Prometheus and the Worried Well

How much medical knowledge is too much? How much is too little? How does knowledge of mortality prompt and/or stall human flourishing?

“Storm over Utah” by Alanna S. Graboyes at ASGraboyesArt.com

This piece appeared on 2/16/25 at the Sensible Medicine substack. (I highly recommend subscribing to them!) An earlier version of this piece appeared at Bastiat’s Window in 2022.

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In Aeschylus’s Prometheus Bound, the titan endows mankind with creativity by giving us fire, stolen from the gods, and by endowing us with a fine balance of knowledge and ignorance about our own mortality. Unaware of death, Aeschylus says, humans are like ants—surviving, but not flourishing. But knowing the exact dates of death robs us of the “blind hope” that underlies creativity. In an era of precision medicine, this balance looms heavily.

Nara Leão was a Brazilian singer, actress, and “the Muse of Bossa Nova.” In the early 1970s, amid Brazil’s political turmoil, she relocated to Paris and largely gave up music to focus on childrearing. In 1979, at age 37, she was diagnosed with an inoperable brain tumor and uncertain remaining lifespan. With this uncertainty, she became furiously productive, racing to bolster her already considerable legacy. She finally succumbed in 1989. This pre-diagnosis video beautifully illustrates her music and ethereal nature.

In our Columbia University apartment in the 1980s, we often encountered a pleasant woman in the elevator. We knew she worked in biology but knew little else about her. Years later, we saw her photo and learned she was Nancy Wexler, a pathbreaking researcher on Huntington's chorea. Her sister, historian Alice Wexler, documented Huntington’s in multiple books. Their mother, grandfather, and three uncles had the illness, and Nancy spent years in remote Venezuelan villages, where the condition was prevalent. Her work enabled geneticists to identify the culpable gene and devise a conclusive test. Then, both sisters faced the decision of whether to be tested. In a 2004 NPR interview, Nancy described the pros and cons of testing, and her observations recall Prometheus’s logic. She could know her fate, good or bad, or live with a 50/50 chance. The New York Times reported in 2020 that Wexler never took the test but was eventually diagnosed with Huntington’s. I’m no doctor but believe the symptoms are obvious in the following 2019 clip.

Singer/songwriter Woody Guthrie had Huntington’s. In his first decades of life, before tests were available, son Arlo Guthrie didn’t know whether he had won or lost the coin toss. He knew that any children he had would face a 25% chance (50% × 50%) of inheriting the illness. He chose to have children anyway, viewing them not as having a 25% chance of inheriting Huntington’s, but rather as a 75% chance that they wouldn’t. He said, “No matter how you cut it, that’s pretty good odds.” He never developed the illness, meaning he and his descendants are likely absolved. I once read that his view was that regardless of whether he developed the illness, he was glad to have been born—and hoped that his children would feel the same.

With something approaching certainty, a Huntington’s test reveals your fate with pre-Promethean certainty. but BRCA screenings are different. A positive test says, “You have a higher probability of developing breast cancer than women who test negative; with a family history, your probability is even higher.” This is enough to persuade some women (e.g., Angelina Jolie) to have prophylactic mastectomies. But there’s still a high likelihood that those undergoing such procedures would never have developed the disease.

Decades ago, I developed some frightening digestive-tract symptoms which turned out to be a minor and temporary acid reflux. Before the diagnosis was made, my doctor said, “Do not go onto WebMD and search for what these symptoms can mean.” I had no intention of doing so. Que será, será.

Thirty years earlier, I had a routine chest x-ray at the University of Virginia. The doctor said, “It looks fine” and sent me home. Soon, the telephone rang, and a nurse asked me to return to the hospital. When I asked why, she chuckled nervously and said, “Oh, it’s probably nothing.” A succession of others responded identically—word-for-word. Finally, I cornered a radiology resident and said, “I’m really tired of this. Would you please tell me what’s going on?” He hung my X-ray on a light board and pointed. “Portions of these two vertebrae in your neck are a different shade than the rest of the vertebrae. This could be because the film had a blotch on it—that sometimes happens near the edge of the film. If not, it means that those portions of your vertebrae are of a different density than the rest of your vertebrae.” I said, “I’m guessing that if that’s true, then this would be bone cancer, and probably a bad one—correct?” He said, “Yes.” I said, “Fine. Now I feel better. I can worry about one thing rather than worrying about every possibility.” The film had a blotch.

A 1960 Twilight Zone episode (“A Nice Place to Visit”) features a small-time hoodlum who finds himself in a very pleasant place which he ultimately determines is the afterlife. He’s surrounded by beautiful women, wins every gamble at the casino tables, and is treated obsequiously by police. After a month, he’s bored out of his mind and demands to know why a hoodlum like himself was sent to Heaven. He demands to be sent to Hell which, he assumes, will better suit his tastes. He is informed that he is, in fact, already in Hell. No doubt, Prometheus posted a positive review on IMDB.

I once read of an 18th-Century German doctor whose notes spoke of a patient with a bunion and breast cancer. The bunion worried her a lot, but the cancer didn’t. Why the paradoxical difference? The bunion interfered with her life, work, and comfort, and it was treatable. The breast cancer would eventually kill her, but so what?

Thousands of genetic tests are now available, and many people take batteries of them through “executive screenings” and the like. Does the value of such testing offset the resulting hypochondria, needless procedures, and iatrogenia?

In The Fragile Species, Lewis Thomas (dean of medicine at Yale and NYU, president of Memorial Sloan-Kettering Institute) wrote:

“The dilemma of modern medicine, and the underlying central flaw in medical education and, most of all, in the training of interns, is the irresistible drive to do something, anything. It is expected by patients and too often agreed to by their doctors, in the face of ignorance.”

In Woody Allen’s Annie Hall (1977), a Brooklyn doctor counsels a Woody Allen-like 9-year-old, Alvy Singer, and his mother:

Doctor: Why are you depressed, Alvy? …
Alvy: The universe is expanding.
Doctor: The universe is expanding?
Alvy: Well, the universe is everything, and if it's expanding, someday it will break apart and that would be the end of everything.
Alvy's Mother: What is that your business? … He stopped doing his homework!
Alvy: What's the point?
Alvy's Mother: What has the universe got to do with it? You're here in Brooklyn. Brooklyn is not expanding.
Doctor: It won't be expanding for billions of years yet, Alvy. And we've gotta try to enjoy ourselves while we're here. Uh?

In 2025, I’m 71. Throughout history, a few hundred or thousand have reached 110. Biomedical gerontologist Aubrey de Grey predicted years ago that the first person to live to 150 is already alive somewhere today. I’ve never been more creative than I am today.

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Bastiat’s Window publisher Robert F. Graboyes is an economist, journalist, and musician whose five degrees include a PhD in economics from Columbia University. An award-winning professor, he received the Reason Foundation’s 2014 Bastiat Prize for Journalism. His musical compositions are on YouTube.