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Science can transform the budget and the economy, as well as medicine. But of course, Washington DC is unlikely to notice.

Posted Jul 09 2011 12:00am
The front page of Friday's Wall Street Journal illustrates the opportunity--and the challenge--facing both the US federal budget and Serious Medicine.   One article details fiscal frustration; the other outlines medical hope.  It's too bad that those who are suffering the frustration don't look to science to alleviate that frustration.   And it's also too bad that those who are offering hope languish outside of the political system.  

The top Journal article is headlined, "Sights Set on Grand Debt Deal," and details yet another round of Washington DC budget negotiations.   If it seems to you as if these budget negotiations stretch on, year after year, decade after decade, with no real resolution--other than that spending goes up---you are right.   In other words, there's a cyclicality to the politics of such fiscalism--and a futility to the actual numbers.   
Of course: In our hyper-pluralistic system, everyone gets a say-so, and that means that there are no final victories.  Everything is an election away from being done, or undone.    The spending cuts, for example, that might be agreed to in this year can simply be repudiated in some future year--see, for example, Sustainable Growth Rate for Medicare.   It's easy to talk tough today, if the cuts come in a decade--but recent political history doesn't point to a very encouraging record that cuts are actually followed through on in some distant outyear. 
But if politics, like human nature, is cyclical, then technology, like science, is cumulative.  That is, for the most part, once something is learned, it is never unlearned.   And so that makes sci-tech qualitatively different from politics.  If we develop a new and better discovery and a process in its wake, those improvements will always stay with us.  With only rare exceptions, nobody, in seek to repeal it.    Every country in the world, for example, makes use of modern medicine--at least for some of its people.  
The bottom article is headlined, "A Lifesaver, Custom-Built in the Lab," and it details the creation of an artificial esophagus to replace the cancer-ridden esophagus of a 36-year-old man living in Sweden, thereby saving his life.   We might note that the new esophagus was frown from adult stem cells--the stem cells, in fact of the man himself.  So no ethical concerns here.  Meanwhile, Swedish science has not only saved the life of a young man, but it's easy to see a new industry being created in Sweden, making not only esophaguses, but every other kind of replacement organ. 
And so now we see something interesting: The budget news goes in one mental "silo," concerning politics and economics, and the medical news goes in another silo, concerning health and science.   For the most part, for reasons CP Snow outlined a half-century ago , the two silos don't really acknowledge each other.  
And so, for example,  it's unlikely that any of the budget negotiators, in either party, are going to come to the next round of negotiations and say, "You know, if we transform medicine, in the way that this news from Sweden suggests we might,  the cost of Medicare might fall, and the economic output of the health sector might increase."  That just won't happen, because as a casual glance at the DC news demonstrates, the political class is simply not very interested in science and technology--that's why sci-tech policy gets so little attention.   Moreover, even if a negotiator were to make that transformative argument, he or she would be dismissed, because, in DC parlance, the positive side science cannot be "scored." That is, the Congressional Budget Office won't score, or calculate, gains from future science. 
But CBO will calculate costs. So if a new federally funded esophagus research & development center were to open up in the US, and it were to cost, say $100 million, CBO would score that cost--another $100 million to the deficit.   And if the esophagus center were to generate great windfalls of money for the US economy, and for the Treasury, the CBO would be happy to score that, too.  But such a positive development, were it to come, would be years away.  And in between, as the esophagus center was ramping up, the CBO would just count its ongoing costs as simply more red ink. 
It's possible to defend the way that CBO does its job--as a matter of accounting rigor, we should not count chickens before they are hatched--but it's not possible to defend making national policy on such a basis.  Why?  Because under CBO rules, the most exciting and potentially transformative projects are scored as costs.  And so when belts tighten, it's easy to cut such costs.  Perversely, CBO would measure such spending reductions as a reduction, and never even think about the foregone gains.  
So most likely, in any kind of budget deal to come, medical R&D will take a hit. And CBO will dutifully  assess the "savings," paying no heed, of course, to the missed opportunities that medical science could have produced with a little help and inspiration.    Meanwhile, the sort of strategic thinking we need, as to what opportunities and needs should be addressed, is pushed out of the way by the bean-counters.   That might be a good way to run an accounting system, but it's a lousy way to run a country.   Such static analysis, applied to things that aren't static, will be the ruin of us.  
And maybe that's why the Swedes are using high-tech science to manufacture organs, generate jobs, and produce hope.  And not us. 
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