The Kaiser Family Foundation takes up the cause of Obamacare. Once again, finance and bureaucracy triumph over medicine and healing.

The Kaiser Family Foundation has released a new animated video, narrated by Cokie Roberts, touting--they would say “explaining” but I maintain that “touting” is a more accurate verb--Obamacare.

Let me begin my review of this new video by saying I am all in favor of using new tools to communicate dense policy information.    We should be using videos and texts and tweets and anything else we can think of to better communicate policy.   If we do, there’s every reason to believe that policy literacy will rise--as the Pew Foundation noted recently, consumption of news is actually rising, as people now find their news on new platforms, such as PDA’s.  So the KFF deserves credit for pushing the envelope of imagination. 

However, it’s just as easy to put a distortion, or worse, into the new media as it is into the old media.   And that’s what we see early on in the nine-minute KFF video, at about the :40 mark, when narrator Roberts says,  “Polls show about three out of ten of us say health care reform will make us better off, a similar number say worse off, and a similar number again say it won't make much difference at all. Some of us don't know what to think. I guess you could say we’re kinda split on this one.”   Well now, that’s a pretty optimistic take on public opinion, in keeping with the strongly pro-Obamacare tone of the whole video.  

Indeed, that “one-third, one-third, one-third” conclusion, which makes everything seem so reasonable and balanced, is starkly at odds with the conclusion of, say, the Gallup Poll, which finds that by a 56:39  spread more Americans disapprove of Obamacare than approve.   I should say that the KFF is a big outfit, and a great resource for healthcare information that might please, at one time or another, all sides in the  debate, and so no doubt there’s a poll that somehow supports Roberts’ assertion.  

Yet as lots of anecdotal information tells us--most notably, the special-election victory of Scott Brown to replace the late Edward M. Kennedy in the US Senate--the preponderance of evidence suggests that Americans are much more anti-Obamacare than pro-Obamacare.   And yet none of that is included in the video.   Thus so the KFF video gets off on the wrong foot, using an assertion that is at best misleading.   

Next, Roberts’ narration takes up the issues that the Obamacare legislation purports to deal with, starting with the cost of healthcare:  

Let’s begin with the problems in our current health care system. Problem number one is, what problem number one usually is, money.  Most people agree that health insurance policies are too expensive. For a family, the average premium is almost $14,000 dollars a year...and growing. Premiums have doubled over the last nine years, ballooning way faster than inflation!  Plus, our population is aging, meaning more people with more health problems. So, health care costs are the fastest growing part of the federal budget.

In the minds of the KFF video creators, that’s an open-and-shut matter of fact: The biggest single issue in healthcare is the cost of care.   

But is that really the case?  When you go to the doctor, do you talk to the doctor about finance?   No.   You talk to the doctor about your health--what hurts, what’s not working, what might even kill you.    For their part, doctors go to medical school to learn the art of healing, not the art of financing.   At best, healthcare finance is a means to an end--the end is better health.   

Moreover, if we wanted to be churlish, we could note that so far at least, there’s no indication that Obamacare has had any success in restraining the growth of healthcare costs.  Indeed, Dr. Arnold Relman, emeritus professor at Harvard Medical School and also the former editor of the New England Journal of Medicine, Relman wrote recently in The New York Review of Books about the Obamacare bill, there was nothing in the design that will ever curb costs: “It has also been promoted by its sponsors as a measure to control costs, but it is not.” but it’s only been six months, maybe that will change--although, again, it’s not at all clear that controlling costs is the right goal to start off with.  

But as noted here in the past at SMS, over the past 40 or so years, doctors and medical scientists have been dethroned from their place at the pinnacle of our healthcare system, replaced by a combination of public- and private-sector financiers.  And these financiers have persuaded Washington DC, at least, that the real issues in healthcare are financial.  In other words, financiers have sold the political elite on a vision of healthcare that is not unlike the financial vision of everything else in the country.  Everything is a financial issue, and if you hire the right bean-counter, backed up, of course, by a Wall Street “quant,” then every problem can be solved. Or if the problem can’t be solved, well, at least the financiers make money.  This “financialization” of everything is a problem everywhere, but it has deformed healthcare policy, to the point where healthcare experts, such as those at KFF, tell us that the issue is medicine is not medicine, but finance.  Perhaps the KFF’s roots, amid Kaiser Permanente, the big managed-care conglomerate are starting to show.  Such a pro-financialist bias might be perfectly understandable, but that doesn’t make the bias more accurate.  

But let’s not ignore the bureaucrats, and their role.  As narrator Roberts tells us, the other problem of healthcare that needs to be solved is the problem of access to health insurance:  

The second problem is that the system is full of holes. Like the fact that people buying insurance on their own can be turned down for having a pre-existing health condition. Small businesses may be charged extra if some of the workers are sick, making insurance unaffordable.  And some insurance policies have a lifetime limit on benefits. After that, you’re out of luck.  That means some of the people least likely to have coverage are the ones who need it most.

To be sure, access to health insurance is a problem, but is it really the second biggest problem in healthcare today?  In America right now, some 85 percent of the population has health insurance.  Meanwhile, more than 600,000 people die every year of heart disease, nearly that many die of cancer,  and rapidly rising diseases such as Alzheimer’s have no cure, no treatment, even.   Surely those death rates, and all the other medical problems that Americans face, deserve some higher priority.  

And so once again, we see the increasing influence of non-doctors, in this case, social-science-oriented policymakers and the bureaucracy.    If financiers have demoted doctors, so have social scientists.   As a result, we have a healthcare system dominated by financiers--including for-profit hospital executives, who seem to spend more time worrying about investor relations and their own bonuses than they do about patients and wellness--and bureaucrats.  And so it shouldn’t be surprising, then, that we are told that cost and access are the number one and number two issues facing healthcare.

So what’s number three on the KFF list?  Actually, there is no number three.   Echoing, once again, the arguments of Obamacare, the KFF video stops at those two issues: cost and access.   The goal of healthcare, according to the Obama/KFF mindmeld, is to hold down the cost and ensure universal access.   We can imagine a company that saw itself as providing a cheap product to all customers.  Never mind whether or not the product was good, the goal is that it is cheap, and that everyone could get it.   Such a company, of course, would not likely stay in business for long, but as we know, the government, as well as richly endowed private foundations, have their own ways of doing things.  

For any discussion of research and cures, well, you’ll have to go somewhere else, other than this video.   Those two words, “research” and “cures,” literally do not appear in the video, just as they have fallen out of the discussion in Washington.    And none of us--not even the financiers and bureaucrats--are better off for it.    

Who Will Mediate the Medicators? Watching the CERites.

In its lead editorial on Sunday, The New York Times editorial page makes a strong argument for Comparative Effectiveness Research (CER),  the process--part scientific, part budgetary, part political--by which the government and other entities decide how effective medical drugs might be, and whether or not they are worth the cost.  In theory, CER makes good sense, but the sine qua non of CER is trust.  That is, we must be able to trust the people doing the CER, because our lives are at stake.

Yet if we don’t trust the “CERites,” as we might call them--that is, if we, the American people, were to conclude that the CERites are just another opaque, unaccountable, and arrogant group of bureaucrats, operating according to a different agenda than public health--then the whole CER system breaks down. 
  

For its part, the Times asks us to trust CER as implemented by the Obama administration; indeed, the Times wants to turn the CERites loose, giving them far greater power than they have at present.   

Under the headline, “Is Newer Better? Not Always,” the Times makes a series of points: First, the newspaper concedes that the prime driver of healthcare costs is better technology, and it freely admits that such improved technology is oftentimes a good thing.  But new technology is not always better--that’s the second point.   And then, third, the paper falls back on a familiar refrain, that the real issue in healthcare is keeping costs under control.  As the Times editorial puts it: 

The Congressional Budget Office estimates that an astonishing half or more of the increased spending for health care in recent decades is due to technological, surgical and clinical advances. For the most part, such advances are a cause for celebration. But an expensive new drug is not always better than an older, cheaper drug, and sometimes a new technology or treatment that is highly effective for some patients is unnecessary or even dangerous for others. The system almost seems designed to keep driving up costs.

We might dwell on that last line, on costs.  Controlling healthcare costs has been a major preoccupation of the liberal left for decades now; touting the “cost-cutting measures” thenabout-to-be-passed healthcare bill in March, President Obama himself declared: “My proposal would bring down the cost of health care for millions--families, businesses, and the federal government.”  

There’s nothing wrong with bringing down costs, of course, but the method by which those costs are to be controlled matters a great deal.  Many of us believe, for example, that a line-ahead emphasis on cost-cutting in healthcare is counterproductive, for two main reasons: first, such cuts are extremely unpopular with voters, so that the cost-cutters are likely to be ex-cost-cutters; second, and more profoundly, the easiest healthcare cuts to make in the short run are those that don’t involve helping people directly and immediately, e.g. the speculative research that might lead to a cure.  And so the immediate desire to cut spending, with little regard for the pain, or the backlash, gets in the way of a more patient determination to cut spending by improving health.  In other words, the cost-cutters, going for the fiscal equivalent of immediate gratification, never solve the real issue of healthcare, which is the chronic mismatch between the demand for healthcare and the supply of healthcare.  

Yet the Times editorialists are not Luddites; they recognize that sometimes new inventions--everything from the wheel to the assembly line to a smart phone--can, in fact, drive down costs.  As they observe, 

Even costly therapies can end up saving money as well as lives. Studies by respected economists have shown that spending on new cardiac treatments, neonatal care for low-birth-weight infants, and mental health drugs have more than paid for themselves.

But then the Times cites examples that it sees as wasteful and costly: 

Consider the prostate-specific antigen test, which is widely used to screen men for possible prostate cancer. In an Op-Ed piece in The Times in March, Richard J. Ablin, the doctor who discovered prostate-specific antigen, described the test as “hardly more effective than a coin toss” at distinguishing who is at risk, and lamented that the test’s popularity has led to “a hugely expensive public health disaster.   Each year some 30 million American men undergo the test at a cost of at least $3 billion, and many go on to have surgery, intensive radiation or other damaging treatments that may not have been necessary.

Dr. Albin, through his achievements, has earned a respectful hearing for his views, but others have differing views--starting with the approximately 200,000 American men diagnosed with the disease every year.   Indeed, well-regarded voices in the debate, such as the National Cancer Institute (NCI), a unit of the National Institutes of Health, don’t seem to agree with Dr. Ablin.  On its website, NCI acknowledges that prostate testing is “controversial,” but in discussing that controversy, NCI cites findings that tend to contradict Dr. Ablin, such as a European study that found that testing led to a 20 percent reduction in deaths from prostate cancer.  Such is the nature of a scientific debate, still very much in flux.   (By the way, the NCI site offers a list of seven speculative treatments--seven different ways, a fiscal pessimist might say, to spend money, or, alternatively, as a medical optimist might say, seven different ways to hopefully defeat prostate cancer.)

But what’s perfectly clear is that men with concerns about prostate cancer--and that category should include men over 40 with a family history and every man over 50--are going to want to seek out their own answer, with their own doctor.   Government diktat is not popular on matters of life and death; one needn’t fear the specter of “death panels” to nonetheless fear bureaucratization of life-and-death decisionmaking.   

In fact, the picture of CER, in practice, as opposed to theory, is distinctly mixed.   The Times hightlights the work of the Dartmouth Atlas of Health Care, one of the central texts of the CER movement, which purports to show gross cost-differentials in hospitals across the country, not connected to efficacy or good results.   But in fact, twice now in recent months now, in February and in June, the Times has attacked the quality of the Dartmouth data, pointing out that the Dartmouthians made  elementary mistakes--or, more likely, omissions: 

But the atlas’s hospital rankings do not take into account care that prolongs or improves lives. If one hospital spends a lot on five patients and manages to keep four of them alive, while another spends less on each but all five die, the hospital that saved patients could rank lower because Dartmouth compares only costs before death.  “It may be that some places that are spending more are actually getting better results,” said Dr. Harlan M. Krumholz, a professor of medicine and health policy expert at Yale.  Failing to receive credit for better care enrages some hospital administrators. But for the Dartmouth researchers, making these administrators uncomfortable is the point of the rankings.  “When you name names, people start paying more attention,” Dr. Fisher said. “We never asserted and never claimed that we judged the quality of care at a hospital—only the cost.”

That’s an interesting admission--if that’s the right word--in the last paragraph: that the Dartmouthians never claimed to be judging the quality of healthcare in their mapmaking.   Once again, this article ran in the Times just three months ago; we can be sure that the Times editorialists read it, the question is why they didn’t refer it.  

One major source for Dartmouth critiques is a piece appearing in the February 17, 2010  New England Journal of Medicine  by Dr. Peter B. Bach, “A Map to Bad Policy--Hospital Efficiency Measures in the Dartmouth Atlas,” also not mentioned by the Times editorialists.   One might think that if the Times editorialists are going to praise Dartmouth, then the paper of record at least ought to note the many criticisms and controversies surrounding the Dartmouth data.  

Also not mentioned in the Times editorial is the role of the pioneering CER agency, National Institute for Health and Clinical Excellence (NICE), part of the United Kingdom’s National Health Service (NHS).  To put it mildly, both NICE and NHS are lightning rods in the UK as well as the US.  A sample headline from a major British newspaper reads, “Sentenced to death on the NHS: Patients with terminal illnesses are being made to die prematurely under an NHS scheme to help end their lives, leading doctors have warned.”   Yet the Times editorializers didn’t mention of that CER work, either, even though we know that top Obama healthcare officials, such as Dr. Donald Berwick, head of the Center for Medicare and Medicaid Services, has been open in expressing his admiration of UK-style CER. 

Indeed, here in the US, we are already seeing the direction in which Obama-style CER, powered by the same mindset as Dartmouth and NICE, is headed.  Last month, Serious Medicine Strategy took note of recent moves by the Obama administration to eliminate federal approval for the anti-breast cancer drug Avastin, on the ground that it costs too much, despite its demonstrated efficacy.  The headline atop the editorial page of The Wall Street Journal last month got right to the point: “The Avastin Mugging.”  

It’s not possible to settle here the debate over the right way to treat breast cancer, any more than it is possible to settle the debate over prostate cancer.  But by the same token, it also won’t be possible for the federal government, either, to settle these debates--because people don’t trust the feds.  And so CER is effectively crippled, because people don’t trust the motives of CERites.   In a democracy, the government doesn't get far, not fo long, without the consent of the governed.  

Unfortunately, the Times editorial didn’t address any of those legitimate concerns, nor even report on the controversies.   

As noted at the beginning of this piece, CER depends on trust.  CERites are the would-be equivalent of Platonic Guardians in the medical world.   To borrow the famous critique of Plato by the Roman poet Juvenal, who asked of Plato's idea, "But who will guard the guardians?"we can ask, in our time, “Who will mediate the medicators?”  Because while CER is a good idea, in theory,  it sure seem as if the CERites, and their editorializing advocates, need to be closely mediated, in practice.  

Healthcare--a source of jobs for the future.

From Fortune magazine's John Bedecarre and Scot Olster. 

Healthcare as an economic driver

Reprinted from my posting to Politico's Arena:

It’s noteworthy that of the 67,000 new jobs created in August, 28,000 were created in the  healthcare sector--that’s 42 percent of the total.  Intuitively, we know healthcare is a natural economic engine--we have an aging population, desirous of more medical services.  And all that cash sitting on the sidelines, waiting to buy something worth buying!

Indeed, since most affluent countries around the world share the same graying demographic, so if the US had wanted to, we could have expanded our healthcare sector to better serve the world--and thereby expanded jobs on the homefront.  

In other words, we could be seeing a lot more job growth in the health sector than we are. And yet curiously, the Obama administration spent the first 14 months of its existence pushing for healthcare insurance, which, by its own declaration, was aimed at reducing costs--that is, shrinking the healthcare sector.  As Obama himself said in July 2009, his “bottom lines” were two: “Does this bill cover all Americans?  Does it drive down costs in the public and private sector over the long term?”

Despite Obamacare’s best efforts at rationing--which, admittedly, are just getting started--healthcare is still a growth sector.   But US healthcare is much smaller today than it would have been if the natural forces driving its growth had been encouraged and channeled toward productive technological improvement, e.g. better medicine and cures.  If Obama had gone that Hamiltonian route, his healthcare plan would, of course, have been much different--and much more popular.  And, in addition, it would be driving a much stronger economic recovery.

Macroeconomic Theory vs. Microeconomic Reality--Guess which one fosters more Serious Medicine?

What should be the focus of our economic policy?  Should it be tangible things, or intangible things?  For too long, SMS believes, Washington policymakers have preferred to think about the gauzy big picture, where grubby realities are veiled behind abstractions; thus policymakers, enthroned in marble palaces, can contemplate numbers and theories, not human beings and reality.   And if this policy bias--an emphasis on grand financial flows, as opposed to mere working and making--just happens to serve the interests of the rentier class, well how 'bout that?  That is, if the bubblemakers and bailouteers prefer Alan Greenspan or Tim Geithner to some manufacturer or wholesaler, maybe that’s not such a coincidence that top officials have thought about finance, not about logistics.  

Yet now that we have seen the damage we have done by an over-reliance on the FIRE sector (Finance, Insurance, and Real Estate) we can conclude that what’s needed, instead, is a granular sense of how physical things get made--even if that means someone's fingernails might get dirty.  We need a more practical emphasis on fostering a climate where more physical things get made, and consumed, for the betterment of our economy, and of our health.

Richard A. Epstein, a professor at NYU and the University of Chicago, as well as a fellow at the Hoover Institution, also finds time to writes for Forbes, where today he delivered a sharp critique, "Our Macroeconomic Fetish," aimed straight at the the macroeconomic theorizing of Paul Krugman and Laura Tyson, who have argued, repeatedly, that the deficit should be larger, in the name, of course, of economic stimulus.  As Epstein puts it:

Unfortunately, both eminent economists keep their heads in the clouds when they ought to plant their feet on the ground. Start with their odd definition of success. The unemployment rate is higher now than it was when the stimulus program began. The secret of our success, evidently, is that the number of unemployed did not go higher still. By dumbing down the definition of success, it becomes impossible for any stimulus program to fail, so long as there is some scenario worse than the one we had, which there always is. By that generous definition, no market has ever failed no matter how dismal its results.

The situation is only worse because while our Keynesian disciplines preach the need for more stimulus now, they offer no explanation as to how much stimulus is too much. The law of diminishing returns applies to every known human activity, including government decisions to prime the pump. Yet both Tyson and Krugman give us no hint about when to quit or why.

After dismissing Krugman, Tyson & Co. Epstein moves to his own prescription, which includes familiar calls for tax cuts, and then an unfamiliar emphasis on microeconomics. As in, macroeconomic theorizing back and forth is important, although just as the left is prone to think that any spending is good, so the right is prone to think that any tax cut is good.    But what matters most to Americans is whether economic condition are such that an entrepreneur feels inspired to invest and create jobs--in the United States.    Not paper profits on Wall Street, not jobs in China, but jobs here in the US.   

Epstein cites three microeconomic projects--housing, the labor force, and medicine.  But as he writes, we should, 

Start with the pharmaceutical and medical device industries, which are beset by an aggressive Food and Drug Administration that thinks that the path to public safety is to raise as many obstacles to the introduction of new drugs and devices as it is humanly possible to design. Longer clinical trials are only the first stage. Silly conflict of interest rules that lead to bad risk assessments is yet a second.

These policies are in turn complemented by the Obama administration's endorsement of extensive tort liability for products that comply with all FDA-mandated warnings, and attacks on the patent protection currently offered existing and new molecular compounds. The pharmaceuticals industry today is consolidating and downsizing. Effect on growth and jobs: negative.

The impact on jobs is negative, and so is the impact on our health.   And as Will Durant said, "The health of a nation is more important than the wealth of a nation." 

No news is bad news on Alzheimer's Disease--but that's no reason to give up.

The above headline, "Years Later, No Magic Bullet Against Alzheimer's Disease," doesn't quite do justice to the grim gist of Gina Kolata's report in The New York Times.   The truth is that we have barely any bullets at all against AD--and we're not even remotely sure if any those bullets can reach the target.

As Kolata makes clear, describing the work of a medical "jury" convened by NIH to consider the status of AD treatment:

“Currently,” the panel wrote, “no evidence of even moderate scientific quality exists to support the association of any modifiable factor (such as nutritional supplements, herbal preparations, dietary factors, prescription or nonprescription drugs, social or economic factors, medical conditions, toxins or environmental exposures) with reduced risk of Alzheimer’s disease.” 



“I was surprised and, at the same time, very sad” about the lack of evidence, said Dr. Martha L. Daviglus, the panel chairwoman and a professor of preventive medicine and medicine at the Feinberg School of Medicine at Northwestern University. “This is something that could happen to any of us, and yet we are at such a primitive state of research.”

To sum up: There's "no evidence" that anything we are doing to forestall or treat Alzheimer's is working.  And the chair of a panel analyzing the evidence calls the state of our effort "primitive." This chart, also in the Times story, sums it up:

This lack of any real good news on AD is a little disheartening, to be sure, but there's not reason to be permanently disheartened.  Science may be the closest thing we have to a free lunch, but it's still not free. And certainly never easy.

Remember the confident predictions of a half-century ago?   We were supposed to have established lunar colonies by now, and been to Mars and back.   We can still get to space in a big way--or achieve a hundred other worthy objectives--but we do have to try.

Adam Keiper, editor of The New Atlantis and 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.

But Americans--most of them--do agree with him on HESC.  For example, 52 percent of Americans think that there should be "fewer or no restrictions" on HESC, according to Gallup, compared to 41 percent who say that there should be the same restrictions or no funding at all.  That's not a huge spread, but it's a spread.   And as noted yesterday, 59 percent of Americans find HESC "morally acceptable,"according to Gallup--that's another good number, from Obama's point of view.  

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.