COMMENT ⊗   VALID 00003 PAGES
C REC  PAGE   DESCRIPTION
C00001 00001
C00002 00002
C00012 00003
C00013 ENDMK
C⊗;

			   MEDICINE


	I take the point of view that medicine is a technology like
transportation or manufacturing.  Its subject is the human body, and
because of the limitations of present science, medicine has concentrated
on the repair of the body.  From my more general point of view, I shall
consider medicine as concerned not only with the repair of the body but
with its improvement.

	From the individual point of view, the largest single complaint
about life is its shortness, and therefore lengthening life is the single
most important problem for medicine.  At present there is no obvious way
of raising the present 75 year normal lifespan even to 95, let alone
doubling it or multiplying it by ten.  However, the advance of biology may
well present humanity with such opportunities within 100 years.  Let me
express my personal disappointment that, contrary to my hopes when I was
young, this advance seems unlikely to occur within my lifetime.

	Incresed lifespan would undoubtedly present society with problems,
even assuming it accompanied by an equivalent expansion of the years in
which a person can work productively.  Many societies have been and are
dominated by the old to an extent that progress depends on their dying.
Democratic capitalist societies seem to have substantially solved the
problem in that neither the Presidency nor Congress nor the government or
industrial bureaucracy is dominated by the senile.  Socialist countries
have not solved the problem.  As far as I can see, Stalin, Mao and Ho Chi
Minh would still be the rulers of their respective countries if they were
still alive.  Gerontocracy in business is still common in the Far Eastern
capitalist countries, although their business practices don't seem to have
suffered from it yet to the extent that might have been expected.  My view
is that individuals will want long life so strongly that society will just
have to adjust itself accordingly when long life becomes possible, and
there is every reason to hope that this adjustment will be possible in
democratic societies without stifling progress.

****

	From this point of view, present medicine and almost all medical
research has one immediately obvious defect.  It is entirely concerned
with the repair of the human body and doesn't even notice the possibility
of making it better.  From the medical point of view, a human body has a
normal state, and the problem is to correct deviations from that state.

	Admittedly, present science doesn't seem to provide obvious
ways of making the body better than normal, and some of those advocated,
such as the drugs of the 1960s, had serious disadvantages.  However,
there has been an excess of regulation amounting to fanaticism.  For
example, before the abuses of the 1960s dexedrine was used for many years
to good effect by millions of people.  Many doctors will tell you in
private conversation that it can still be used to good effect and safely
to increase alertness and physical performance in many conditions.  Of
course, mistakes can be made and addictive personalities can become
addicted.  But the hysteria of the media - including the medical media -
and the government was unselective, and the benefits were lost.  The dogma
of normality played an important role in this.

	Here are some possibilities for improvement:

.item← 0
	#. A person should be able to monitor and control his blood
chemistry in order to improve his physical and mental state.  This
requires imbedded blood chemistry sensors with readouts on the
alread multi-functional digital wristwatch.  Beyond that he needs the
ability to cause substances to be injected into his blood and if possible
to be filtered out of his blood.  The control of the bloodstream should
be partly voluntary and partly automatic but under the control of the
user of the system.

	Perhaps we'll get blood chemistry control through the back door.
It will be devised for people whose immediate survival
depends on it, tested on their behalf and on them, eventually
become available for people with ordinary elevated blood pressure
and finally to everyone.  I suppose this isn't such a bad scenario.

	#. The concept of "medical advice" needs to be rehabilitated.
A doctor must be an advisor not a controller.  Therefore, the individual
needs to have direct access to medicine and medical devices.

	Of course, there are cases where the individual is physically
or mentally incapable of acting in his own best interests, so that
the policy I advocate will harm him.  However, the ideology is such
that the right of a person to control his body is not considered at
all as an independent consideration, and the individuals who have
died when they didn't go to the doctor but who might have lived
had they been able to buy the necessary drugs in the drugstore are
not charged against the current restrictive procedures.
[The slogan of control of one's own body is today advanced in the
single matter of abortion].

	I once asked a former FDA Commissioner at a public meeting
whether there was any evidence that the more restrictive prescription
policy in the U.S. had saved lives compared to the more relaxed
policies in Europe.  When he replied that there was no such evidence,
I was relieved to believe that the man's regulatory ethic was less
pervasive than I had believed.  Later I had second thoughts, speculating
that his answer was merely related to a conflict over turf between
the FDA and the doctors.   [OMIT]

	Note the ideological gimmick that is used.  Instead of asking
whether the individual has the right to buy a drug, the followers
of the regulatory ethic ``question'' whether the pharmacist or the
drug company should have the right to sell it to him.

	Perhaps the problem would be transformed by the development
of a miniature computer controlled home organic chemistry laboratory
that could manufacture on the spot any drug for which a synthesis had
been published.  A person owning such a machine could key in aspirin
or dexedrine or cocaine, and the machine would emit the pills after
a time.  Scary but better than the present situation.  As Jerry
Pournelle puts it, think of it as evolution in action.

	Helmholtz, the attached memory, merger with machines

	3. Climb Mount Everest or walk across the Arctic alone.

	4. Swim the Atlantic.

	5. Live 500 years.

	6. Run 25 miles to work in the morning in an hour and back in
the afternoon without being especially tired.

	7. Have the information in the Library of Congress as readily
available at any time as if one remembered it.