Too much time on my back

I’m waiting for muscles in my back to calm down. While I’m
waiting my mind has been turning around ideas about what I think the future
will hold. The result is far-out, but I swear I’m not on anything stronger that
Advil.

Look good, feel good, live forever

I have quoted the phrase above from Leonard Schaeffer,
CEO of WellPoint, before. He claims that, from what he sees thousands of health
insurance customers demanding, he thinks “look good, feel good, and live
forever” describes the full domain of what people want. Health professions have
concentrated in the past on the second one: feel good. Most physicians,
academics, health policy wonks would still define health as the amelioration
and defeat of diseases that seriously compromise normal functions or end life.
Genetic abnormalities, infection, tumors, deterioration, trauma all still
constitute the front line of health issues. Since those things have not been
mastered, they will remain high priorities.


Nevertheless, the other two seem to be coming on pretty
strong. Schaeffer would say the trio really defines what people deeply desire.
Increasingly a wide variety of what has been considered cosmetic, vanity
procedures are being routinely sought. We now have entertainment from “extreme
makeovers” of homes and of people. In my own family a 40-year-old, single-mom
recently had major refurbishing by elective, uninsured surgery. I’m wondering
if she’ll have more at 60. And her very attractive daughter wants, for high
school graduation, surgery to correct a less than flattering bump in her nose.
What will another 20 or 30 years draw her to?

While many will criticize the expansion of enhancement, I
suspect that in the long run the marketplace will prevail. There is no culture
that believes more strongly than American culture that your birth condition or
even your current condition is not your destiny. You can be more; you can have
more. People will get what they’re willing to pay for. Indeed, our economy
thrives on free market choice and people indulging their impulses. Buy now, pay
later; “you’re worth it,” “just do it,” and on, and on, and on. We live in a
culture saturated with messages to go ahead and indulge that impulse, have what
you want financed at low, low interest rates.

Yesterday I heard something pretty funny. Two California
legislators are introducing a law to keep Californians from suing fast food
companies for getting fat. They say people need to exercise some
self-responsibility and self-restraint. I say if people bought only what they
absolutely need our economy would implode like a black hole. And haven’t they
heard: “its good to be full.” They can’t be serious.

The third item, “live forever,” was outside the bounds of
health care and reasonable thought until just recently. Despite legendary
quests for fountains of youth and the like, scientists and doctors assumed
death was inevitable. But more recently that assumption is being challenged.
The question is: Why don’t people live forever? If there is a limit,
what is it? Can it be changed? We have discovered that it is impossible to
travel faster than light because of a fundamental law of the universe, but
nobody’s discovered a similar absolute reason for death. We don’t expire like a
driver’s license. We don’t have a “spark of life” that inevitably sputters out.
It seems that death comes as a result of concrete physical changes. We die for
cause. Now, instead of just researching how to ameliorate the effects of age,
scientists are seriously studying the molecular basis of aging and death.

What strikes me, as someone who’s looked at cancer many
years, is that perhaps the biology of aging is on about the same order of
complexity as cancer. We have a long ways to go before we understand the
molecular complexity of cancer enough to master it, and when we do I suspect we
will have a great deal of the knowledge we need to understand the molecular
mechanisms of aging and death. Cancer remains dauntingly complex, but we’re not
giving up. I think the same thing is beginning to happen with aging.

So I think in the US—and in the rest of the growing,
worldwide consumer economy—people will explore the outer limits of what they
can do…and afford. Indeed, both “look good” and “live forever” will be economic
choices as much as medical choices. People will need to decide how much they’re
willing to pay for it, or what they’re not going to buy to get it. A full body
makeover—not an “extreme” makeover—probably costs about as much as a good
family sedan. So which do you want?

In the future, health—in the broader consumer sense of
health—may not be a matter of what’s possible but what’s affordable. Just how
“healthy” can you afford to be? (Actually, we’re already pretty close to that
kind of health care now.) How long can you afford to live? What other
goods will you give up to look better, feel better, and live longer? How much
of your lifetime wealth will you allocate to those things?

Will we move toward those outer boundaries? Well, I think
so. People don’t want to die, and humanity will keep spending and researching
until we’ve determined whether or not immortality is possible. I doubt we’ll
have the answer and the means in the next couple of decades to defy death as
some project, but I think a huge part will be detailed out in the 21st
century because of what I think of as “The Perfect Storm.”

Several factors are converging right now that will drive
enormous exploration of what’s possible with human mechanics. Firstly, here is
the US there is the massive baby boom population heading toward old age. But
this is a generation that will scarcely acknowledge that it’s not young
anymore. We’ve got 60-year-old rockers still prancing around on stage, wrinkled
as prunes, screaming, “Ah can’t get no sat-iss-fak-shun!” Secondly, that
generation has very large amounts of money and a proclivity to spend it. I
suspect that baby boomers, by and large, are willing to spend whatever it takes
to “look good, feel good” etc. The tradition of holding on to wealth to leave a
legacy seems to be dwindling. Finally, we have a massive medical/technological
industry gearing up to provide a cornucopia of products and devices to satisfy
the late-in-life desires of boomers. The wealth of boomers will drive forward
research and technology on the three consumer-driven fronts I’ve been talking
about. A huge amount will be accomplished in the next four to five decades
before the last of us boomers topple into the grave…or the cryo-tank.

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