HUM-MOLGEN archive: LITE, ETHI: Book review

This is the first in what we hope will be a series of book reviews published on HUM-MOLGEN. It seems particularly relevant in the light of very recent public dicussions of 20th century eugenic sterilization practices in Sweden, Norway and Austria. Arthur Bergen, LITE editor Hans Goerl, ETHI editor ******************************************************* "Creating Born Criminals : Biological Theories of Crime and Eugenics" Author: Nicole Hahn Rafter List: $36.95 Publisher: Univ of Illinois Pr (Trd) ISBN: 0252022378 Review by David W. Moskowitz In her latest book, "Creating Born Criminals" , Dr. Nicole Hahn Rafter carefully instructs the reader, who she assumes (quite correctly, in my case) knows nothing about criminology, eugenics, or the early twentieth century literature on moral imbeciles. The result is an exhilarating insight into how the best and the brightest in America came to embrace eugenics out of altruistic, professionally incontestable reasons. The fallacy of eugenics suddenly becomes eminently understandable in human terms. Beginning with the title of her thoroughly researched book, Professor Rafter gets to the very heart of the matter: how much of behavior, especially criminal behavior, is due to nature (genetics), and how much to nurture (environment)? Is there such an entity as a "born criminal", and, if so, who "creates" him or her? Did a nascent profession "create the monster to justify its own existenceS, as Dr. Rafter strongly suggests, or does nature (read God, genes, or the like) actually produce stone cold criminals for society to puzzle over? The current consensus appears to be that both genetics and environment are inextricably linked in producing any outcome of biological interest, including antisocial or criminal behavior. I share with professionals like Dr. Rafter the bias (hope, really) that criminal behavior could never result from a fully loving and wise environment. It is probably relevant to this discussion that novelty seeking behavior in mice may relate to the dopamine circuitry of the limbic system. With the discovery of each new Mendelian disease gene, however, it is becoming painfully apparent how little we know of genetic environmental interactions in even the simplest of cases, when only a single gene is involved. We are still barely looking through a glass darkly at the much more complex polygenic and environmental interactions which presumably result in criminal behavior. Given our current state of ignorance about a topic which every adult in the civilized world is asked by their elected representatives to have a firm opinion on (namely crime), it is remarkable, although perhaps not surprising, to see the degree of professional certainty about this topic at the turn of the century. Professor Rafter reminds us of a not too distant past (the fifty year span from the 1870s until the 1920s) when it became dogma within the United States penal profession that poor mental performance was highly correlated with poor moral performance, and that the most scientific and effective method to rid society of criminal behavior was to limit sexual reproduction of born criminals. Dr. Rafter shows us exactly how this rather bizarre conclusion was reached. This book is recommended for anyone who, like myself, knows that eugenics is "bad," but doesn't understand how intelligent, professionally ambitious, "good" people could have embraced it. Dr. Rafter's book highlights the importance for any profession related to genetics to, first of all, acknowledge its own limitations. In addition to the Hippocratic injunction of nonmaleficence("primum non nocereS), humility should perhaps be the oath of any genetics investigator. In the spirit of Nathaniel Hawthorne, in "The Scarlet Letter", every genetics investigator should be required in some way to "Be true, be true, be true; show freely to the world, if not your worst, at least some aspect by which your worst may be inferred.S Dr. Rafter further reminds us of the social danger of concentrating scientific resources and power in the hands of a few, admittedly gifted, individuals. In the current climate of research cutbacks, the danger is at least as great as it was a century ago. Those lucky few who still belong to the "club" of funded genetics investigators would of course never dream of criticizing the hand that feeds them. To an outsider like myself, the "club" seems to be getting even smaller and more unanimous. It is disquieting, for example, that the Consensus Statement on Informed Consent for Genetic Research on Stored Tissue Samples (JAMA 274[22]:11995) has already become law, at least in so far as NIH grants are concerned. (Having to get informed consent before using archived DNA specimens obviously limits the playing field to those with a large enough research team to do so; this effectively eliminates any "mom and pop" labs from the competition). Last summer's salvos from the Human Genome Center against the IVF Institute for daring to offer BRCA1 testing are somewhat chilling, as if knowledge should be withheld from the "hoi poloi" until those in command at the NIH say otherwise. There has also been discussion recently of a "National Genetics Board " to limit the availability of genetic testing to only those people participating in NIH sponsored clinical trials; this move would cut out commercial upstarts like the IVF Institute altogether. Professor Rafter makes abundantly clear in her excellent book that if the last century's tragic experience with eugenics taught us anything, it is the danger of hubris, and the saving power of a fully informed democracy. All those engaged in setting the future tone of medicine would benefit greatly from this eminently clear retelling of the recent past. David W. Moskowitz, MD, MA, FACPSt. Louis, Missouri. e-mail: dwmoskowitz@pol.net