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Deep fears

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7350.0/h (Published 08 June 2002) Cite this as: BMJ 2002;324:h

Medicine favours a rational approach to the world, but deep cultural fears constantly get in the way of rationality. This journal describes three possible examples.

Brain death is a recent invention, prompted by the need to harvest organs for transplantation (p 1401). To many people the idea that there are two ways to be dead is strange. Surely if one death is final the other must be less than final. And wouldn't someone who was less than finally dead still be alive? Most doctors in Britain are comfortable with the concept of brain death, although there are exceptions who campaign tirelessly against it. In contrast, Japanese people find the concept of brain death unacceptable. Most people in the world, including many in Britain, lie on a spectrum of opinion somewhere between British doctors and the Japanese public. The idea of being declared dead while still alive—and perhaps even being buried—is a deep seated fear, explaining why some Victorians were buried with telephones. (“Sorry, there's been a dreadful mistake. Please start digging at once.”)

It was probably that deep fear that led to the dramatic reaction to a famous television programme in Britain in the 1980s that argued that people had been declared brain dead and subsequently gone on to live normal lives. Carl Gray reviews a book that suggests that there continue to be widespread anxieties about brain death (p 1401). Perhaps one day the anxiety will sweep through a population somewhere, closing down most transplantation.

Cloning also creates deep fears. Imagine entering a room and encountering 10 people who are you. Imagine a factory that makes human beings as other factories make dolls. Imagine fighting an army of thousands of clones. These are absurd, antirational images, but they feed anxieties over stem cell research. Fred Charatan describes how “big advertising” has joined the intense battle over stem cell research in the United States (p 1402). One agency uses a famous American couple, Harry and Louise, to make the case for stem cell research: “One [congressional] bill puts scientists in jail for working to cure our niece's diabetes.” Another agency has fought back by producing “clones” called Harriet and Louis who argue that “some biotech companies will do just about anything to make a buck.” Lawyers are now involved.

Deep fear of the adulteration of food may play some part in widespread governmental reluctance to mandate universal fortification of flour with folic acid. Godfrey Oakley argues that the case for fortifying flour is overwhelming and that arguments against it are specious (p 1348). He finds it particularly ironic that Britain has not required fortification as it was a British trial that showed that supplementation could prevent three quarters of cases of spina bifida and anencephaly. The United States, Canada, Chile, and other countries have made the step, but European countries haven't. Deep seated public anxieties rather than flimsy rational arguments may be the real reason for governmental reluctance to require fortification.

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