you possibly be troubled in terms of the big future with trivial issues of right wing fundamentalists of the time. That will pass.

HEFFNER: Yet you are the one who doesn’t inveigh against that influence but you’re not very kind about the right-wing influence in our times. You’re not very generous to them.

WEISSMAN: Well I think proper conservatism is the only way you can keep liberalism honest. I think religious zealotry is the enemy of both. So I’m talking specifically about the religious orthodoxy of the Right. And I would argue that religious orthodoxy of the cultural Left is also a threat. But that’s another issue.

HEFFNER: You’re very even handed and that’s…I want to thank you for joining me on this program, Dr. Gerald Weissman. Thanks very much. You even give ME hope.

And thanks, too, to you in the audience. I hope you’ll join us again next time. And if you care to share your thoughts about today’s program and it’s rather extraordinary guest, please write to THE OPEN MIND, P.O. Box 7977, FDR Station, New York, NY 10150. For transcripts send $4.00 in check or money order. Meanwhile, as an old friend used to say, “Good night and good luck”.