Sunday, May 23, 2010

Man Made Life: What Would Cordwainer Smith Say to Craig Venter?

As usual, The Economist's take on Craig Venter's announcement of synthetic life--more precisely, the creation of a bacterium with a synthetic genome--is thoughtful and thought-provoking.  The piece was evocatively entitled, "And man made life: Artificial life, the stuff of dreams and nightmares, has arrived."  

There will be much back-and-forthing as to the impact that Venter--working with Hamilton Smith--will have, including some contextualization, even minimalization, of the Venter/Smith achievement, but The Economist gets to the bottom line: 

It will be a while, yet, before lifeforms are routinely designed on a laptop. But this will come. The past decade, since the completion of the Human Genome Project, has seen two related developments that make it almost inevitable. One is an extraordinary rise in the speed, and fall in the cost, of analysing the DNA sequences that encode the natural “software” of life. What once took years and cost millions now takes days and costs thousands. Databases are filling up with the genomes of everything from the tiniest virus to the tallest tree.

Indeed, this might be a case where the who-what-wheres of journalism, important as they are, prove to be inadequate compared to the speculative challenge of understanding the road ahead.

Serious Medicine Strategist Jim Woodhill puts himself in the camp of those who believe that what Venter has wrought will, indeed, be big.   And to illustrate the potential scope of the Venter-ized future, Woodhill reminds us an unjustly neglected sci-fi writer, Cordwainer Smith, who imagined for us a universe in which Serious Medicine is really serious, where Serious Medicine is the most valuable commodity in the cosmos.   As Woodhill recalls it:

Smith wrote of a future world where a drug called "stroon" was distilled from the vomit of gigantic mutant sick sheep.  Stroon, also known (for some unknown reason) as the "Santaclara Drug" granted its taker health without aging while he kept taking it.  The value of stroon was so high that when one 18-year-old Old North Australian sheep rancher was able, with the aid of a family heirloom war computer, to corner the stroon futures market, he became wealthy enough to buy everything.

OK, some might say, that's just sci-fi, published half a century ago.   But Woodhill connects Smith's work to the present debate, specifically, the way that we finance healthcare--and let that healthcare financing get the better of our overall Serious Medicine Strategizing.   Let's remember, folks, the central issue of healthcare is cures, not cost.  The politicians have taken their eye off that ball, because we have let them.   And so the beancounters, who have gained ascendancy over the politicos, in the wonkrooms of Washington, have trumped the medical visionaries, such as Venter.   That's why we could have a healthcare debate, over the last year-and-a-half, that paid almost no attention to the prospect of actually curing diseases.   We will finance illness--and expand the financing of illness--but we seem to have relatively little interest in actually curing disease and restoring people to health.   That's not what the average American thinks, but the average American wasn't really consulted in the debate.   

As Woodhill explains:

One of my (in)sanity checks on the healthcare reform debate is to note that the discovery of a Santaclara Drug that cost, say, 20% of U.S. GDP (initially) to synthesize in great enough amounts for our entire population would be a disaster within the current accepted public policy model.  I mean, 17% of GDP would go to 20%!  (And more than 20% because stroon would not eliminate trauma care, maternity wards, etc., just heart disease, cancer, major mental illness...)

Woodhill is exactly right.   Venter opens up the prospect of genuine medical/scientific breakthroughs, the kind that would paradigm-shift medicine, and paradigm-shift the economy, too.   Just as Cordwainer Smith, in his own way, imagined a half-century ago. 

Today,  we might imagine what America would look like if we were systematically applying Venter's technology--in a legal and ethical way, of course--to the health challenges at hand.   What if we were to help Venter, and all the others doing this work, help us?  What if we launch a national medical-economic strategy to do the sort of research that would lead to the sort of wonder-drugs that would make America a medical and economic magnet for the world?    Such an achievement is admittedly speculative, but if we could do it, the achievement would dwarf some minor tweak--or even a big shift--in the way that we finance healthcare. 

No wonder, then, that Washington isn't interested in turning the reins of healthcare policy over to science--because whatever science creates, by definition, wouldn't be invented in DC.  It might be financed in DC--and maybe it should be financed in DC--but it would be created in a lab out beyond the Beltway somewhere.  And that act of medical-scientific creation would, in effect, disempower the political class.   

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