Neuroscience is starting to deliver new therapies for cognitive disorders. But what about cosmetic neurology, asks neurologist Anjan Chatterjee?

"Capitalism depends on the notion of counterculture to peddle new styles to the many who seek a veneer of cool as they go about their quotidian lives," writes Hal Niedzviecki. "But that is only part of the story."

"For decades, parents and pediatricians have sought to offer children whose anatomy does not conform to strictly male or female standards a surgical fix. But the private quest for "normal" is now being challenged in a very public way by some adults who underwent genital surgery and speak of a high physical and emotional toll."

Mireya Navarro discusses the controversial topic of surgery for intersexed infants in her New York Times article, "When Gender Isn't a Given."

"Evidence that antidepressant drugs like Seroxat and Prozac could make people homicidal is being ignored by the body responsible for regulating medicines in the UK, a leading expert said yesterday."

"The charge came from David Healy, an expert on psychiatric drugs from north Wales whose warnings that the drugs could cause suicide prompted a major inquiry. That investigation, by an expert working group of the Medicines and Healthcare Products Regulatory Authority, led to the entire class of drugs except Prozac being banned last year from use in children. "

See "Seroxat and Prozac 'can make people homicidal'" in The Guardian.

"Last week, a federal advisory panel urged regulators to warn parents that antidepressant drugs not only increase the risk of suicide in some children, but that most have a poor track record in curing their disease."

"The recommendation came after a yearlong debate over whether the drugs are as safe and effective as advertised. It was based on evidence that a small minority of children show increased signs of suicidal behavior when taking the drugs."

"Through it all, one of the drugs seemed somehow above the fray: Prozac."

"Although the warning is recommended for Prozac as well as other drugs, Prozac is still the only one approved by the Food and Drug Administration for the treatment of depression in children and adolescents. A large government-financed trial recently found that it worked better than talk therapy in helping teenagers overcome depression. And when British health officials announced a sweeping ban of antidepressant use in children, which touched off the debate last year, they specifically exempted Prozac."

"But is it really that different?"

"The short answer is no, experts say. Although chemically distinct from other drugs in the same class, Prozac works on precisely the same principle, they say, and there's no evidence that it is significantly safer or more effective than the others in treating childhood depression. Prozac has shown in several trials that it can relieve depression in youngsters and adolescents significantly better than dummy pills. Such convincing evidence is not available for the other drugs. But, research psychiatrists say, that does not mean the other drugs in the same family do not work in young people, only that they have not been properly tested."

Read more in The New York Times.

"Psychiatrists, pediatricians and family practice doctors said in interviews that they would restrict their use of antidepressants in the wake of a federal advisory committee's decision that the medicines should contain severe warnings about the risks of suicide."

"Dr. Alexander Lerman, a child and adolescent psychiatrist in New York City, said that he would no longer prescribe the medicines to some children and that for the rest he would sit down with their parents and discuss in detail the risks of the drugs."

"The advisory committee made its recommendation after reviewing numerous studies of antidepressants. Although no children in any study of the drugs committed suicide, there were reports of increased suicidal thoughts and behavior. The risks are greatest in the first weeks of therapy."

Read more in The New York Times.

"Top officials of the Food and Drug Administration acknowledged for the first time on Monday that antidepressants appeared to lead some children and teenagers to become suicidal."

Dr. Robert Temple, director of the F.D.A.'s office of medical policy, said after an emotional public hearing here that analyses of 15 clinical trials, some of which were hidden for years from the public by the drug companies that sponsored them, showed a consistent link with suicidal behavior."

"I think that we now all believe that there is an increase in suicidal thinking and action that is consistent across all the drugs,'' Dr. Temple said, summarizing the agency's presentation to a special advisory committee. "This looks like it's a true bill.''

"The acknowledgement, made after the hearing, comes a year after the agency suppressed the conclusions of its own drug-safety analyst, Dr. Andrew Mosholder, who first found a link between the drugs and suicide in teenagers and children. Agency officials wrote in internal memorandums that Dr. Mosholder's analysis was unreliable, and they hired researchers at Columbia University to re-analyze the same data. That study recently reached conclusions nearly identical to Dr. Mosholder's."

Read more in The New York Times.

Foreign Policy magazine asked eight people to write about the most dangerous ideas in the world. Francis Fukuyama chose "transhumanism."

See http://www.foreignpolicy.com/story/cms.php?story_id=220

----------------------------------------------------
Foreign Policy
Sept/Oct 2004
TRANSHUMANISM
By Francis Fukuyama

For the last several decades, a strange liberation movement has grown within the developed world. Its crusaders aim much higher than civil rights campaigners, feminists, or gayrights advocates. They want nothing less than to liberate the human race from its biological constraints. As "transhumanists" see it, humans must wrest their biological destiny from evolution's blind process of random variation and adaptation and move to
the next stage as a species.

It is tempting to dismiss transhumanists as some sort of odd cult, nothing more than science fiction taken too seriously: Witness their over-the-top Web sites and recent press releases ("Cyborg Thinkers to Address Humanity's Future," proclaims one). The plans of some transhumanists to freeze themselves cryogenically in hopes of being revived in a future age seem only to confirm the movement's place on the intellectual fringe.

But is the fundamental tenet of transhumanism - that we will someday use biotechnology to make ourselves stronger, smarter, less prone to violence, and longer-lived - really so outlandish? Transhumanism of a sort is implicit in much of the research agenda of ontemporary biomedicine. The new procedures and technologies emerging from research laboratories and hospitals-whether mood-altering drugs, substances to boost muscle mass or selectively erase memory, prenatal genetic screening, or gene therapy-can as easily be used to "enhance" the species as to ease or ameliorate illness.

Although the rapid advances in biotechnology often leave us vaguely uncomfortable, the intellectual or moral threat they represent is not always easy to identify. The human race, after all, is a pretty sorry mess, with our stubborn diseases, physical limitations, and short lives. Throw in humanity's jealousies, violence, and constant anxieties, and the transhumanist project begins to look downright reasonable. If it were technologically possible, why wouldn't we want to transcend our current species? The seeming reasonableness of the project, particularly when considered in small increments, is part of its danger. Society is unlikely to fall suddenly under the spell of the transhumanist worldview. But it is very possible that we will nibble at biotechnology's tempting offerings without realizing that they come at a frightful moral cost.

The first victim of transhumanism might be equality. The U.S. Declaration of Independence says that "all men are created equal," and the most serious political fights in the history of the United States have been over who qualifies as fully human. Women and blacks did not make the cut in 1776 when Thomas Jefferson penned the declaration.
Slowly and painfully, advanced societies have realized that simply being human entitles a person to political and legal equality. In effect, we have drawn a red line around the uman being and said that it is sacrosanct.

Underlying this idea of the equality of rights is the belief that we all possess a human essence that dwarfs manifest differences in skin color, beauty, and even intelligence. This essence, and the view that individuals therefore have inherent value, is at the heart of political liberalism. But modifying that essence is the core of the transhumanist project. If we start transforming ourselves into something superior, what rights will these enhanced creatures claim, and what rights will they possess when compared to those left behind? If some move ahead, can anyone afford not to follow? These questions are troubling enough within rich, developed societies. Add in the implications for citizens of the world's poorest countries-for whom biotechnology's marvels likely will be out of reach - and the threat to the idea of equality becomes even more menacing.

Transhumanism's advocates think they understand what constitutes a good human being, and they are happy to leave behind the limited, mortal, natural beings they see around them in favor of something better. But do they really comprehend ultimate human goods? For all our obvious faults, we humans are miraculously complex products of a long evolutionary process-products whose whole is much more than the sum of our parts. Our good characteristics are intimately connected to our bad ones: If we weren't violent and aggressive, we wouldn't be able to defend ourselves; if we didn't have feelings of exclusivity, we wouldn't be loyal to those close to us; if we never felt jealousy, we would also never feel love. Even our mortality plays a critical function in allowing our species as a whole to survive and adapt (and transhumanists are just about the last group I'd like to see live forever). Modifying any one of our key characteristics inevitably entails modifying a complex, interlinked package of traits, and we will never be able to anticipate the ultimate outcome.

Nobody knows what technological possibilities will emerge for human self-modification. But we can already see the stirrings of Promethean desires in how we prescribe drugs to alter the behavior and personalities of our children. The environmental movement has taught us humility and respect for the integrity of nonhuman nature. We need a
similar humility concerning our human nature. If we do not develop it soon, we may unwittingly invite the transhumanists to deface humanity with their genetic bulldozers and psychotropic shopping malls.

"I was visiting the Berkshires earlier this summer when Simon Winchester's name came up. Winchester has a house out there, and his local acolytes sing his praises. This is, after all, a man not much older than myself who has written more than a dozen well-reviewed books, at least one of which -- "The Professor and the Madman" -- was what we lucre-crazed scribblers would call a runaway bestseller. My friends and I marveled: How does he do it? And then it hit me: literary doping."

"Why didn't I realize this earlier? It explains everything. How can, say, Christopher Buckley, who is my age and attended the same sort of white-glove finishing schools that I did, have so outstripped me? He has written 11 books, innumerable humor articles for The New Yorker, The New York Times, and The Wall Street Journal. He edits a magazine, Forbes/FYI, and, for all I know, he's a regular on one of those prestigious TV shows I never watch because all the panelists are younger and more successful than I am."

"Put another way: Has Stephen King submitted to a blood test lately?"

See "The Dope on Prolific Writers" by Alex Beam in The Boston Globe.