The New England Journal of Medicine publishes an overview medical article every year entitled the Shattuck Lecture. This year they featured a seminar discussion with 13 panelists from a variety of policy level positions, including medicine, academic, business, insurance and politics. This seminar will have a major impact on US governmental policy because it comes from the most prestigious medical journal in the country. The magazine article was unfortunately too short to give any of the various participants enough time and space to develop their positions properly, and the published article becomes little more than a collection of paragraph long outlines of complex problems with little offered in the way of workable solutions. After several pages of these very brief presentations the concluding page was a simple off-loading the problem onto the presidential candidates. However, after dumping the problem onto the candidates their published conclusion about the candidates stated plans were, “Part of it is fantasy based on a lack of understanding about how things really work now. We will have to wait till after the election—see how things settle out. And then engage in a realistic discussion about how to pick this up together.” The United States government turns to these “experts” for their expert advice, and what they got from them was not well presented suggestions, but this kind of worthless buck passing. Bah humbug.
This panel was supposed to make recommendations on “The Health Of The Nation”, and because they were dealing with that enormous abstract issue one would expect them to cope with it from a grand, and abstract point of view—from the long term health of the people. But, they didn’t do that. Instead they were trying to cope with a nation of 300 million people with a life (a political life of 232 years since its birth) on a personal short term basis of doctors being paid. It was on a four year election cycle basis at most. This panel may have been filled with experts in their various fields, but they certainly didn’t approach their stated goal properly because the health of the nation is not a four year issue it is much grander issue.
There is a fundamental problem underlying these peoples approach, and it is a problem which compounds the practice of morality with the practice of democracy. This problem has been recognized since the beginnings of the idea of democracy, by the early Greek philosophers, and that is that it tends to be very short sighted. Democracy is founded upon an ideal of giving the people the right to determine their destiny which is an excellent idea, but what happens in practice is that the ideas which dominate the public’s attention are presented to the controlling majority of the people in the moment of decision as the short term moral thing to do. Thus a democratic country becomes very susceptible to complex problems being reduced to eloquent catch phrases, slogans, and pretty faces presenting moral sounding platitudes. What leadership is forced to do if it wants to stay in power, and be successful is to present ideas which sound beautiful now, and which permit a behavior which can be defended with beautiful rhetoric at the next election in the same momentarily beautiful way. This Shattuck Lecture had the stated intent of trying to take a more objective, and longer point of view on the health of the whole nation, but it avoided this by its shifting the long term thinking and responsibility onto the totally overbooked candidates, who have many other responsibilities. These policy researchers and presenters did our country a great disservice by not delving deeper into the issue.
Because the Shattuck Lecture was so very shallow in its time perception it didn’t even remotely come close to the fundamental long term health care problem of our 232 year old country. The problem about to be broached here never enters public discussion, because it has no visible effect in four years, but in 232 years more it will have a vast and perhaps overwhelming impact. It may have impacts greater than all other health disasters combined that occur in that long period of time. The problem is that the very success of our current medical establishment has a negative impact upon our nations genetic health.
In a natural situation in which all wild species live, and in which all humans lived up until the advent of modern medicine, about one hundred years ago, most births did not result in individuals which themselves reproduced. Today because of high quality medical care virtually all births result in individuals that reach sexual maturity, and are capable of reproduction. That is wonderful in the short run, but in the long run it is not so good because of the introduction of health destroying genetic disorders. The long run is only one hundred years and certainly far less than 232 year life of our country. That number of years is chosen to give some time perspective to this problem. Assuming a generation to be twenty years there would be eleven generations in that time period. Our country has lived that long, and we should do what we can to see that it lives in good health that much longer.
Here is the problem: approximately six percent of babies born in the US have visible birth defects, and the number of invisible defects makes the total number of defects greater. Some of this disorder is heritable, and is passed on to these individuals’ children, who in twenty years pass it on to their children, and so on for eleven generations in this example. After that period the number of people affected with the disorder would be enormous. A simple multiple by 2 with each generation reaches 2048 by the end of that time. That is sad enough, but that genetic problem is derived from a single individual. The medical disaster being currently created by our medical establishment is far worse than a simple compound interest type of problem because of the other babies being born into this current six percent with other heritable problems. These will compound at a similar rate, and they will interbreed with all of the others with problems, and thus there will soon be babies born with multiple defects which in their turn will be passed to their children. In a natural situation these are cleared out of the gene pool by natural selection.
Because modern medicine has been so very successful there has been no way to remove these unfortunate genes from the group’s gene pool, and so it grows. In a single generation the problem is invisible; even in two or three it doesn’t become visible because who remembers how things were sixty years ago at a time when they were twenty years old, and just might have become aware of birth defects. Sixty years ago infectious disease, and communicable disease and war were far more visible health problems. This gene defect is an abstract problem, and is not visible without a very long time sense, but in time periods of one hundred years or so it becomes visible and in two hundred years it will become devastating to the whole country. There is the hope that genetic engineering can eliminate genetic disorders although dealing with 6.7 billion individuals on a high tech genetic basis seems unlikely when at present it is difficult to find enough money to put up mosquito netting in bedrooms of malaria infected countries, and even that is being paid for with outside foreign charity.
The Shattuck Lecture probably wouldn’t have admitted onto their panel a person who discussed long term genetic health even though it fitted in perfectly with the stated goal of “Health of the Nation” because it would be seen as admitting to the value of eugenics, and that has been an anathema subject for seventy years. Ultimately the panels short sighted, even microscopic sighted policy making will bring disaster to humanity unless the likes of Craig Venter, and his genetic engineers can find a solution. He and his co-researchers should be supported in every way possible in their quest for a better world. However, his struggle has been a terrible one against the powers that be in Washington on the Human Genome project, and so far not much better on the other projects he has for saving humanity. Cleaning up the gene pool of heritable disease should be at the top of the agenda on National Health. The ancient pre-human women who set humanity upon the healthy path to intelligence and morality a hundred thousand years ago were far more sensible than the high minded, highly credentialed and highly paid people of the Shattuck Lecture.