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In the Thick of Things: Jonathan Moreno

In his newest book, the Penn Integrates Knowledge professor ranges across disciplines to examine America’s longstanding ambivalence toward science.

From Penn Medicine, Summer 2012

By John Shea

 

Bioethics-topics

Science: Americans have long had a love-hate relationship with it. Some Americans have been suspicious of science, its fruits, and its practitioners; others have sung its praises with enthusiasm; and still others have felt an uncomfortable ambivalence. That’s the topic of the latest book by Jonathan D. Moreno, Ph.D., The Body Politic: The Battle Over Science in America (2011). Moreno is one of the University’s Penn Integrates Knowledge professors, 14 at last count, each with academic appointments in two schools. Moreno is a member of the Department of Medical Ethics and Health Policy in the Perelman School of Medicine and of the Department of History and Sociology of Science in the School of Arts & Sciences. With his wide range of interests and expertise, Moreno is well suited to explore the particular strain of American history that is the subject of The Body Politic.

The Founding Fathers included several of the most prominent scientists and science-minded men of that time. Thomas Jefferson and Benjamin Franklin are among the most widely known. Less well known, as Moreno points out, are the related ideas of Alexander Hamilton. He proposed prizes, patents, and “premiums” for innovation, “similar to today’s tax credits for research and development” (TBP, p. 37). One of the epigrams Moreno selected for the book comes from Franklin himself, in a 1780 letter to Joseph Priestley, part of which reads:

“This rapid Progress true Science now makes, occasions my regretting sometimes that I was born so soon. It is impossible to imagine the Height to which may be carried, in a thousand years, the Power of Man over Matter. . . . [A]ll Diseases may by sure means be prevented or cured, . . .”

Even if Science and its companion Medicine have not yet cured or prevented all diseases, it’s likely that today’s physician-scientists share Franklin’s positive vision.

But the second epigram, Edgar Allan Poe’s “Sonnet – to Science” (1829), presents a much less favorable view of science. Here it is a vulture that preys on the poet’s heart and whose wings “are dull realities.” In Poe’s view, Science has done little more than drive myth and fantasy away and leave little of worth behind. As Moreno noted in an appearance at the University of Pennsylvania bookstore last fall, Poe’s era was also the era of Mary Shelley’s Frankenstein. Although there is a “monster” in the novel, it is actually Victor Frankenstein, the scientist, who is the villain, a victim of misguided hubris.

In part, this extreme divergence in the views of Franklin and Poe can be explained by the change in the nation’s status – from a brand-new democracy moving forth with enthusiasm and idealism to one struggling with the hard realities of nationhood. But a comparable divergence has been with us to this day. According to Moreno, “Reservations about rapid technological change are widely shared regardless of political party or philosophy. In America the tension between approval of science and worry about the rapid changes it can bring bubbles up in special ways when moral or cultural choices seem to be involved. We’ve seen this tension play out time and again in our seemingly endless controversies about the teaching of evolution, reproductive rights, the moral status of the human embryo, the origins of the universe, and nearly all the issues of science that relate to human values” (TBP, p. 16).

In recent decades, Moreno argues, this division has been sharpened and made more vehement. Today, even politicians feel compelled to state their positions on these divisive issues. Moreno notes that chimeras (organisms composed of two or more genetically distinct cells) have been used in important medical research for decades; pigskin grafts have been used to minimize scarring in humans with severe burns, and cow arterial grafts have been used for reconstructing human arteries. But many people are concerned about future steps. For example, Christine O’Donnell, later to be the Republican candidate for the U.S. Senate in Delaware, appeared on The O’Reilly Factor (Fox News) in 2007 as part of a debate on stem cell research. There, she asserted – falsely – that “American scientific companies are cross-breeding humans and animals and coming up with mice with fully functioning human brains.” Similarly, in 2009, Gov. Bobby Jindal (Louisiana) signed into law a bill prohibiting human-nonhuman hybrids.

At the Penn bookstore, Moreno described The Body Politic as an attempt to gauge the importance of the debates on medical and scientific issues and to put them in a historical and cultural context. Biology, he explained, has become part of national politics – in short, biopolitics. One instance involved two politicians then running for the Republican nomination for president, U.S. Representative Michele Bachman (Minnesota) and Gov. Rick Perry (Texas). They squared off about whether the government – of the State of Texas, in this case – should mandate that girls receive the HPV vaccine. The twist in this case was that, on many other issues, Bachman and Perry shared very conservative values. What Moreno came to understand is that the science could create “some strange, unexpected bedfellows.” For example, some liberal women’s groups supported Perry’s mandate.

Moreno later elaborated, touching on one of the more unexpected themes of the book. In 1998, scientists at the University of Wisconsin isolated human embryonic stem cells, which were seen to be master cells that give rise to all the others types of cell in the human body. “ . . . [W]e potentially had at hand the key to using our own biological materials to heal ourselves by replacing defective tissues in hearts, livers, pancreases, brains, or in fact any other organ or tissue system in the body” (TBP, pp. 106-107). In his talk, Moreno pointed out that the President’s Council on Bioethics under George W. Bush – dominated by neoconservatives – was firmly against cloning. They believed that its implications are likely “to lead us down a very dark path.” In their view, cells would be commodified, even bought and sold in the marketplace. The neoconservative view, Moreno said, is that technology “disrupts our sense of what it is to be human.” Where liberals are likely to say that embryos are not persons, conservatives insist that embryos are human, not merely “a bag of cells.”

The irony, as Moreno explains, is that Marx and Engels made a similar argument about capitalism, that it turns humans and everything around them into commodities. In broad terms, while bioconservatives on the right worry about the implications of extreme capitalism, “green” progressives worry that new technology would increase social inequalities and harm the ecology. Both groups are against science without controls and regulations.

But why on earth would any right-thinking American citizen regard science and scientists with distrust? In Undue Risk: Secret State Experiments on Humans (1999), Moreno provided several reasons. In The Body Politic, Moreno offers several more. Among the most compelling is the support among some scientists and government officials for eugenics and social engineering. Moreno notes the “Model Eugenical Sterilization Law” published by Harry Laughlin of the Eugenics Records Office at Cold Spring Harbor. Laughlin had a doctorate in cytology/cell biology from Princeton University. Some readers will be startled to read the quotation from Oliver Wendell Holmes when, in 1927, the Supreme Court justice wrote a decision upholding a Virginia law. The state invoked the law to sterilize a “feeble-minded” and sexually promiscuous 17-year-old girl.

In more general terms, many Americans have felt uneasy about science because it can be seen as subversive. As Moreno puts it, “Science is no respecter of the preferences of the powerful. It challenges prejudices, obscures boundaries, and undermines familiar categories. It threatens comforting and stultifying dogma” (TBP, p. 31). The theory of evolution, Moreno notes in the same chapter, upsets a conservative world view and casts doubt on the notion of a designed universe – and the place of humans in it.

In 2010, the National Science Board reported that 68 percent of Americans said that the benefits of scientific research strongly outweigh the harmful results, whereas 10 percent said that the harms outweigh the benefits. But the Board also found that “nearly half of Americans believe that ‘science makes our way of life change too fast’” (TBP, p. 15). That ambivalence will likely intensify as specialized science becomes more difficult to understand – and when the new biology continues to break down familiar boundaries.

Even if, as Moreno states, science can be disconfirmed by experiment and is a self-correcting process, that may not be comfort enough for many Americans.

Moreno was recruited to Penn in 2006 from the University of Virginia, where he was a professor of biomedical ethics and director of the Center for Biomedical Ethics. He was also a senior fellow at the Center for American Progress in Washington, D.C., a position he retains. The Penn Integrates Knowledge initiative, launched a year earlier by Amy Gutmann, Ph.D., the University’s president, seeks to recruit exceptional faculty members whose research and teaching exemplify the integration of knowledge across disciplines. Moreno earned his doctorate in philosophy from Washington University in St. Louis. He also holds an endowed chair, as all PIK professors do: the David and Lyn Silfen University Professorship.

Moreno came to Penn as a highly sought commentator for such TV and radio programs as ABC World News Tonight and NPR’s All Things Considered, and he was frequently quoted in major newspapers and magazines. In his time as a PIK professor, he has not slowed his pace. He has appeared in The Atlantic and is a regular contributor to The Huffington Post, where he can respond in a timely fashion to many of the events and opinions of the day. More recently, he has also been posting for Psychology Today.

Speaking about The Body Politic on the Penn campus, Moreno noted that his publisher encouraged him to have a Facebook page, and he has also has a Twitter account. As he mentioned in an interview, “It is different now. You have to be aware of social media. And I want my ideas out, I want to be ‘on the radar.’” In short, Moreno relishes the role of public intellectual, a breed that seemed in danger of extinction.

Founding-FathersTopics of his recent postings have included the firestorm over Plan B (also known as the “morning-after pill”), in which Moreno notes that Kathleen Sebelius, Secretary of the Department of Health and Human Services, overruled the recommendations of the Food and Drug Administration and its panel of scientists and denied over-the-counter access to the pill by girls under 17; the widely differing views of what constitutes “personhood” and recent efforts by some conservatives to define it as including the embryo at the moment of conception; and the importance of a “frontier” in inspiring American progress and the possibility that a NASA manned mission to Mars might “save” American science from American politics.

Another recent post by Moreno appeared first in The Wall Street Journal: “Robot Soldiers Will Be a Reality – and a Threat.” In the piece, he cites technologies “on the horizon,” including using brain-machine interface technologies to give remote pilots of drone aircrafts instantaneous control through their thoughts alone. Another technology being explored is “whole brain emulation,” which would involve “uploading a mind from a brain into a non-biological substrate.” But what might advantage one side in a conflict would likely be turned against it in time. Moreno concludes that “fully autonomous offensive lethal weapons should never be permitted.”

In Mind Wars: Brain Science and National Defense (2006) and elsewhere, Moreno has made similar points – that technologies that derive in some way from defense-funded projects are often open to dual use. They can be used for the general good as well as in military situations, and discoveries in neuroscience can be adapted for military use. As he said in an interview with Science & The City (2006), “ . . . there’s evidence that beta blockers, which are used for people with heart disease, can be used to treat people with post-traumatic stress disorder. There are some people who believe that not only are they useful after someone has been in a stressful situation, but it might even be plausible to give somebody a beta blocker before they go into a stressful situation. . . . Imagine if you were to give a beta blocker to a soldier before he or she went into a combat situation. On the one hand you might prevent or at least ameliorate the terrible emotional feelings that could come from what they see and do in combat, but, to put it in a single phrase, do we want an army of guilt-free soldiers”?

Another point that Moreno emphasized in Mind Wars is the responsibility of scientists to consider the social and ethical issues raised by their research. While writing the book, he could not persuade many neuroscientists “to talk for the record about the downside of their own field’s involvement in national security work” (MW, p. 5).

Moreno has a distinguished record of service on several important commissions that have influenced public policy. These include the National Human Research Protections Advisory Committee, the National Bioethics Advisory Commission, and the President’s Committee on Human Radiation Experiments. An elected member of the Institute of Medicine of the National Academies, Moreno was co-chair of the Committee on Guidelines for Human Embryonic Stem Cell Research, sponsored by the Institute of Medicine and the National Research Council. He has also served as president of the American Society for Bioethics and Humanities.

It is not surprising that the career arc of such a visible bioethicist would have intersected with Penn’s prominent Center for Bioethics. In 1998, when the Human Research Ethics Group published its report in The Journal of the American Medical Association on updating protections for human subjects involved in research, Moreno was lead author. The Human Research Ethics Group as a whole was administered by Penn’s Center for Bioethics and included such Penn authors as Arthur L. Caplan, Ph.D., founding director of the center, who will soon be concluding his 18-year stay at Penn and moving to N.Y.U.’s Langone Medical Center, and Paul Root Wolpe, Ph.D., who now heads the Bioethics Center at Emory University. (Caplan and Moreno, in fact, knew each other as graduate students in New York City in the 1970s.)

About Moreno, Caplan says, “Jonathan has an unmatched ability to use history to illuminate current debates in bioethics. He brings a broad vision to his work and is able to incorporate an understanding of cutting-edge science into his incisive, historically grounded, normative thinking.”

In the midst of the more recent theoretical and historical books that Moreno has written or edited, Ethics in Clinical Practice seems something of an anomaly. The second edition, written with Judith C. Ahronheim, M.D., and Connie Zuckerman, J.D., appeared in 2005. As the preface puts it, this edition “gives heightened attention to newer ethical dilemmas spawned by the advances in medical genetics, organ transplantation, HIV medicine, and assisted reproductive technologies, and by complementary/alternative medicine, managed care, physician-assisted suicide, and other timely issues.” In effect, the second edition of Ethics in Clinical Practice illuminates many of the issues that underlie The Body Politic, but from a different angle. Or a combination of angles, given that the book was “prepared collaboratively by a physician, a philosopher, and an attorney. . . .” Here the focus is on everyday practice, not from a distance but on the ground level. After some general discussion, the authors look closely at 31 hypothetical – but realistic – cases. Among them: “Withholding Tube Feeding in a Woman with Advanced Dementia”; “‘Do Everything’: Physician Obligations in the Face of Family Demands”; and “A Pregnant Woman Using Cocaine.” In each case, the primary issues to consider are named, followed by fuller medical considerations, and then ethical and legal considerations.

Confronting such issues was in some ways Moreno’s introduction to bioethics. He was a young professor of philosophy when the call came to teach a new course in bioethics. As Moreno puts it, an untenured assistant professor never says no in such situations! He would teach Philosophy 101 in the morning to 80 undergraduates “who were barely there”; then, in the afternoon, he would talk with physicians “who were hanging on my every word” as they considered the issues they had to face at the university’s hospital. Those situations were often tense, often tangled – precisely like those described in Ethics in Clinical Practice.

Moreno
Jonathan Moreno, PhD
(Photo by Candace diCarlo)

For about 20 years, Moreno focused on clinical ethics. What precipitated his shift to a different kind of ethics was being appointed to the President’s Committee on Human Radiation Experiments. He came to realize that bioethics could play an important role in shaping public policy. From there it was a short step to considering the ethical aspects of such important issues as national security and neuroscience. “You can understand so much through the nation’s security concerns,” he says. When Undue Risk appeared in 1999, The New York Times Book Review noted that “the historical record he presents in Undue Risk strongly supports his contention that the rights of human subjects deserve to be held paramount over any needs of national security.”

Only two years later, a different kind of security concern struck the United States: the anthrax attacks. Moreno realized that there was nothing in the bioethics literature about biological weapons. In addition, even as neuroscience was burgeoning, nobody was exploring the national security angle. “I was afraid some smart science writer was going to write it first,” he says. But he published Mind Wars in 2006, to very favorable reviews. Again, the critics praised his clear, conversational prose. And, despite his affiliation with the liberal-leaning Center for American Progress, his moderate, balanced tone.

From his affiliation with the Center for American Progress, it’s clear that Moreno considers himself a progressive. At a campus Knowledge by the Slice presentation this spring, he stated, “I leave my politics at the classroom door,” but he feels freer to express those views in his writing. Still, Moreno clearly intends to avoid the noisy back-and-forth assaults parodied in the early days of Saturday Night Live. In The Body Politic, he discusses a neoconservative writer’s criticism of “the new commerce of the body” – paid egg donations, the market in medications for erectile dysfunction, and so on. The writer blames technology and cultural permissiveness, with no mention of the underlying socioeconomic forces. Moreno answers: “One would think the blame for these problems lies partly with an economic system that allows everything to be priced and sold.”

His approach is more in line with what the Center for American Progress urges on its Web site: “Challenge conservative misinformation with the facts.” Heat not necessary. In fact, in an interview, Moreno points out that some of the harshest criticism of The Body Politic has come from the left. That kind of response, he says, “helped me understand how it was so easy to fall into the conventional scheme.” He recalls what a good teacher said: “Give me the best argument you can against your position.” A student’s position will stand or fall depending on how it withstands such scrutiny.

Moreno’s father, J. L. Moreno, was a well-known psychiatrist, born in Austria, who is considered the pioneer of group psychology, role playing, psychodrama, and encounter groups. His mother, Zerka T. Moreno, is a psychotherapist. (She has just published a memoir at the age of 94.) They had a private 20-acre sanitarium in New York’s Hudson Valley. When I suggested that the young Moreno’s household and upbringing were not at all like those depicted in the typical situation comedies of the late 1950s and early 1960s, he laughed. “In some respects, it was very close to Leave It to Beaver.” His childhood home, he continued, was picturesque Americana but depressed, something of “a shabby river town.”

But there were certainly some telling differences from the old sitcom. At the beginning of Mind Wars, Moreno recounts an episode that he did not understand at the time. One Saturday morning, a yellow school bus arrived at the sanitarium and dropped off about two dozen young men and women. Ten-year-old Jonathan organized an impromptu softball game with them, and they played for an hour. Then the visitors went inside. “Years later, when I was a college student, I asked my mother, who worked closely with my father, about that weekend. ‘Oh,’ she said, ‘that was a group of patients referred to your father by a psychiatrist in Manhattan. They were here to try LSD as part of their therapy. It didn’t work.’” At the time, the senior Moreno was authorized to order certain controlled substances from government-approved producers for his work. For Moreno, the episode was an unsuspected exposure to some later concerns like bioethics and neuroscience.

Given his wide interests, I asked Moreno what he brings to his work and at what stage: philosophy, American history, bioethics? “I can’t disentangle them anymore,” he replied, calling himself “disconcertingly interdisciplinary.” He is, he confessed, “interested in everything – thank God for PIK!” Moreno drew a contrast to his father’s era, when the barriers between disciplines were not so strong. The senior Moreno pursued psychiatry, theater, theology, and whatever else interested him. It is a pattern Jonathan seems to have embraced as well.

Which may be one reason he hesitated when asked what he likes to do when not engaged in his work. “I’m pathetic,” he replied with a grin. He goes to dinner, goes to the gym, travels. Then he mentioned one pastime that is not at all surprising – reading. At the recommendation of a friend, he reread Enders Game, a science-fiction novel by Orson Scott Card. He was currently reading Plain Honest Men: The Making of the American Constitution (2009), to try to understand the Founding Fathers more. The author, Richard Beeman, Ph.D., is a longtime professor of history at Penn and former associate dean of the School of Arts and Sciences. Another book that is holding Moreno’s interest is the fourth volume in Robert Caro’s monumental biography of Lyndon Johnson.

For Moreno, history appears to be a constant. Perhaps it offers some comfort as well. After all, in The Body Politic, he suggests that America is a product of the Enlightenment. “It is fair to say that no nation has ever been founded by people who were more oriented toward the pursuit and propagation of knowledge than the United States” (p. 35). The nation is, in effect, an idea and, to borrow a term from science, an experiment. Moreno has no sympathy for what he calls “a gloating ‘American exceptionalism,’” and he acknowledges that America’s history “is stained with the blood of those who were left out” (p. 185). But its history as a whole, its progress so far, provide reasons for hope.

 

What Is Biopolitics

Biopolitics is the nonviolent struggle for control over actual and imagined achievements of the new biology and the new world it symbolizes. Whether that world is seen as better or worse than our own, the very idea of such power stimulates deep reservations on both the left and the right about the implications of the post-Enlightenment, scientific worldview. . . . But when the full range of biopolitical issues are considered along with the motivating concerns behind them, the picture turns out to be far more complicated than is captured by the left-right spectrum. Consider, for example, those who might broadly be identified as bioconservatives: they worry that the life sciences will modify human abilities in comparison with some natural norm. But there are bioconservatives on the right and on the left. Bioconservatives on the right emphasize that a loss of traditional values could result, especially the dignity that should be ascribed to all persons. Bioconservatives on the left focus on the possibility that social inequalities and ecological problems could be grievously aggravated by biotechnological innovations.

            (The Body Politic, p. 121)      

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