Together with philosopher David Wasserman, Asch wrote in 2005 that using genetic tests to screen out a fetus with a known disability is evidence of pernicious “synecdoche.” Ordinarily, synecdoche is a value-neutral figure of speech, in which some single part stands for the whole—as in the common use of “White House” to stand for the executive branch of government. But Asch and Wasserman’s meaning was more loaded: prenatal genetic tests, they argued, too often let a single trait become the sole characteristic of a fetus, allowing it to “obscure or efface the whole.” In other words, genetic data, once known, generally become the only data in the room. Taking a “synecdochal approach” to prenatal testing, Asch and Wasserman warned—in the era just prior to consumer genetic sequencing—allows one fact about a potential child to “overwhelm and negate all other hoped-for attributes.”
We won’t know what Asch would have made of 23andMe, designer babies, or broader claims for personal genomics. But her intellectual legacy only grows more relevant in the era of ever-cheaper, personalized genetic data. Asch understood that there are plenty of things technologies like prenatal genetic testing can tell us. But the choices and challenges in defining a life worth living, and living well—it may be that these aren’t technological problems at all.
Not everyone agreed that gout was a malady, or a bad thing. Some saw it as Nature’s warning, or as a deliverance from worse afflictions (it was better than haemorrhoids, for instance), and had no desire to be cured of it. As this book says, it was often regarded as a life assurance, not a death sentence. Gilbert Sheldon, Archbishop of Canterbury under Charles II, ‘supposedly offered £1000 to any person who would “help him to the gout”, looking upon it as the only remedy for the distemper in his head, which he feared might in time prove an apoplexy; as in fine it did and killed him’. William Cowper congratulated a friend on contracting the disorder, ‘because it seems to promise us that we shall keep you long’. Hester Piozzi’s husband grew worried and alarmed if his gout did not return regularly.
Besides, gout was very much a mark of status. Lord Chesterfield said it was ‘the distemper of a gentleman, whereas the rheumatism is the distemper of a hackney coachman’. It attacked not only the wealthy but the creative, which meant that no man of letters could afford to be without it. Some thought it was the hallmark of genius, a view obstinately perpetuated by Havelock Ellis. In short, it was an honour to have gout and the phrase ‘the honour of the gout’ was in free use. The authors quote Earl Nugent’s apology to the Duke of Newcastle for failing to wait on him: ‘He received the Honor of His Grace’s card here, where he has been detained by the Honor of the Gout.’ For a person of the lower orders to aspire to the honour of the gout was unthinkable. Artisans and crofters did not know their luck; hard work every day kept uric acid at bay. ‘Live upon sixpence a day – and earn it’ was the cure for gout advocated by the surgeon John Abernethy.