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Why public health campaigns should not promote enhancement

by Rebecca Roache

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

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
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.

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

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

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
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.

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.

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5 Comment on this post

  1. “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).”

    Advertising for energy drinks suggests just the opposite, however, and there has been an absolute boom in sales over the past decade [1]. In the United States, and increasingly in the UK, gas (petrol) stations carry drinks with names like “Monster”, “Rockstar” and, of course, “Red Bull.” The packaging for these drinks boasts of Xtreme caffeine, monster energy, etc. [2]

    To be sure, buying an energy drink to boost your concentration or energy is of a different kind than eating healthily and exercising regularly. But if growth in the volume of sales is any indication, perhaps public health officials might learn a trick or two from the advertising folks at Red Bull [3] or Monster [4].


  2. Yes – very true! It’s not just energy drinks either. The ‘Lynx effect’ adverts promote shower gels and deodorants as having enhancing properties, albeit in a way that is far too silly for anyone to suspect it of being scientifically respectable. No doubt there are many more examples. It’s interesting to consider the circumstances under which people might be attracted to or repelled by enhancements. The authors of the study I mentioned were (as its title reveals) concerned with enhancement of traits considered fundamental to people’s characters.

  3. I would be cautious in drawing conclusions from this 2008 study. Apart from anything else, “Zeltor – Become Who You Are” is a good deal catchier than “Zeltor – Become More Than Who You Are”. When it comes to advertising slogans, less is generally more.

    It’s true that the word “enhancement” has an oddball, unnatural ring to it. But the fact is that we are trying to improve on nature all the time – otherwise why do we dye our hair? And does Backhouse have any empirical evidence to suggest that telling mothers that breastfeeding is normal is more effective?

    Perhaps the best strategy is precisely to point out that trying to improve our conditions is something that we humans naturally want to do. In which case, “Become Who You Are” could plausibly used as a slogan in favour of enhancement.

    By the way, why IS breastfeeding better?

  4. I think there’s more to it than the catchiness of the tagline. It fits in with the more general point that people are willing to expend more effort to recoup a loss than they are to secure a gain (a preference for which there is lots of evidence in the relevant psychology/economics literature). In this case, we might view Zeltor as being presented either as a means of recouping a lost aspect of one’s character or as a means of adding to one’s character; as such, that people favour the former is unsurprising.

    I agree that (ordinary, non-oddball) people are eager to enhance themselves in many circumstances. The point that is worrying from the point of view of public health campaigns is that, unless people are already motivated to enhance themselves in a particular way, it *may* be difficult to persuade them to do so, and easier to persuade them to take something more like therapeutic action. I write ‘may’ because this is not something I’ve researched very thoroughly – this blog comes at the beginning of my investigations for a more dedicated project! I agree with your point about the best strategy … I guess the challenge for public health campaigners would be how to present this sophisticated point in a way that can be quickly grasped by an often inattentive public.

    As for why breastfeeding is better – I haven’t actually made that claim here. My point is that *if* the government wants to promote breastfeeding, it may be better not to present it as an enhancement. As a point of interest, there seems to be quite a bit of evidence for the advantages of breastfeeding over formula feeding, about which you can find out if you Google it – although you do have to wade through a wealth of spurious claims!

  5. Many thanks for this.

    If I’m absolutely honest, at the moment I don’t really care whether breastfeeding is better (and from what point of view) so I’ll leave that question aside! But this issue about public attitudes to enhancement and how to motivate change in behaviour is of course a crucial policy question (although arguably it’s an empirical rather than a philosphical/ethical one).

    I take your point about the Zeltor case being about more than catchiness of the tagline given the wealth of other evidence. A key point here is that my suggested strategy does not entirely address this point. But then again, perhaps it cannot be addressed without deceiving the public, which we should not do for a variety of reasons. By this I mean that if a particular measure (let’s take making more friends as an example) is in reality an enhancement rather than a recouping of loss, perhaps we just have to accept that they will be less motivated.

    Here’s a thought, though (inspired from a many-worlds interpretation of quantum mechanics and especially Julian Barbour’s ideas about the nature of time). With every second that goes past, possible futures that previously were open to us, become closed. From that point of view, we never gain anything, we only lose possible futures. What we all want, of course, is to keep open the desirable futures and close off the undesirable ones. If we see “enhancement” (whether technological or of the “making friends” variety) in this context, then what we are doing is to encourage people to avoid losing the opportunity of living long, healthy and enjoyable lives. This is still not “recouping loss” (it’s rather preventing loss of possible desirable futures), but if appropriately packaged it could point a way to providing the sense of urgency that is necessary to motivate behavioural change.

    Anyway good luck with your research!

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