FOR some it will evoke images of Woody Allen鈥檚 鈥渙rgasmatron鈥�. Others will recall the legendary cafe scene in When Harry Met Sally. Whatever leaps to mind, few of us will react with a completely straight face to the news that a woman in the US has become the first volunteer to try out a spinal implant designed to generate intense sexual arousal at the flick of a hand-held switch (see 鈥淲anted: people to test orgasmatron鈥�).
Our sniggers are not just about the sex. They betray a prejudice that respectable medicine can only ever be about combating disease, saving lives or restoring functional deficits. Surgical interventions whose rewards lie outside these boundaries we consider suspect. We sweat and worry about where the new surgery will take us, and yet fail to recognise the full potential benefits to patients or calmly weigh them against any risks.
This biased mindset was evident following last week鈥檚 report on face transplant surgery from London鈥檚 Royal College of Surgeons. At least two teams are serious about offering face transplants to people severely disfigured by injury or disease. They argue that at present patients may have to endure scores of reconstructive operations for less than great results, so why not use the intact face of a donor?
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The report concludes that such a move would be premature. Reasonably enough it points out that the recipients would have to take a potentially toxic cocktail of drugs to stave of rejection. And if the drugs fail, any team would need a credible plan for removing the transplant to clear the way for conventional plastic surgery. These are the core risks to be weighed in any future decisions.
But a raft of other concerns voiced by the report and in the ensuing debate look distinctly suspect. The risks of transplant drugs are real enough but not uncertain. The same drugs are given to thousands of recipients of other transplants. Even more unfair is the suggestion that patients may be so unhinged by disfigurement 鈥� and so desperate for treatment 鈥� that they cannot be trusted to give informed consent. The same charge could be levelled against would-be kidney recipients who are keen to get off dialysis or those with Parkinson鈥檚 volunteering for experimental brain surgery. Rule all such patients out and pioneering medicine grinds to a halt.
Also dubious is the idea that face transplants pose some sort of threat to individual identity or society. Initially, any operations are likely to involve draping an outer envelope of skin and fat over a patient鈥檚 existing bone structure, so any resemblance with the donor is likely to be slight. It is hard to see what cause there might be, other than superstition, for the communities concerned to be alarmed or distressed by the surgery.
The panel鈥檚 experts implore us to worry about the psychological impact on patients of having a face transplant. We should worry just as much about the impact of enduring years of conventional plastic surgery for a face that still makes people stop and stare.