Who runs American Healthcare? Answer: politicians, regulators, and financiers. Not an encouraging sign for Serious Medicine.
Posted Aug 26 2010 12:00am
Adam Keiper, editor of The New Atlantisand fellow at the Ethics and Public Policy Center , thoughtfully critiques my SMS blog post of yesterday , in which I raised the possibility that Barack Obama could pull a "Harry Truman" on the opposition Republicans this summer and fall. This back-and-forthing comes in the wake of Judge Royce Lamberth's decision, earlier this week, freezing federal funding for embryonic stem cell research. (In his crisply written National Review Online article, Keiper also critiques Will Saletan's piece in Slate.com , but I will stick to my own defense here.)
Keiper opposes embryonic stem cell research--that's the editorial thrust of Atlantis and also the general line at the EPPC--and yet I will not engage on the issue of the ethics of human embryonic stem cell (HESC) research. This author will acknowledge that there are legitimate moral-ethical reasons to oppose HESC research, but at the same time, I will insist that there are solid moral-ethical reasons to support such research, starting with healing the sick. Indeed, in keeping with the technoprogressive orientation of this blog, I will note that there's plenty of evidence to suggest that continued progress on hESC will soon eliminate the need for the "E" in stem cell research , because scientists will be able to routinely create new "pluripotent" stem cells from a variety of sources, not including embryos. That's been a familiar pattern in the history of science, of course: The initial research is crude, or painful, or expensive, and only with the passage of time--the painful ascent up the learning curve--does the process get cheaper, better, and even more humane.
So rather than getting into a bioethics argument--if we were to have one, I am sure that at the end of it it, Keiper and I would still respectfully disagree--I will focus on the politics, where I think I have the better argument--even if Obama shows no likelihood for taking it.
In NRO, Keiper argues that the Truman-Obama parallel is not correct because while the country was basically with Truman in 1948, Americans are not with Obama in 2010. And while Keiper is right about that--that's not what I said. I never argued that Obama has the majority with him--I said that he has the majority on this one issue.
Indeed, I am fully aware that Obama is on the wrong side, public-opinion-wise, on the 10 most issues facing the country as Rasmussen Reports shows us (stem cell is not on the top 10, although healthcare is, showing Obama's deficit to be just eight points, one of his better showings--more on that in the future). Indeed, according to Gallup , liberals are on the losing side of most public disputes--self-described conservatives outnumber self-described liberals by 42:20, better than 2:1. That's why Obama can't reveal his true self, and can't rally the country to his larger agenda: The country doesn't agree with him.
If Obama wanted to, he could use the bully pulpit and move those numbers even higher, while energizing his own base.
I should hasten to say that I did not vote for Obama in 2008. But I am an advocate of medical research, and think it should be higher--much higher--on the national agenda. Medical research and the search for cures--as distinct from healthcare financing--should be in the nation's top ten, top five, even. Such elevation takes leadership--from someone.
As I wrote yesterday, I strongly doubt that Obama is the right leader, but that's not only his loss, it's our loss. Because the followership is certainly there, waiting to be mobilized, among a public that wants medical advancement. Six years ago, in California voters approved a $3 billion stem cell--including HESC--funding plan by a 59:41 percent margin ; other states, too--including Connecticut, Delaware, Florida, Illinois, Maryland, Massachusetts, Missouri, New Jersey, and Ohio-- have set up state-funded programs of one kind or another . And I would wager that 90 percent or more of those who are engaged in medicine and medical research support HESC. So if this were to become a larger issue, Obama and the pro-stem cell forces would have huge support from prominent opinion leaders.
And that's why I argued that Obama could invoke a "Truman Strategy," rallying the voters to his side--on this one issue. Would it work well enough to get Obama re-elected? Probably not. But it might work well enough to advance some cures, and to save some lives.
PS: I have always been intrigued by The New Atlantis. The title, of course, refers back to the work, four centuries ago, of Francis Bacon, the father of modern scientific research. As the "About" section of the TNA site explains
The New Atlantis (1627) was the title Francis Bacon selected for his fable of a society living with the benefits and challenges of advanced science and technology. Bacon, a founder and champion of modern science, sought not only to highlight the potential of technology to improve human life, but also to foresee some of the social, moral, and political difficulties that confront a society shaped by the great scientific enterprise. His book offers no obvious answers; perhaps it seduces more than it warns. But the tale also hints at some of the dilemmas that arise with the ability to remake and reconfigure the natural world: governing science, so that it might flourish freely without destroying or dehumanizing us, and understanding the effect of technology on human life, human aspiration, and the human good. To a great extent, we live in the world Bacon imagined, and now we must find a way to live well with both its burdens and its blessings. This very challenge, which now confronts our own society most forcefully, is the focus of this journal.
Anytime such a great figure as Bacon gets worked into the public discourse, I am happy. But frankly, the folks at TNA seem to be among the very, very few who think that Bacon was in any way ambivalent about the potential of science to improve the world. Others agree: Harvard's I. Bernard Cohen wrote in 1985 that Bacon's New Atlantis was "utopian," while MIT's Alan Lightman wrote in 2003 that Bacon had described a "utopian kingdom," a place where, as Lightman put it, "Air is treated for the preservation of health," where experts advance toward "the perfection of agriculture," and "the development of flowering plants for medicinal use." Sounds good to me!
For what it's worth, I wrote about in the stem cell topic five years ago, in a column published in the June 7, 2005 edition of Newsday. I think it holds up pretty well--and Bacon, of course, holds up very well: The stem cell debate grows increasingly angry as the science behind it gains momentum. Indeed, the science has a whole lot of momentum—four centuries’ worth. On May 24, the House of Representatives voted to lift federal limits on embryonic stem cell research. But President Bush vows to veto any bill that reaches his desk—and if so, it would be the first veto of his presidency. But the wind is at the back of the pro-stem cellers; a CBS poll shows 58 percent of Americans supporting embryonic stem cell research. Meanwhile, the states are rushing ahead. Last year, California voted $3 billion for stem cell research. This year, Connecticut and Massachusetts have enacted their own state programs. And now comes the big news from South Korea, where scientists have made a huge advance in cloning. In a nutshell, the enticing prospect—or, if one prefers, the evil nightmare—of “therapeutic cloning” is within reach. No wonder tempers are rising back in the US. Michael Kinsley, editorial page editor of The Los Angeles Times, who suffers from Parkinson’s Disease, wrote: “Imagine what it's like to open the newspaper . . . and read that scientists in faraway South Korea have made a huge breakthrough toward curing a disease that is slowly wrecking your life. But closer to home, your own government is trying to prevent that cure.” That’s powerful first-person stuff. Similarly, Jonathan Alter, columnist for Newsweek--and a self-described cancer survivor and beneficiary of adult stem cell therapy—argued that “only Bush bitter-enders and the pope are in the perverse position of valuing the life of an ailing human being less than that of a tiny clump of cells no bigger than the period at the end of this sentence.” Those on the other side of the debate are intense, too. Chuck Colson, leading Christian activist, declares that stem cell proponents have “decided to throw all moral caution to the wind.” And Sen. Rick Santorum, Republican of Pennsylvania, denounces the prospect of “the wholesale destruction of human life, paid for by the federal government.” But government involvement in scientific research of just about every kind goes back a long way. All the way back, in fact, to Sir Francis Bacon. Four hundred years ago, in 1605, Bacon published The Advancement of Learning, which helped launch the scientific revolution. Although most “scientists,” through the ages, had been alchemists and sorcerers—their quest was to rediscover the lost secrets of the past, which, of course, didn’t exist--Bacon was on to something new. He looked to the future with confidence and, more to the point, a plan for state support. In a subsequent work, The New Atlantis, Bacon outlined a utopia, in which “pioneers” are subsidized as they “try new experiments, such as themselves think good.” As historian Harvey Wheeler explained, Bacon intended his work to be “a practical handbook for bringing about a marriage between science and government.” That marriage first occurred in Bacon’s England, where the Royal Society of London for Improving Natural Knowledge was founded in 1660. Since then, every advanced nation has developed its own scientific-industrial complex; these knowledge collectives inevitably suffuse their societies with their own techno-progressive ideology. And so that’s where the momentum behind research, including stem cell research, has been coming from these past four centuries. But what about morality? What about the sanctity of life? As Bush puts it, we must “balance ethics and science.” True enough, but who does the balancing? Answer: lots of people, in lots of countries, with lots of different perspectives. As Santorum’s fellow Pennsylvania Republican Senator, Arlen Specter, observed, “The U.S. government can't control what goes on in South Korea, maybe not even California.” The Baconian Grand Plan has gone worldwide. The historian Thomas Carlyle held that Bacon could “converse with this universe, first hand.” That was true then, and it’s true of scientists now. Bacon’s vision of inevitable scientific progress still holds us in its thrall, like it or not.