Regulating Identity: Medical Regulation as Social Control

New biomedical technologies offer growing opportunities not only to prevent and treat illnesses, but also to change how healthy people think, feel, behave, and appear to others. Controversies over these nontherapeutic practices are a pervasive feature of contemporary American culture, from students on “study drugs” and cops on steroids to skin-lightening by black celebrities and the over-prescription of antidepressants. Yet the diversity of these controversies often masks their common root—namely, disputes about the propriety of using medical technologies as tools for shaping one’s identity. Some observers believe these so-called “enhancement” practices threaten important values, offering unfair advantages to users and undermining their ability to lead “authentic” lives. But existing systems of medical regulation, which were designed to promote the safety of therapeutic treatments and to deter drug abuse, are largely blind to concerns beyond protecting human health. As identity-modifying practices continue to proliferate, calls are growing to restrict access to these technologies on moral grounds. These proposals overlook the United States’ extensive and unfortunate experiences regulating nontherapeutic medical practices to enforce contested conceptions of morality. From Prohibition and the war on drugs to laws restricting contraceptives and abortion procedures, these efforts have been costly, ineffective, and intrusive. They have also interfered with fundamental liberties involving bodily integrity and identity—a fact that is widely recognized in the context of reproduction technologies, but largely overlooked with respect to other medical interventions. Rather than expanding our reliance on contested moral concerns in policing access to medical interventions, the U.S. should purge its existing regulation of morality-based intrusions and recommit itself to protecting human health

Regulating Identity: Medical Regulation as Social Control

New biomedical technologies offer growing opportunities not only to prevent and treat illnesses, but also to change how healthy people think, feel, behave, and appear to others. Controversies over these nontherapeutic practices are a pervasive feature of contemporary American culture, from students on study drugs and cops on steroids to skin-lightening by black celebrities and the over-prescription of antidepressants. Yet the diversity of these controversies often masks their common root-namely, disputes about the propriety of using medical technologies as tools for shaping one\u27s identity. Some observers believe these so-called enhancement practices threaten important values, offering unfair advantages to users and undermining their ability to lead authentic lives. But existing systems of medical regulation, which were desined to promote the safety of therapeutic treatments and to deter drug abuse, are largely blind to concerns beyond protecting human health. As identity-modifying practices continue to proliferate, calls are growing to restrict access to these technologies on moral grounds. These proposals overlook the United States\u27 extensive and unfortunate experiences regulating nontherapeutic medical practices to enforce contested conceptions of morality. From Prohibition and the war on drugs to laws restricting contraceptives and abortion procedures, these efforts have been costly, ineffective, and intrusive. They have also interfered with fundamental liberties involving bodily integrity and identity-a fact that is widely recognized in the context of reproduction technologies, but largely overlooked with respect to other medical interventions. Rather than expanding our reliance on contested moral concerns in policing access to medical interventions, the U.S. should purge its existing regulation of morality-based intrusions and recommit itself to protecting human health

Regulating Identity: Medical Regulation as Social Control

New biomedical technologies offer growing opportunities not only to prevent and treat illnesses, but also to change how healthy people think, feel, behave, and appear to others. Controversies over these nontherapeutic practices are a pervasive feature of contemporary American culture, from students on study drugs and cops on steroids to skin-lightening by black celebrities and the over-prescription of antidepressants. Yet the diversity of these controversies often masks their common root-namely, disputes about the propriety of using medical technologies as tools for shaping one\u27s identity. Some observers believe these so-called enhancement practices threaten important values, offering unfair advantages to users and undermining their ability to lead authentic lives. But existing systems of medical regulation, which were desined to promote the safety of therapeutic treatments and to deter drug abuse, are largely blind to concerns beyond protecting human health. As identity-modifying practices continue to proliferate, calls are growing to restrict access to these technologies on moral grounds. These proposals overlook the United States\u27 extensive and unfortunate experiences regulating nontherapeutic medical practices to enforce contested conceptions of morality. From Prohibition and the war on drugs to laws restricting contraceptives and abortion procedures, these efforts have been costly, ineffective, and intrusive. They have also interfered with fundamental liberties involving bodily integrity and identity-a fact that is widely recognized in the context of reproduction technologies, but largely overlooked with respect to other medical interventions. Rather than expanding our reliance on contested moral concerns in policing access to medical interventions, the U.S. should purge its existing regulation of morality-based intrusions and recommit itself to protecting human health

Involuntarily Committed Patients as Prisoners

Part I relates several stories of involuntarily committed patients who were recruited into studies posing serious risks. Part II draws on these cases to argue that the involuntary commitment of these patients leaves them vulnerable to unethical treatment by researchers. Their inherently coercive circumstances present an overwhelming obstacle to voluntary consent, and their captive status makes them attractive targets for research that could be performed using less vulnerable subjects. Part III argues that most research on this patient population is improper under generally applicable principles of informed consent and fair subject selection. However, existing protections have proved insufficient to prevent unethical recruitment of these patients. Accordingly, Part IV builds on the Institute of Medicine\u27s call for expanding the definition of prisoner in federal regulations, arguing that civilly committed patients should be included within its ambit and that the Common Rule\u27s protections should be applied to all research involving involuntarily confined subjects

Prescription Psychedelics: The Road from FDA Approval to Clinical Practice

After languishing for decades from legal restrictions and stigma, research into psychedelic drugs is exploding, with the encouragement of the US Food and Drug Administration (FDA). Recent clinical trial successes suggest some long-banned drugs could soon be authorized as treatments for debilitating illnesses. Yet because of these drugs’ history, FDA approval would be just 1 important step in a complex process to transform these compounds into therapies. Incorporating psychedelic drugs into clinical practice will require peeling back multiple layers of legal prohibition, clarifying prescribing guidelines, and developing treatment models that work for drug makers, physicians, and payers