AANS Neurosurgeon : Editorial License

Volume 24, Number 2, 2015

Is Ignorance Bliss?

Michael Schulder, MD, FAANS

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Cartoon illustrated by Hubert Lee, MD, HBSc; concept by Eve C. Tsai, MD, PhD, FAANS.

Gattaca” is a 1997 film, starring a nearly affectless Ethan Hawke, that poses the question of how much genetic screening is good for us. Set in “the near future” (I guess not quite 2015, as it turns out), it portrays a society where children whose genetic profile is somehow unfavorable are shunted off into lives with no promise, even though such discrimination is officially illegal. There is no happy ending to the movie, although the hero does manage to overcome his label as a “de-gene-arate” by a combination of determination, smarts and law-breaking.

Clearly, “Gattaca” (the title is an acronym of DNA base pairs, get it?) is a polemic meant to warn us of the dangers of rigid application of genetic testing. It’s not a very good movie, but it makes a point that still is timely. The in-vitro genetic manipulation and gestation in the novel “Brave New World” (1932) is so satirical and even today beyond our technological capabilities that it remains easy to dismiss. But the world of “Gattaca” is one that we already live in, more or less. Should someone with the gene for Huntington’s disease be allowed to buy life insurance? What if he is close to the typical age of disease onset? Would you hire that person for a job that had a 25-year horizon? And that example is almost simplistically obvious. The number of conditions whose likelihood or at least predilection can be predicted by genetic testing grows each year, well beyond those that are autosomal dominant.

Of course, the options for screening go well beyond the genetic. MRI up to 3 Tesla has no side effects, beyond the discomfort of claustrophobia in certain patients. Should everyone in the world get an annual MRI to see if they have a small brain tumor (glioma, schwannoma, pituitary adenoma — take your pick)? No, because such testing is too expensive, time-consuming and not universally available.

But what if the opposite were true? Soon enough, probably within the lifetime of someone reading this, it will be. What would you do with the information — operate on everyone with a positive finding? Stereotactic radiosurgery (SRS)? You would subject persons to complications that they could have avoided for decades and perhaps for their entire lives. This is only another small example of what we can test for today with imaging and other noninvasive methods.

So, as in so much else in our professional lives, ask yourselves: What would you want for yourself or your family, currently in perfect health? To screen, or not to screen? To deal with problems ahead of time, or to live in blissful ignorance?

Michael Schulder, MD, FAANS, is editor of AANS Neurosurgeon and serves as chair of the AANS Neurosurgeon Editorial Board. Dr. Schulder is a professor and vice-chairman of the department of neurosurgery at the Hofstra North Shore LIJ School of Medicine in New York, as well as director of the Brain Tumor Center at the Cushing Neuroscience Institute. He also serves as the AANS Historian. The author reported no conflicts for disclosure.


  1. David Yazdan,MD,FACS,FAANS. says:

    Yes,excellent article. I still believe we have the obligation to tell the Pt. he or she what is going on in their body.Of course with a great deal of empathy. We do not always advocate prophylactic surgery,every case has to be handled with great care,discussing it with the Pt.

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  2. Jonathan Awori says:

    Thank you for your insightful article and your provocative questions Dr. Schulder. One would think that the continual progress of science and medicine would make the answers to such questions more objective, but I think the opposite is true. Having more information shifts many of the answers to these questions to the individual and his or her temperament. Is ignorance bliss? Yes, if you are the kind of person who is comfortable with a certain level of ambiguity. No, if you have the personality that finds peace in all the cards being laid on the table. And so, I would echo Dr. Yazdan’s call to have very, thoughtful and personal discussions with patients so as to discern not only what will heal their bodies, but what will settle their spirits.

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