Tocqueville and the Revolution

Continuing my Tocqueville inquiries by reading The Ancien Régime and the French Revolution. A wonderful book even where it is wrong-headed. Tocqueville is addicted to grand generalizations. He, quite obviously, believes that there are “laws” of politics akin to natural laws—and sees his job as the discovery and articulation of those laws. But no matter. His desire to probe to the underlying forces, the correct causal account, is his strength as well as his weakness. He is not a chronicler of events; he is a discerner of patterns and a moralist through and through. Pay no heed to the fundamentals and disaster must follow is his mantra.

By temperament, of course, I want to apply his moralizing to current conditions. But that only succeeds to a very limited extent. The world he describes is so foreign to 21^st century America that the parallels are faint. Most important is his utter ignorance of—and disinterest in—capitalism. His social world is comprised of a fading but reliably selfish aristocracy (content to take the nation down with it as it slips into the trash can of history), a middle class that, far from being Marx’s capitalists, are merchants and public officials, and the peasantry. In other words, Tocqueville is not interested in (or is blind to) the production of goods apart from the agricultural. He never once considers the economics of empire, the accumulation of capital, or the games of financial speculation. For him, the French aristocracy has ceded its power (its actual ability to influence the course government—and the nation—takes) in return for tax exemptions, thus enabling the “centralization” of power in the hands of the monarch.

That “centralization” is the great theme of the book. Such centralization, Tocqueville argues: 1. necessarily entails the diminution, even the complete loss, of freedom—and is the form that tyranny takes in the modern age; 2. motivates the revolution at the moment when the loss of freedom becomes too great to bear. This mostly conservative thinker, astoundingly, writes (in an aside that belies the significance of the claim): “revolutions, which are the final safeguards of nations” (106 in the Penguin Classic edition); and 3. is evidence of the revolution’s failure. The whole thesis of the book is that the centralization of power originated under the pre-Revolution monarchy, was what caused the Revolution, and, yet, was only intensified by the events subsequent upon the Revolution (namely, the reigns of Napoleon I and, in Tocqueville’s own time, the reign of Napoleon III, whom Tocqueville hated with admirable passion). Thus, the continuity of French politics from 1700 to 1850 is more important, Tocqueville argues, than any other changes (decline in the power of the Catholic Church or the abolition of the Bourbon dynasty) that the Revolution did bring about.

I will get into details in subsequent posts. But two more general, orienting comments, are in order here. First, Tocqueville’s distinctive understanding of “liberty.” For Tocqueville, the two great political truths of the modern age are the passions for liberty and for equality. And the great conundrum faced by the moderns is how to make those two desirables compatible. “Liberty” to Tocqueville means, in a very Kantian way, obedience to laws of one’s own making. Liberty is always opposed to license in his thought. Tyranny is being subject to laws made by others—or being subject to the license enabled by anarchy. Liberty is the political ability to make the laws oneself—but entails the responsibility of then following (obeying) those laws. No liberty without corresponding duties and responsibilities.

Centralization is thus the enemy of liberty because it takes the power to govern out of the hands of the people and places it in the hands of the central government. In this respect, Tocqueville is akin to Jefferson in celebrating the town meeting and local assemblies of all sorts. Centralization is, also, the enemy of equality because it gives some people power while depriving others of it. Accumulation of power is, just like accumulation of capital, a generator of inequality.

But, because he is not an anarchist, Tocqueville is a believer in authority. It is all well and good to claim authority (ultimately) rests in the people, in the demos, but there will always be wielders of authority, its functionaries. And how to prevent a divide, an inequality, to develop between those who wield authority and those who are subject to it is a perennial problem.

This leads directly to the second point. Tocqueville is firmly in the republican virtue tradition. His only way of addressing the problem of the possible abuses of power, of the ill effects of power being accumulated in certain key persons, offices, or institutions is to appeal to the virtues required of the people in those offices and institutions.

I am increasingly coming to believe the virtue tradition is not wrong. My negative way of phrasing it shows how uneasy this conclusion makes me. But I think the alternative is very, very wrong-headed. We are not going to devise, once and for all, a fool and knave-proof system. There is not some perfect constitution, some perfect legal code, that is going to get things right once and for all. Dreaming of a perfect fix is disastrous politically. (Why? Because it encourages the idea that we just need to do the engineering, then walk away and let the machine function properly. This is Marx’s delusion about the withering away of the state because only administrative details will persist after communism is installed. Politics is the perpetual give and take among interested parties. To think it is not perpetual is to cede the field to one’s adversaries.)

Whatever system one devises is going to generate efforts to game it. Eternal vigilance is always required because knaves are ever present. A system must define what virtue is, must try its hardest to prevent knavery where possible and punish it when it occurs (as it inevitably will), and revise itself as new problems arise or new capabilities are needed. The system can aspire to be better than the imperfect humans who implement it, but it should never delude itself that it can transform those humans into angels. Without virtue any system will fail. With virtue, perhaps most systems will muddle along.

Tocqueville, in this book, is concerned with the ways the system of the ancient régime actually encouraged, even rewarded, the lack of virtue. That’s a rich vein of thought—and one applicable, with attention to relevant differences, to our own time. How are we to understand a society that seems organized to produce vice, particularly selfishness?

One Tocquevillian thought: those who wish to accumulate political power are well served by granting to other citizens the opportunity to accumulate economic power. A quid pro quo. We’ll leave you alone in the economic sphere if you let us have our way in the political sphere. I don’t think that’s what is happening in today’s America–mostly because economic and political power are so closely intertwined–but it is an interesting way to think about liberalism over the long run (i.e. from 1750 to 1980) and, thus, perhaps a way to distinguish liberalism from neo-liberalism (the post 1980 order).

Final Thoughts on Genetic Science

I highly recommend this essay by Matthew Cobb in the New York Review of Books. It is a wonderfully succinct and admirably clear account of the current state of genetic science–and of the technical, moral, economic, and political issues that follow from what we can now do to genes.

I want to get down here some final reactions to the Mukherjee book, reactions also spurred by reading the Cobb essay.

Back to Down syndrome as a way of thinking about natural selection. Mukherjee points out that natural selection works at the level of phenotype (the features of the organism), not at the level of genetics. That is, natural selection works for or against what genes produce, but has no way of intervening in genes directly. That’s why recessive traits can continue to exist despite their not leading to fitness. But the case of Down syndrome is even weirder. Down syndrome is a mutation, a random genetic event. There are no carriers–although if a woman with Down syndrome has a child, the chances are about 50% that her child will have Down syndrome. Males with Down syndrome are generally infertile, although now there have been some cases of Down syndrome males having children. In sum, the actual incidences of Down syndrome persons having children are very low, but the former belief that Down syndrome came with infertility has now been disproved.

No matter. The bigger point is that Down Syndrome, in the vast majority of cases and certainly throughout most of evolutionary history, has not been passed down from parent to child via genetic inheritance the way sickle cell anemia is. Rather, Down syndrome is the result of a mutation. But–and this is the remarkable thing–it is a mutation that, while random, occurs with a fairly regular probability that can be predicted. About 1 in 1000 for a mother aged 20; about 3 in 1000 for a mother aged 45. The regular process of creating human children predictably produces Down syndrome babies even though each of those events is random, just like each individual coin flip. So here we have natural selection undermined by a stubborn, apparently ineradicable, mutation. There is no way to argue that natural selection chooses Down syndrome, because Down syndrome persons do not reproduce (except in very rare cases). But natural selection, which can only work through reproduction, also fails to eliminate Down syndrome because another naturally occurring phenomenon–a random, but still regular, mutation–over-rules natural selection. My point is only that natural selection is not the only game in town; it doesn’t completely rule which mutations persist and which don’t. Another blow to Darwinian reductionism.

2. One fascinating thing about the history Mukherjee tells is that “the gene” was posited as a theoretical necessity before there was any proof of its actual, material existence. Like the unobservables in physics, the gene was needed to explain certain phenomena even when the techniques needed to locate the gene did not exist.

3. Eugenics are usefully defined by Mukherjee as any attempt to eliminate certain genes from the gene pool. Early 20th century eugenics–both in the US and Germany–(like natural selection) worked at the level of features, of the phenotype. Newgenics (as some people are calling 21st century eugenics) works at the level of the gene. Again, we need to be precise. We can eliminate the existence of Down syndrome persons if prenatal testing leads to the universal termination of fetuses with Down syndrome. But we can’t eliminate the mutation that causes Down syndrome so long as there is human reproduction. We can, if embryos are produced artificially, eliminate Down syndrome by controlling the reproductive process to such an extent that the mutation does not occur. We can, however, eliminate hemophilia because it is a “one gene syndrome,” not a mutation, and targeted gene therapies can kill off that gene in its carriers. Whether that elimination would be permanent is unclear–since presumably future mutations could bring it back. But, at least theoretically, if an entire population was fully genetically tested, then the hemophilia gene could be eliminated in every one who possessed it. It is this fact, that we have now acquired the technical prowess for that kind of targeted gene therapy, that is at the heart of Cobb’s essay.

4. Mukherjee’s definition (from Victor McKusick) of illness: “relative incongruence between a genotype and an evironment” (449). Which means there are always two possibilities: working on the “patient” or working on the environment. Disability activists often tell us that we don’t think often enough or creatively enough about amending the environment. A reminder of old leftist arguments about psychiatry. What proves I am crazy–and not this society in which I have to live? As Mukherjee puts it: “A child with a high-functioning form of autism may be impaired in this world, but might be hyperfunctional in another–one in which, say, the performance of complex arithmetic calculations, or the sorting of objects by the subtlest gradations of color, is a requirement for survival or success” (449).

5. Cobb, more than Mukherjee, considers the dangers attached to the privatization of techniques developed by and even genes uncovered by the new genetic science. Here we are back on Chris Newfield territory, the way in which public resources are used to produce knowledge which is then privatized. In Newfield’s account (in Unmaking the University [Johns Hopkins University Press, 2016]), the so-called public/private partnerships and the offices of “technology transfer” so lauded on today’s campuses are just a colossal rip-off. A disproportionate share of the risk and cost of research (the vast majority of which, after all, never bears any monetizable fruit) is borne by the university, but then, when a commercially viable result is produced, private corporations swoop in to license or patent it–and to begin to produce it for profit. It is the scientific equivalent of the banks relying on the government to cover its losses (through the Federal Reserve and bail-outs) while they get to keep all their profits. And this way of thinking about the issue doesn’t even touch the larger issues of a) our totally broken patent system which has allowed impossibly vague and far-reaching “ownership” of fundamental ideas and techniques that haven’t even been connected to actual production of anything yet and b) how privatization (as we have seen in spades with big pharma) leads to differential access to therapies that were developed on the public dime. So everyone pays the first time around (through tax payer subsidies of research) and then the fortunate (those with enough disposable income) get to pay again the second time around, when they actually avail themselves of the results of that research. Cobb tells us how Berkeley and MIT are engaged in a nasty patent fight over gene therapy–about which university’s scientists got there first and, hence, have the right to patent it.

6. It’s a complex world out there. The complexities of the genetic system are only matched by the complexities of political and social realities. One thing comes through loud and clear in the scientific story: complexity is a short-term, but not a long-term, barrier. Problems get solved. Everything hopeful or fearful (often both) prophets of genetic science told us would someday be possible is just about at hand. Things are generally more complicated than first imagined. Nature is actually not all that elegant. It’s more of a Rube Goldberg machine than some sleek Maserati. Natural selection, like Donald Rumsfeld, has to work with the army it has, the materials at hand. Plus (as I keep insisting) it doesn’t utterly rule the roost, so there are various compromises along the way. But science really does seem up to the challenge of figuring it out. Complexity itself is not going to prove a shelter for the romantics who cringe at the thought of full, disenchanted explanations. Individual variation is a more hopeful shelter. The introduction of chance–through mutation, incomplete penetrance, environmental differences and the like–still suggests limits to our predictive powers when it comes to saying what trajectory any individual’s life will take (even when we have a full map of his or her genetic makeup). Still, science’s doggedness is impressive–and contrasts strongly with our inability (in the social sciences) to make much sense of our political and social realities. Our lack of command over those scenarios seems more obvious every day. John Dewey’s optimistic belief that the ways science has increased our comprehension of nature would be mirrored by a corresponding increase of our comprehension of society seems the least credible feature of his pragmatism. The advances made by genetic science wouldn’t be half as scary if we had any reason to be confident that we had the political capability of handling and controlling this new knowledge. But just about everything we witness in our everyday world leads to exactly the opposite conclusion. Neither the scientists nor the polis seems up to the task of using this knowledge either wisely or well.

Gene Regulation—and Darwinian Fundamentalism

Turns out that regulation is biological and genetic as well as political. One major functions of genes is to regulate, mostly in the form of on and off signals. It is genes that have the job of activating immune system responses to external microbes—and then to shutting off those responses once the threat is defanged. Hence, over-reactive immune systems are results of the off switch not being pulled, whereas immune system deficiencies occur because the on button does not get pushed. The body, too, can overdo things, can push past limits best left intact.

Immune system responses are obvious cases where genes are activated by environmental triggers. There are other fairly obvious environmental factors—like adequate nutrition. More mysterious is “incomplete penetrance”—i.e. the fact that two organisms can possess the same gene, but it only expresses itself in one of them. Such is the case, for example, for women who carry a gene highly associated with breast cancer. But only highly associated; that gene does not result in 100% of the women who possess it eventually getting breast cancer. More like 60%. (Incomplete penetrance, then, is one way harmful genes do not get eliminated through natural selection.)

Mukherjee sums up what genes do with the three “R”s: regulation, replication, and recombination. To which he then adds a fourth: repair. It’s the replication part that gets most of the press: cloning and all that. But it’s regulation and recombination that makes straight-forward genetic engineering and simple-minded Darwinian fundamentalism equally pipe dreams. There’s just way too much slippage in the process, too large an element of chance along with environmental factors that would be difficult to control even if we understood them completely.

Hemophilia offers a good example of why a simple fitness story doesn’t work. The gene that causes can be carried by the mother, but only expresses itself in male progeny. Therefore, because the gene is recessive in women, natural selection doesn’t get the opportunity to eliminate it. Even though there is no way to link hemophilia to fitness, it persists.

Furthermore, while hemophilia is one of those diseases that can be linked to a specific gene, there are lots of conditions and abilities—smell is one good example—that are the product of multiple genes, often in the dozens, sometimes over one hundred. Natural selection can’t zero in on a defective gene in such cases, plus mucking around in such complex systems often has bad side effects. The complexity of human biology, in other words, works against any simplistic understanding of natural selection. Features of the human organism are just too inter-related to make targeted elimination of specific features possible in many, many (although not all) instances.

In addition, there are the benefits of diversity itself. The trouble with Darwinian fundamentalism is that it takes the ranking approach to human behavior and personality and capabilities—as if it were the AP ranking of college basketball teams. The “fittest”—absolute superlative—is what emerges from evolution. But that’s nonsense. There are multiple possible ways of surviving to the point of reproduction. Evolution, at best, eliminates those that can’t survive until reproduction. It does not optimize; it does not only select the best. The “good enough” survive as well.

And the survival of that diverse range is crucial because a diverse gene pool is the vast reserve army by which a species arms itself against environmental change. An over-specialized species, ill equipped to adapt to change, will not survive in the long run. Far from needing the fittest, evolution needs the diverse, a whole range of types and variants.

To switch the focus to emphasizing how evolution selects a wide range instead of “the fittest” is to understand why evolution is not destiny nor even an indicator of set limits. New environments will call forth new adaptive behaviors—and a rich gene pool will ensure that such adaptions are possible. Not for everyone perhaps, but for some. Not to mention that the complexity of the system lays itself open to new interactive patterns, along with innovative recombinations and the development of regulative responses to new triggers. Of course, translating from a specific genetic make-up to behavioral patterns and capabilities is very difficult. Such a holistic vision of human functioning–arising out of the base of genes–is still far beyond our analytic abilities.

Natural selection, in short, is not the conservative’s dream of a Hobbesian competition of all against all. It is not just that humans, quite obviously given their extra-long immaturity, cannot survive except in mutual aid societies; it is also because the elimination of all diverse others would quickly lead to the extinction of the species. To put it in the bluntest terms: if I only worked to ensure the survival of my genes—and not those of anyone else—I would be murdering the species. A purely selfish gene will not see too many generations.

Self-Regulation

I am reading Siddhartha Mukherjee’s The Gene: An Intimate History (Scribner, 2016). Lots of interest here—and lots of scientific information that is simply new to me and sometimes beyond my ability to comprehend. More on that, perhaps, later.

For the moment, I want to focus on a more political point. Mukherjee devotes a few pages to a 1975 conference at Asilomar (near Monterey in California) in which genetic scientists hammered out an agreement to not pursue certain possible laboratory experiments and procedures because of the potential danger of loosing pathogens into the world.

Quoting from Mukherjee’s account:

“Extraordinary technologies demand extraordinary caution, and political forces could hardly be trusted to assess the perils or the promise of gene cloning (nor, for that matter, had political forces been particularly wise about handling genetic technologies in the past [a reference to forced sterilizations in the US and Nazi eugenics]). In 1973, less than two years before Asilomar, President Nixon, fed up with his scientific advisors, had vengefully scrapped the Office of Science and Technology, sending spasms of anxiety through the scientific community. Impulsive, authoritarian, and suspicious of science even at the best of times, the president might impose arbitrary control on scientists’ autonomy at any time.

A crucial choice was at stake: scientists could relinquish the control of gene cloning to unpredictable regulators and find their work arbitrarily constrained—or they could become science regulators themselves. How were biologists to confront the risks and uncertainties of recombinant DNA? By using the methods they knew best: gathering data, sifting evidence, evaluating risks, making decisions under uncertainty—and quarreling relentlessly. ‘The most important lesson of Assilomar,’ [Paul] Berg [Stanford professor and key figure at the conference] said, ‘was to demonstrate that scientists were capable of self-governance.’ Those accustomed to the ‘unfettered pursuit of research’ would have to learn to fetter themselves” (232-233).

Except, of course, that they don’t—fetter themselves that is. Oddly enough, Mukherjee doesn’t seem to see this. He hails Asilomar as “a graduation ceremony for the new genetics” (235). Less than ten pages later, as Mukherjee retails the story of the creation of synthetic insulin, we learn that the success comes from a private company, Genentech, which beats the Harvard team working on the same problem because unconstrained by university regulations and caution. Later, Mukherjee treats Craig Venter, who creates a private company to compete with the government-funded Human Genome Project, much more kindly than many commentators do, while gingerly avoiding the issue of what corners Venters allowed himself to cut by stepping outside of a regulatory regime.

At issue, however, is not Mukherjee’s failure to develop a coherent stance on regulation. Rather, I am interested in the whole notion of self-regulation—and in the paradoxes of regulation itself.

For starters, regulation is a tough one for people because it is not full-bore permission and it is not full-bore prohibition. If I give my teen-age son a curfew, I am regulating his behavior, but not forbidding him to go out at night, and not granting permission for him to stay out all night. Seems simple enough in principle—but it proves very difficult in practice. The regulation sets a clearly visible limit which (as we know from the Garden of Eden) creates an immediate and powerful temptation.

With self-regulation, then, the limit setter and the tempted transgressor have to be one and the same. Again, it is trivially true that learning how to regulate oneself, to set and abide by limits not externally imposed, is a crucial step toward maturation. I am hardly saying that humans are incapable of avoiding “over-doing” something.

But the case is very different when strong social incentives are in place to reward going past a limit. That situation appears particularly relevant in any competitive environment. So, in sports, using performance enhancing drugs or even just over-training (to the point of self-harm) are such strong temptations because the rewards for success are so massive. Similarly, in science, where getting there first is just about everything (to echo Vince Lombardi). And the same is true, of course, in economic competitions, where various forms of unregulated or expressly forbidden, behaviors can reap one a market advantage.

George Bernard Shaw said “all professions are a conspiracy against the layman.” By that, he meant that professions claim to have expertise and knowledge that the ordinary person does not possess. One of the first consequences of that claim is that professions want to be self-governed, to get out from under any external oversight. The outsiders cannot possibly understand the full complexity of our professional tasks—and hence can only muck things up by interfering.

I was in a room full of hedge fund managers and Wall Street financial guys (none of the finance people was a woman) shortly after the 2008 election of Obama in the aftermath of that fall’s financial meltdown. To a man, this group lamented how the Democrats were going to cripple financial markets and the absolutely essential flow of capital by coming in and ignorantly regulating things. There was not a single iota of self-doubt expressed by this group. They were too focused on the image of themselves as victims of innocent politicians.

In short, it is hard to believe that any profession can ever successfully regulate itself. The reward structures internal to the profession are tied too closely to surpassing limits. After all, regulation is about trimming back, about not letting everything that is possible be undertaken. And the logic of the profession is to push relentlessly forward.

But, as Mukherjee’s anecdote about Nixon (making him sound remarkably like Trump) reminds us, are the politicians really in a better position to do the regulating? When we watch the spectacle of our politicians denying climate change, endorsing nut-case theories about vaccinations and autism, and calling for a balanced federal budget and a return to the gold standard, aren’t we forced to agree that their ignorance should not be allowed to cripple the experts’ knowledge?

How, in other words, are we to establish true accountability? Some, of course, say we should rely on markets for that. But the market’s decision is always (even when it does come—and it does not always come) after the fact. The harm has been done. Regulations are often also created after the fact, to prevent a disaster happening a second time. But regulations are also anticipatory. My curfew for my teen-age son was not motivated by any particular incident. It is just a rule that seems to fit the circumstances—and some possible issues. So regulation is not just in order to hold people accountable; it is also about prevention. Don’t do this because it will have bad consequences.

That still leaves the question of who is the best judge of possible bad consequences. I don’t think the profession itself is. Professionals have their minds fixed on other things—on success as their profession defines it, on pushing the limits, on following a line of thought or action out to all its logical and possible conclusions. But no one else seems to be in a very good position to set the boundaries. We reach here a fundamental dilemma in democratic governance. The professions need to be governed by a demos that actually lacks good credentials for doing the governing. We are stuck, I would say, with trial and error, with repeated attempts to regulate that will be resisted by the professions and yet still must be enforced, with (hopefully) continual revision as some regulations prove salutary and others harmful or useless.

Regulation will also have to be dynamic—no once and for all fix will ever be achieved—because the attempt to evade regulations will be endless, as will be the emergence of new possibilities and innovations. (I scorn the oft-heard conservative argument that regulations are counter-productive because they generate evasion. No one uses that argument against the prohibition of murder or the regulation of prescription drugs.) Some of those innovations will have arisen precisely as mechanisms to evade regulation. But others arise just because human ingenuity knows no bounds and things undreamed of in the current regulatory scheme become possible. Trying to tailor old regulations (for radio and TV) to handle new media (the internet), to take just one example, is a fool’s errand. But in an atmosphere of knee-jerk hostility to regulation, devising a whole new regulatory framework is almost impossible. The result is the current patent mess, which cries out for a reform that seems beyond our political capability to enact.

So let me conclude by considering that wide-spread hostility to regulation. Every one of us has experienced it: some bureaucratic barrier placed between us and just getting the job done. “Enough to make me a Republican,” was my exasperated way of responding to HR hurdles in the days when I was trying to hire staff for the Institute that I directed. It was fairly easy (in almost all cases if one could look at the thing impartially) to see why a certain regulation was in place, what possible abuse it was trying to guard against, but that didn’t lessen the hassle of having to abide by the regulation.

But it is also worth thinking about just what regulations disallow—or enable. Our heroic individualists always claim regulations stiffly ingenuity, creative thinking, going beyond the current sense of what is thinkable or doable. Nonsense. Just like those who talk most loudly about risk are actually risk averse (businesses make bets when the odds are stacked in their favor), what really irks most people about regulations is that they assault their habitual ways of doing things. Many of those HR regulations were about insuring a diverse applicant pool and avoiding the nepotism and unconscious biases that lead to all-white offices. Similarly, requiring that professors deposit their syllabi with a central office prior to the semester’s start means they must actually plan their classes and inform their students about the course’s content and expectations. Regulations are ways of intervening in shoddy professional practices, of trying to not let habit rule the roost.

And regulations are also reminders that you, perhaps, are not the best judge of your performance. In my corner of the professional world, college professors, there is deep resentment against the introduction of notions like “learning outcomes” and attempts to measure whether those outcomes have been attained by students. Finding the right metrics is, no doubt, very difficult, but there is absolutely no denying at this late date the well-documented findings that lectures and reading are a poor way to transmit information to today’s students. But deny those findings my colleagues will. It was good enough for them—and they are also damned sure their students are learning lots. How do they now this latter fact? They can just tell.

External demands that any profession actually demonstrate, actually prove, its worth can only be to the good, in my opinion. I sure as hell don’t want an unregulated Wall Street. So how can I, in good faith, then argue for unregulated professors? The give-and-take, the endless jostling and disputes, between the professions and those external to them that try to regulate them is never going to be resolved. But that process is far preferable to the delusion that the profession will self-regulate. Just recall that every time a new environmental or economic policy is bruited in our fair land, some industry group will step forward and say: “We will voluntarily adopt this standard. Just leave it up to us.” How many times should we fall for that ploy?

As Michael Bérubé puts it in Life as Jamie Knows It, “bioethics is too important to be entrusted to the bioethicists.” The same goes for every profession. It has to be kept on its toes by knowing not just that outsiders are watching, but also by knowing that outsiders wield regulatory power to intervene in its practices. And when such interventions come, let the fight begin.