The Earnest Pupil

Genomics and Myths of Merit in Health

Obesity comes largely from an inheritance of susceptibility. But this fact is a challenge for many people to accept. Instead, they insist on explaining obesity and health as the result of choices and merit. Good choices beget good health. Bioethics professor Lisa Parker suggests that we give up some of these myths of merit and health. They get in the way of making good use of new genomic technology for personal health.

Parker offered these insights to conclude a series of four seminars on ethical aspects of genomics. She directs the Center for Bioethics and Health Law at the University of Pittsburgh.

Fortune and Merit

Parker draws on the work of Michael Sandel. Our moral minds tell us that prosperity and health result from our individual efforts. But in The Tyranny of Merit Sandel writes:

“The Protestant work ethic began as a tense dialectic of grace and merit, helplessness and self-help. In the end, merit drove out grace. The ethic of mastery and self-making overwhelmed the ethic of gratitude and humility.”

This ethic drives us to believe that we deserve our good fortune. Sociologist Max Weber explained the difficulty of good fortune:

“The fortunate man is seldom satisfied with the fact of being fortunate, beyond this he needs to know that he has a right to his good fortune. He wants to be convinced he deserves it and above all that he deserves it in comparison with others. Good fortune, thus wants to be legitimate fortune.”

From Chance to Choice

Genomic technologies give us tools to better understand the interaction of genes and environments. They should lead us to give up the false dichotomy of nature versus nurture. The chance inheritance of good health – including resistance to obesity – becomes something that is less of a mystery and more open to our mastery.

Already we have a few tools to understand the genetic basis for obesity. We have treatments, such as setmelanotide, that can help to overcome this in some forms. More knowledge will bring us more tools and more options.

But the real challenge will be one of justice and equity. Will these innovations be available to all who need them, or constrained by wealth and privilege? If we can let go of some myths of merit, perhaps we can open up to the possibility of better health for all.

Click here, here, here, and here for Parker’s four seminars on the ethical aspects of genomics. For her slides from these seminars, click here, here, here, and here.

The Earnest Pupil, painting by Eastman Johnson / WikiArt

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May 25, 2021