I got to review Malcolm Gladwell’s latest book, and as highbrow easy reading goes, he’s pretty hard to beat. One of his essays, on the creator of the Pill, provides much food for thought from a pro-woman perspective.
He identifies Dr. Rook’s major error in being maintaining a 28 day cycle for contraceptive pills, which he did in the belief that, by mimicking nature, this method would gain approval amongst Catholics (being one himself). What’s especially fascinating, though, is his look at the research into menstruation in pre-industrial societies.
What he demonstrates is that, in a state of nature, women would have perhaps 100 menstrual cycles in their lifetime, while for women in the developed world today, it can be as high as 500 cycles. Since each cycle involved changes to breast, endometrial and ovarian tissue, and since malignant growths are often found when cells must repeatedly regenerate (why sunburns are linked to skin cancer, and smoking to lung cancer), reducing the number of menstrual cycles a woman experiences should in theory reduce their risk of reproductive cancers. And what evidence there is in this area bears the theory out. The factors in nature that reduce the number of cycles aren’t ones we would like to recreate: late onset of puberty caused by malnutrition, for instance, or a high infant mortality rate. At least one of them, we can influence: breastfeeding reduces these risks, in part because it suppresses ovulation for a time after birth. This is why reproductive cancers have long been known to be less common among women who carry multiple children to term and breastfeed them: each birth would represent anywhere from 12 to 24 months without ovulation.
Now my two major concerns with the Pill are that it sometimes (we don’t know how much) acts as an abortifacient, and that its effects on women’s health are mixed – while it reduces risk of ovarian cancer, the benefits it confers with respect to breast cancer are cancelled by the risks it carries due to, it seems, synthetic hormones. The current Holy Grail of researchers, according to Gladwell, would be a birth control pill that suppresses ovulation all the time, thus reducing the repeated changes that can lead to cancer, as well as preventing the fertilization of an egg, since no egg would be released; and to do this with hormones that would have no adverse effects on risk of breast cancer, or anything else.
So, since I have no philosophical objection to birth control, I find myself thinking that such a Pill would be a very good thing. This is despite my general aversion to medical intervention without a good reason. The impression I got from Gladwell’s essay is that this may be just around the corner.
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Andrea adds: Rebecca’s full review is here.
by 
I thank you for a thoughtful and insightful post. However, I must admit to being deeply troubled by the suggestion you make in the last couple paragraphs about the “Holy Grail” of contraception. The reason I am so distressed by reading this is that I think you (and Gladwell, really) have alighted quite squarely on the necessary goal of birth-control development, and I think that this highlights the fundamental philosophical problem to be had with birth-control.
The contraceptive mentality (and, I might add, the mentality of much of modern medicine as a whole) is that, by exercising control over our bodies, we can live longer. Thus, the Holy Grail will allow a woman to make her reproductive system “disappear” without side effects (except when she desired to have children, presumably) in order to suppress what Gladwell sees as the detrimental effects of ovulation on the woman’s life span. However, this is an incredibly mechanistic view of the human body. It’s analogous to how we treat a car, for example: if I want to go faster, but I don’t need to feel comfortable, I take out the air conditioning and the heavy upholstery so that the machine fits my needs. Yet the human body is not a machine, but rather must be considered as a unified whole. By trying to use or knowledge to “conquer” the undesirable aspects of our bodies, we turn them into completely functional realities: we separate our sense of “body” from our sense of “self,” and in doing so we sacrifice the dignity of our bodies.
CONTINUED…
This mentality is prevalent in many aspects of the modern human experience. Take, for example, the machination of the body that is pornography. Pornography “thingifies” the bodies of the actors, thus objectifying the persons themselves in the mind of the viewer. If our bodies are really just machines or tools – i.e. things with no intrinsic dignity – then pornography is perfectly acceptable.
Now the argument will certainly be made that by exercising our reasoned understanding of our bodies, we have achieved great things in medicine: extending our lives and improving their quality. To this, I must submit. There does not seem to be anything intrinsically wrong with understanding the body’s mechanisms (it is, after all, a material reality) as long as this understanding is used in a way which is congruent with the dignity of the body as a whole. Knee surgery, for example, temporarily “breaks” the body – cutting the skin and putting foreign objects in the joint. But surgery is done with a restorative intent – the knee has somehow become non-functional and measures are taken in order to restore it to its original function. The fact that temporary damage must be done to the body is not intended, even if it is foreseen (ideally, one does not intend to need knee surgery, but the need comes about as a result of some unintended circumstance). With birth control, this is not the case.
CONTINUED…
The Pill intends to take a function of a woman’s body which is working perfectly well (her fertility) and to break it, simply so that her body conforms to the desire of her will, which is, as stated above, to avoid the “bad side effects” of ovulation (but more often in order to have sex without any reproductive consequences). As such, the Pill is not a restorative use of our understanding of the mechanisms of the body, but an imperialistic one: the reproductive system is to be conquered.
Here again a counter-argument will be made: if ovulation really does have negative effects on the woman’s body, then certainly the use of the Pill is restorative and not simply “imperialistic.” But keep in mind that these “negative effects” are considered from the point of view of life-span alone. If you ovulate, the studies show, you may get cancer and die. Well, I hate to break it to you, but a similar argument could be made regarding any function of our bodies, because we will all eventually succumb to death. Any medical idea which does not recognize and operate within the pre-condition of the inevitability of bodily death if simply foolishness. If any natural function of the human body is seen as detrimental to health, then it is obviously the idea of “health” which needs to be evaluated, and not the functioning of the body.
This, then, is the fundamental error of the contraceptive mentality. It over-mechanizes the human body – robbing it of its dignity as an integral part of the human person (with which it is, in a sense, identifiable) – and shows itself to be a manifestation of the imperialism of the mind over all physical realities: body, land, etc. Francis Bacon said “Ipsa scientia potestas est“: “Knowledge itself is power.” And modern science has, for the most part, come to see itself as the source of mankind’s power. Yet power needs restraint unless it is to become an inhuman totalitarianism. Therefore, medicine should submit itself to the primacy of the reality of the human body, and work within the structure which the body provides, rather than working to destroy that structure.
Please forgive the length of this comment, but I felt the need to put some of these thoughts of mine in writing and this blog seems to be the unlucky recipient of the outcome of this desire. I hope that these thoughts have given you something of an understanding into the nature of a philosophical (really, an anthropological) ground for opposition to birth-control (that is – the Pill). In the spirit of full disclosure I am a Roman Catholic and therefore have many other reasons why contraception in general and the Pill in particular are morally wrong, but I have tried to provide a presentation of why the Pill is anthropologically wrong rather than being morally wrong. Please keep up the excellent work on this blog. I get great joy from reading it every day.
Billy, I found your comments very enlightening, clarifying what was more a gut instinct with me. I love that phrase, “the imperialistic use of our bodies.” Looked at in the way you have laid out, the connection between artificial birth control, particularly the pill, and the abortion, seems very clear.
I’m not an expert on this, but it does occur to me that a pill that completly inhibits menstration should also provide a more consistant inhibition of ovulation, as there is less variation in hormone levels. If my unqualified guess is true, this means that it would not only have the potential to reduce cancer rates but also to resolve the lingering possibility of occasionally acting as an abortificant.
Billy: I’ve read your posts twice, and still have trouble understanding you. This idea of objectifying the body doesn’t strike me as inherently problematic at all. The body is an object. It’s an extremally complicated object, with many interacting systems of mixed mechanical and chemical nature, but an object nontheless. It has components that go wrong, and which can be fixed. It’s functions can be adjusted by someone who properly understands the mechanisms by which it functions. The human body is nothing but a natural machine, and only by studying it as an object can it be understood. Understanding it leads to better medical technology, the cure of diseases, increased lifespans and a generally more comfortable existance.
You seem to place a great deal of importance on preserving what is ‘natural’ – but there is hardly anything natural to preserve. The natural lifespan of a human ‘in the wild’ – that is without medical technology or the packaged and dependable food and water supplies of modern civilisation – is around fourty years. Diseases are natural, and yet I do not believe you would object to the use of artificially-produced antibiotics to cure them.
Under the rules of what is natural, I wouldn’t even be able to see well enough to read your comments. I require strong glasses, without which the text is hopelessly blurred. Glasses, I note, which could have been invented only following a mechanistic understanding of the human eye not as somehow part of the dignity of a person but as an optical device.
The reproductive system should be, as you put it, “conquered.” Just as countless other biological inconveniences already have been. There is nothing inherently perfect in a natural state of the human body – it works, most of the time, but when it doesn’t suit the desires of it’s occupent why not bend it to their whim? Heal the injuries, cure the disease – even shave off facial hair for a more trivial example of something unnatural. Produce the glasses I wear. If someone has a serious organ problem, transplant in a replacement – or go one further, and manufacture a new organ entirely from artificial materials from artificial joints to functional (If, admitidly, still inferior to the natural) hearts. So many unnatural ways to maintain and improve it, and yet you only seem to object to those relating to the reproductive system?
Given enough time and knowledge, not only will the reproductive system be conquered, but possibly even death itsself – there are exotic hypothetical means by which immortality might be achieved, still in the realm of science fiction, but which may one day become possible. You say that the human body has dignity, but what could strip it of dignity more than death? A mechanical understanding can push that death ever further away, and offers the hope of one day escaping it altogether.
“If any natural function of the human body is seen as detrimental to health, then it is obviously the idea of “health” which needs to be evaluated, and not the functioning of the body.”
Ever heard of autoimmune diseases?
Under this line of reasoning, you couldn’t even try to treat acne.
“Any medical idea which does not recognize and operate within the pre-condition of the inevitability of bodily death if simply foolishness.”
Then what is the point of medicine? Why not simply allow those of fall ill to die naturally? If you accept death as inevitable, than at most you are buying more time and it really seems pointless. Die now, die later, dead either way.
The body is not an object. It is a living organism experienced subjectively by the living person. To say the body is a machine is not to understand what a metaphor is. Machines were invented by man; we precede them. Prior to machines, our bodies existed and they were not machines. A mechanistic view of the human body is a historical view, only possible in a world where machines have been invented and we can use them as a metaphor to understand the body. However, we should understand that while a mechanistic view can be helpful in medicine, it is only a metaphor or one way of understanding what the body is, and should be recognized a partial. That is why so many people are so dissatisfied with mainstream medicine, which doesn’t take away from what it can do.
But I am not going to use it as the primary metaphor for my understanding and experience of my body. I am not out to conquer my body, or its reproductive system for that matter.
The point of medicine is to heal illness and alleviate suffering, not to conquer death. Death is inevitable. Again, because mainstream medicine is forgetting this, it is pretty generally useless when it comes to terminal and palliative care.
For something inevitable, a great deal of effort going into postponeing it as long as possible.
Your romantisation of the body does not reflect modern understanding. The mechanistic view is not merely helpful in medicine: It *is* medicine. The field is founded entirely upon a mechanistic view.
Anyway, if the point of medicine is to ‘alleviate suffering,’ that means it’s eventual goal must be to eliminate death. Death is suffering, for those left behind – not to mention a great loss for the deceased.
You’ve also inadvertantly presented a very good argument for euthanasia there, arguing that medicine is obliged to alleviate suffering but not to prevent death. I get the impression that wasn’t your intention.
Suricou Raven –
To understand what I have written, it will help to know the sense in which I am using some terms which you seem to have taken differently.
First of all, I believe you over-emphasize my point about what is “natural” – I used that word only once, in the sentence which you quoted in your second post. In that quote I did not mean to use the word “natural” as in “not artificial,” (cf. your reference to a human ‘in the wild’) but rather as in “pertaining to the nature of the body.” The example of autoimmune disease serves perfectly to illustrate this point. These diseases are not man-made, nor are they, in a sense, “foreign” to the body – the body is attacking itself. But, these diseases are not part of what we think of as a normally functioning body. Therefore, even an autoimmune disease is “unnatural” because it’s not part of the nature of the human body to have such a disease. The same applies to your examples of disease, eyeglasses, injuries, etc.*
It is on the other hand, part of the body’s nature to have a reproductive system – so the absurdity I’m trying to point out is in pitting a normally functioning aspect of a person’s body against the person’s body.
to be continued. . .
* I will note that I was greatly struck by the ingenuity of your comment about shaving. This is just one example of something where the body’s normal functioning is counteracted strictly for the sake of vanity (i suppose this fits in the category with liposuction or breast augmentation or getting braces). You’ll be delighted to know that I am clean-shaven, proof that I do not think that frustration of the body’s normal functioning is intrinsically evil. But I hope we’ll agree that reproductive system is far more integral to the person than the facial (or leg or armpit or whatever) hair.
ad SR – continued
I will note that there is a distinction between a mechanistic viewpoint (what I call “imperialistic”) and a good scientific understanding of the body’s mechanisms. I said above: “There does not seem to be anything intrinsically wrong with understanding the body’s mechanisms (it is, after all, a material reality) as long as this understanding is used in a way which is congruent with the dignity of the body as a whole.” I may have also added: the dignity of the person as a whole.
Most medical practices rely on our understanding of the body’s mechanisms, which is great. But the reduction of the body to a strictly mechanistic understanding breeds what I referred to as the separation of “our sense of ‘body’ from our sense of ‘self'”. Note that the example I used to highlight this separation (pornography) has nothing to do with the understanding of the body’s mechanisms. One need not be a medical physician to be a pornographer. Mary Ann says very poignantly: “To say the body is a machine is not to understand what a metaphor is”. A mechanistic understanding misses the metaphor. Understanding the mechanism does not.
Hopefully this helps you understand that I am not against understanding mechanisms, but against a mechanistic understanding.
to be continued . . .
ad SR continued:
On the inevitability of death, I would say this:
I disagree with Mary Ann that the point of medicine is to alleviate suffering. This is completely impossible and, as you say, would lead to a culture where people were simply killed off to “alleviate suffering” – which is a great oxymoron. Peter Singer thinks along these lines – a type of radical utilitarianism I suppose. Needless to say, Mr. Singer and I don’t often find ourselves in agreement.
Yet to say that death is inevitable is not to say that we should encourage or expedite the inevitable, nor is it to say that we should embrace it – death is not a good thing. Yet the fight against the inevitability of death must be understood with respect to proportionality. We must ask: To what extent may we postpone death? and also: To what extent must we postpone death? Needless to say I won’t elaborate my viewpoints on these issues here, but I will note that these are obviously questions not of medicine but of morality – not is questions but ought questions. Ultimately I believe that medical science is subject to moral precepts – and further, these precepts cannot be determined by science itself.
Thus, the reason I chose the rather striking words “imperialism” and “conquer” was to highlight the fact that medical science (and much of modern science) seems to operate in a different moral sphere than other human action. Why? If the science of nuclear fission and fusion has given us an opportunity for clean power and also has given us Hiroshima and Nagasaki, then we must be willing to ask: is there no limit? Is the sum totality of what nuclear physics has allowed us to do as a human race good or bad? To refuse to ask this question is to embrace the newest “Manifest Destiny” of modernity – but the savages we seek to conquer and eradicate are ourselves as moral beings. I myself will not embrace this imperialism.
Actually, billy d, I think we probably agree more than not. My understanding of the word alleviate is not to eradicate but to lessen or make less severe; that is surely not a completely impossible goal and it is usually why many people seek medical help in the first place?
Mary Ann –
It seems to me like we agree on a great deal. But, you said that “the point of medicine is to heal illness and alleviate suffering.” I think you’re on to something with the “heal illness” part, because medicine must be considered mostly in a restorative manner: that is to say medicine should seek (as its purpose) to restore each person’s body, to the extent possible, to what a human body is supposed to be.
To think in terms of suffering however, begins to be overly utilitarian (cf. my Peter Singer comment). Medicine can certainly remove pain, but if that’s conceived as the main goal, things begin to get a little shady. I suffer when my child dies, but it’s not the place of medicine to remove that suffering. If I fall and break my leg, sure the doctor gives me some drugs to help with the pain, but if I’m going to die in three weeks and I will be in great pain for that time, I don’t just want the doctor to poison me, even though there would be “less” suffering in that scenario. Therefore the purpose (or, in your words, the “point”) of medicine cannot be to simply lower the sum total of suffering in my life – not to mention that idea that suffering is hardly quantifiable.
I’m still inclined to think the distinction is between the alleviation of pain and suffering and its remova. I suppose we could also make the distinction between physical pain and other kinds of suffering, but we do also look to medicine to alleviate mental and emotional pain (maybe at times we shouldn’t). I have chronic physical pain and it is beginning to look like it cannot be healed. I look to medicine to help alleviate the pain so I can function in my life. Not to remove it ; it’s beginning to look like it will only be removed with death or complete paralysis from the neck down. Surely we look to medicine to alleviate the pain associated with chronic conditions? And I was very happy to experience the alleviation of pain and suffering available through modern medicine when I was giving birth, when my body was doing what it was expected to do quite nicely, accompanied by agonizing pain.
I do think that if the removal of suffering becomes the main goal things will become shady quickly.
Yes, I think you’re right. I can’t make a complete proscription against removing pain through artificial means, as long as it’s not done at all costs.
Singer talks about the “sum total” of suffering and how that must be diminished, which is the utilitarianism I was talking about. But as long as we don’t fall into the “sum total” mentality (CS Lewis writes very well against this), then I must admit there’s probably nothing wrong with saying that one of the goals of medicine can be alleviating pain within reason.
Firstly we simply need to forgo ALL your intellectual discussions and ask Billy, are you male or female? If male, butt out, this simply does not concern you as you do not own and operate a female reproductive system, so you do not get a say in this matter!!! If female, how many years have you suffered crippling menstrual pains and debilitating diarrhoea and vomiting?? I would guess none. I have suffered from early puberty at age 11 till quite recently at the age if 40, with crippling and debilitating mentrual symptoms, from a set of reproductive organs that DO NOT WORK!! why then is it wrong from any perspective for me to be allowed to stop my suffering with the OCP? I had a brief period of 5 years in my 20’s where I took it and alleviated my suffering and I chose to go back on it recently as I got sick of my 68 day menstruations!! The church needs to keep it’s nose out of this debate once and for all. It is a woman’s choice to alleviate the inconvenience and often crippling pain of menstruation, especially if she suffers a non working reproductive system like I do, or doesn’t wish to use her system as she doesn’t want children or can’t find a suitable mate. Even a Roman Catholic should be in favour of the use of the OCP in circumstances like mine?? Either way, it’s a woman’s choice, not an anthropologist’s or clergyman’s or anyone else. Debate over!!