'Better Than Well'

The biggest growth industry in health care isn't in actually healing people, but in improving people

Photo by Tom Foley

by Jason Sanford

From M, spring 2003

Don't like who you are? For every reason to dislike yourself--"I hate my nose, sex, hair, voice, life"--there are an equal number of ways to fix what's wrong. Mood-altering drugs. Breast implants. Wrinkle-be-gone Botox injections. The biggest growth industry in health care isn't in actually healing people, but in improving people.

University of Minnesota professor Carl Elliot explores this territory in Better Than Well: American Medicine Meets the American Dream. Elliot, a medical doctor who teaches bioethics, calls medical treatments that are not medically necessary "enhancement technologies." In his book, Elliot describes the different enhancement technologies that Americans passionately embrace--Ritalin, liposuction, silicon injections for fuller lips--along with related nonmedical enhancements like accent-reducing voice lessons.

"The handicaps that enhancement technologies are meant to fix--social inadequacy, stigmatization, shame, problems finding a partner or a job--are the results of social values and attitudes that ought to be changed. Yet, not only do enhancement technologies do nothing to improve these attitudes, they make them worse. The more breast augmentations are performed, the more entrenched the preference for large breasts..." from Better Than Well

Elliot isn't sure if these technologies are good or bad. For example, the wart a doctor removed from your nose may not have been harmful to your health, but few would argue against taking off warts to look more beautiful. But move to a doctor severing the facial nerves that make a person blush--merely because he or she often turns red in public--and the issue isn't so cut and dry.

In analyzing why Americans so readily embrace enhancement technologies, Elliot reminds us that in our society what counts is beauty and success. And given the prevailing attitude that "I deserve to look and feel my best," it's easy to rationalize that Prozac or breast implants will make us the person we are meant to be. But what kind of society does this make us, Elliot asks, when injecting wrinkles with a deadly poison (Botox is made from the toxin botulin) is seen as one way to achieve both our spiritual and physical potential?

In his introduction, Elliot says that his aim "is not to make an argument so much as a diagnosis." And the book's diagnosis? Many Americans may say they're uneasy about using enhancement technologies to improve their lives, but cosmetic surgery is still a booming business.

Better Than Well: American Medicine Meets the American Dream by Carl Elliot; W.W. Norton; ISBN 0-393-05201-X; $26.95.