Session Speaker

Ethical Dilemmas in Enhancement Technology
Sunil Wimalawansa
USA

Medical technological advances leading to enhancing drugs and devises have grown exponentially over the past two decades due the demand and extensive advertising. This includes performance enhancing drugs such as anabolic steroids (many are illegal), sexual function enhancing agents [e.g., Sildenafil (Viagra®), Tadalafil (Cialis®), Vardenafil (Levitra®)], expensive medical devises and surgical interventions, and plastic surgery (breast enhancements, face-lifts, tummy-tucks, liposuction, etc.). Whether it is sports activities (unfair advantages), sexual activities (promiscuous, spreading AIDs), or advertising (to whom?), many of these have social, economic as well as legal consequences beyond the person who is engaged in enhancement activity including their spouses, family, community and indeed the society. In addition to satisfying the needs of the person requesting enhancement intervention, the above-mentioned areas and groups must be taken into account by the physicians during decision making process.

One classic example of a medical enhancement is the discovery of potentials of phosphor diasterase (PDE)-5 inhibitors. Studies have shown that electrical stimulation of strips of rabbit corpus cavernosum caused a transient but marked relaxation of smooth muscle that was prevented by adding nitric oxide synthase inhibitors, and enhanced by addition of cyclic GMP-PDE inhibitors. Many patients with impotence suffer from an impaired nitric oxide cyclic/GMP pathway in their erectile tissue, and this laid the foundation for the development of erectile dysfunction drugs for human sexual dysfunction. Inhibition of specific isoform of cyclic GMP-PDE/5 allows accumulation of cyclic GMP when guanylate cyclase is activated by nitric oxide released from the nerves innervating the erectile tissue, leading to sustained penile erection. In addition to exclude medical contra-indications, one needs to consider many ethical issues before prescribing these agents.

Another question to consider is while half the world’s population is below the poverty line and starving, can the medical community ethically justify spending limited precious resources (time, money, efforts, and expertise) on these enhancement improvement technologies, and the medications benefiting just a few? Where is the priority? Are we robbing the poor to satisfy the rich or, allowing the free market to determine who is going to survive? For example, cost of a dialysis machine, one heart operation, or any organ/bone marrow transplantation procedure in the West, one can immunize against infectious agents and preventable cancer, in an entire group of villagers consisting over 20,000 people in a developing country and thereby preventing hundreds of deaths from these preventable diseases (versus one death form an expensive intervention); i.e., a massive cost-effectiveness. The money one spends to buy a cup of coffee or one pill of Viagra can be invested to immunize a family of five in the East. Even today, over a third of the world’s community has neither access to immunizations, nor safe and clean drinking water. The latter kills over 6 million people per year (80% of them under the age of five) in the non-industrialized countries. In this regards, for the cost of one major life-saving operation, or for that matter one cosmetic surgery, one can implement a safe drinking water program to multiple villages, saving hundreds of lives (in comparison to one or two lives saved by major surgery or experience chemotherapy given to one person). Although it is simply the tip of an iceberg, the above-mentioned are some basic ethical issues physicians need to consider before embarking on prescribing cosmetic surgery or performance enhancement technologies to patients.