Medicine, the final frontier?

By M.S.

IN A typically thought-provoking post, Kevin Drum suggests that contra the arguments of Tyler Cowen ("The Great Stagnation"), Neal Stephenson ("Innovation Starvation"), and Peter Thiel, the modern engine of technological discovery may not be running out of steam quite so fast. As Mr Drum writes, the strong version of the argument is that, whereas someone from 1890 would find everyday life in 1950 unrecognisable and startlingly futuristic, someone from 1950 would find everyday life in 2010 pretty much similar, with a bunch of tweaks and upgrades—with the sole exception of information technology. This, however, isn't necessarily the best way to look at things.

But although I've often thought about innovation this way too, the more I've chewed it over the more I've decided that it misses something. Most of the best known inventions of the early 20th century were actually offshoots of two really big inventions: electrification and the internal combustion engine. By contrast, the late 20th century had one really big invention: digital computers. Obviously two is more than one, but still, looked at that way, the difference between the two periods becomes a bit more modest. The difference between the offshoots of those big inventions is probably more modest than we think too. Just as we once made better and better use of electrification, we're now making better and better use of digital computing. And to call all these computing-inspired inventions mere "improvements" is like calling TV a mere improvement of radio. These are bigger deals than we often think. We have computers themselves, of course, plus smartphones, the internet, CAT scans, vastly improved supply chain management, fast gene sequencing, GPS, Lasik surgery, e-readers, ATMs and debit cards, video games, and much more.

It looks to me as though Mr Drum has actually missed something here that makes his case simultaneously better and strangely worse. There is another area where almost all the big technological revolutions have come since the middle of the 20th century: medicine. The situation with health care is almost the reverse of that with most other consumer technology. While someone from 1890 would have found a hospital in 1950 pretty much familiar, with a bunch of tweaks and upgrades, someone from 1950 would find a hospital today unrecognisable and startlingly futuristic. From widespread use of blood banks and antibiotics to defibrillators, epidural anaesthesia during delivery, heart surgery and angioplasty, laboratory diagnosis of viruses and bacterial infections, tumor biopsies and chemotherapy, and of course organ transplants, MRIs, and so forth, most of what we expect to see when we go to a hospital these days was developed in the second half of the 20th century. Not to mention the drugs we buy, both prescription and over the counter: birth-control pills, antihistamines, antidepressants, anti-retrovirals, et cetera. So in that sense the score would seem to be even at two-all: electrification and the internal combustion engine, versus digital computers and most of the technology of modern biomedicine.

The down side of this, however, is twofold. First of all, the pace of innovation in pharmaceuticals has slowed to a crawl. Antibiotics are failing to keep up with resistant bacteria: the FDA approved 16 new antibiotics between 1983-7, five between 2003-7, and two since 2008. A few weeks ago I spoke with the CEO of an information and publishing company that just sold its pharmaceuticals information arm; industry profits have fallen to the point where they didn't see any growth there any more. In that sense the pharmaceutical situation seems to support the stagnation thesis.

But at a deeper level, we tend to think about the growth of medical technology and the health-care industry differently than we do the growth of other sorts of technologies and industries. We celebrate the technological revolutions that shifted us from an economy mainly focused on getting enough food to eat well, to an economy focused on manufacturing technological goods that enabled us to live well. We're prepared to embrace robotics revolutions that shift us from an economy focused on manufacturing technological goods to one focused on paying other people to perform useful or entertaining services for us. But when it comes to medicine, we have mixed feelings. I'm happy that people today spend much more on cars, computers, clothes and entertainment than they do on food. I wouldn't be happy with an economy in which people spent more on health care than they do on cars, computers, clothes and entertainment. Perhaps it's because the most expensive health care is so often delivered in the last months of terminal illness, and doesn't seem to result in a high quality of life. But I'm not sure my distaste for the idea of an ever-expanding health-care sector is entirely rational. It's certainly logical that in an economy starved for demand, the most promising source might be the inexhaustible and doomed human desire for victory over death. Yet it also seems somehow perverse.