A Case of Premature Senility : ‘Health alliances’ and government control will discourage research and specialists, leaving us to the mercy of mediocrity.

One of the most striking aspects of a young, dynamic biologic system is variability. The new little heart in your baby daughter can easily speed up by 60 beats a minute when she fusses. Watch a 2-year-old play and you know why menopause occurs as early as it does. A young planet has a dynamic geology and as it ages, geologic processes generally grow more staid. Regularity thus becomes the mark of middle age in most systems, physical or biological. As the system’s life span lengthens, regularity is replaced by chaos: the arrhythmia in your old dog’s heart, the red giant sun consuming the planets it has nurtured for billions of years.

Political structures, too, have internal dynamic evolutions. In youth a society allows for individual and group creativity. National middle age and senescence see more and more encrusting regulations, more and more of a consensus in the body politic that everything should be identical for all members. Somewhere in the process, the will to grow and change is lost.

We’ve gotten ourselves a President, middle-aged himself both mentally and physically, who epitomizes our society’s aging process. But it wasn’t very long ago that the United States was young and had a determination to make our children’s lives better, to “boldly go where no man has gone before.” Our science became the best in the world, and the spinoffs from our young eager minds have made life better for all the people of the world. President Kennedy gave this country a mandate and a timetable for reaching the moon, and we did it, with the help of many scientists whose contributions have never been acknowledged. (They’d make far better national heroes than Roseanne Arnold or Kurt Cobain.)

But now, the United States has entered middle age. We don’t dream any more of new frontiers; we seek only to stay comfortable and not exert ourselves too much. Now that the space program and much pure research have been gutted, either through taxes and regulations or failure to fund, the politicians are out hunting for a new target. In the zeal to “take care of the problems here at home,” our prematurely gray and potbellied government has decided to meet all health-care needs with the fast-food approach. They are playing a shell game with choice, in that health alliances will allow you a choice from only a limited menu of providers and access to specialists only after you have run the requisite obstacle course of overburdened gatekeepers. Waits for such “elective” procedures as cardiac surgery will result in predictable deaths, as they have in England while people wait for their names to ascend to the top of the waiting list.

But the most subtle and disastrous effect of systematically dismantling the best health-care system in the world will be the loss of our research capability. Surgeons, pulmonologists, perinatologists and other specialists have spent lifetimes honing their skills. As they are deprived of their patients and their ability to use and pass on their thought processes, we will have lost an irreplaceable resource.

Much research effort has been done in the private sector, and profit is certainly a powerful motivator here. Yet none will deny that the efforts of pharmaceutical (and other) companies have meant better patient care. A new class of drugs, for example, has changed the outlook for many heart-failure victims, and immunization against a common form of meningitis has dramatically reduced this disease. In the process, medical costs for these two diseases have been reduced. But now companies are afraid to commit much funding to research, since it takes many years to capitalize on advancements. By then, federally enforced reduced drug costs may disallow profits, and the ever-present threat of litigation means that new vaccines or prostheses may actually lose money for the companies developing them.

Once we destroy specialty practices and medical innovation, we will forgo our place in the tremendous progress awaiting us as the chromosomes are mapped and substances like local growth factors actually can be manufactured. Government control of health research and development may mean that whatever is the politically correct disease, be it breast cancer, AIDS, Alzheimer’s or something else, will probably get the lion’s share of the research funding.

America needs leaders of vision to prevent premature national senility, not leaders whose main objective is to set the status quo in concrete. As Bernard Weatherell, former speaker of the British House of Commons, says: “Virtually all civilizations of the world have faded away not from enemy action but usually from decay . . . from bondage to spiritual faith, from spiritual faith to courage, from courage to liberty, from liberty to abundance, from abundance to apathy, from apathy to dependence, from dependence once more to bondage.”