American medicine meets the American dream

Editor—Upshur says that the problems associated with enhancement technologies are deeply related to affluence, which may seem unjust.¹ Yet we see self administration of unnecessary enhancements by poor people, often. Example: inner city people who sport sculpted hair styles weekly but won't get free health maintenance, even vaccinations.

In our compassionate zeal to flatten inequalities, we forget that much inequality is self perpetuated, preferring to think, “They can't help it.” Conversely, sometimes enhancements are life saving. When is teenage acne—rejection, loss of self esteem, depression, suicide—a cosmetic illness?

The slippery slope of judgment requires educated, ethical, free doctors. This implies a medical system supplying the needy with basic care, not entitlements, paid by the group (government or insurance), and with enhancements paid by the individual unless modified by a doctor's considered opinion.

If enhancements require affluence, so be it. Those funding the first wave are the guinea pigs. With competition, prices fall and all can afford. Soon it's mainstream.