Why public health campaigns should not promote enhancement

by Rebecca Roache

Human
enhancement is a hot topic in bioethics. 
Typically conceived as the use of technology to raise human capacities
above what is merely healthy or normal, it attracts questions such as, Is it
ethical?  Is it desirable?  Is it cheating? and, Should the state
subsidise it?  A common view is that,
whilst therapy—which aims to restore human capacities to what is healthy or
normal, but not to raise them above this level—is desirable; enhancement is at
best unnecessary [1], and at worst unethical [2].  Human enhancement, one might be tempted to
think, is for oddballs only: the average person is content merely to be
healthy.

Strange,
then, that many desirable, commonplace activities are often presented in the
public sphere as more akin to enhancement than therapy.  Today, the BBC reports a study showing that ‘[h]aving a
good network of friends and neighbours boosts survival chances by 50%’.  This claim, along with the tone of the
article, implicitly assumes that normality in this context is the absence of a
good network of friends and neighbours: it is relative to this normal level
that one’s life expectancy can be boosted by having lots of friends.  Having lots of friends, then, is an enhancement.  Similarly,
a recent article quotes the lead researcher on a
study demonstrating the health benefits of exercise as saying that ‘walking to
the shops or walking the children to school can lengthen your life’—lengthen it,
we are led to assume, compared to the average lifespan of people who do not
participate in such activities, which therefore constitutes normality in this
context.  And the University of Cambridge
reported a study finding
that exercising regularly, eating five portions of fruit or vegetables a day,
not smoking, and consuming alcohol in moderation ‘can add an average of 14
years life expectancy’, which implies that normality involves doing little
exercise, not eating much fruit and veg, smoking, and drinking excessively.

These
pictures of normality fail to correspond with what most of us intuitively take
it to be; and having good friends, walking to the shops, eating fruit and veg,
and not smoking are not the sort of things that immediately spring to mind at
the mention of human enhancement.  That
the concept of normality is not as simple as it might at first seem, and that human
enhancement is not all about brain implants and doping, is familiar territory
to bioethicists; and highlighting these academic points is not my aim here.  I want, instead, to
highlight something more concerning: namely, that presenting a beneficial
activity as enhancing is a fairly good way of discouraging people from doing
it.

The problem
is that, generally speaking, people are more willing to try therapies than enhancements.  In other words, they are more likely to do
something that they see as merely restoring health than they are to do
something that they see as improving on what is healthy.  A 2008 study [3] found that, when presented
with a fictional drug called Zeltor, participants were more likely to express
willingness to try it when it was described with the tagline ‘Zeltor—Become Who
You Are’ than when it was described with ‘Zeltor—Become More Than Who You Are’.  The lesson for public health campaigns is
this: to get people to do things that are good for them, present those activities
as health-restoring (therapeutic) rather than health-exceeding (enhancing).  Indeed, it could be that a good way of
sabotaging a public health campaign is to speak in terms of enhancements.

This final
point was recently recognised by the Breastfeeding Network, which called for
the government to scrap its ‘breast is best’ slogan on the ground that it does not convince mothers to breastfeed.  The chair of the Breastfeeding Network, Lesley
Backhouse, complained that the slogan ‘implies something special, whereas
breastfeeding is the physiological norm, and suggests that formula is the
standard way to feed babies’.  She
stressed the importance of presenting breastfeeding as the ‘normal’ method of
feeding.

If presenting beneficial activities as enhancing makes it
less likely that people will do them, why is it so common?  A likely explanation is that it makes for
more upbeat, feel-good reporting.  ‘Breastfeeding
improves the health of babies and mothers’ reassures breastfeeding mothers
without upsetting mothers who formula feed; conversely, ‘formula feeding harms
babies and mothers’ is a much less palatable message for formula-feeding
mothers, and fails to provide breastfeeding mothers with a pat on the back.  Similarly, ‘You are more likely to die early
if you are friendless’ is far more depressing than ‘You are more likely to live
longer if you have a lot of friends’; and so on.

Using such
messages as part of public health campaigns, however, may well be a case of
killing with kindness.  Presenting
beneficial activities as enhancing may make people feel better about
themselves, but if they fail to convince them to take steps to improve their
health, the messages serve little practical purpose.  As England’s public health minister, Anne
Milton, commented today, if hurting people’s feelings a little makes
them healthier, it is a price worth paying.

[1] For
example, Leon Kass dismisses attempts radically to extend the human lifespan on
the ground that it would not be desirable to live much longer than is
average.  Kass, L. R., ‘Ageless Bodies,
Happy Souls: Biotechnology and the Pursuit of Perfection’, The New Atlantis
(Spring 2003): 9-28.

[2]
Consider the well-publicised debate about ‘doping’ in sport.

[3] Riis,
J., J.P. Simmons, G.P. Goodwin, ‘Preferences for Enhancement Pharamceuticals:
The Reluctance to Enhance Fundamental Traits’, Journal of Consumer Research 35
(October 2008): 495-508.