Alan E. Nourse - The Bladerunner (10 page)

Long ago now, Doc thought, and still the bitterness and pain. It was easy, now, to blame the Natnrists, but they were by no means the only ones. In those days the whole country was aflame, and the Naturists only a tiny segment of the rioters. By the late 1980s the health care in the country had reached a point of no return—a point at which something desperate was bound to happen. For over a decade the stage had been set, with full-scale government-subsidized medical insurance providing care not only for the poor, the aged, and the medically handicapped but for everyone else as well. At the same time medical research, with massive federal assistance, had blossomed as never before. The new cancer vaccines, although no cine for malignant diseases, helped immensely to prevent them, while newly discovered drugs prolonged the lives of late-stage cancer victims. With the problem of rejection finally conquered, organ transplants had become commonplace, providing ever-better control of such notorious killers as coronary artery disease and kidney disease. Above all, a greater understanding of bio-feedback mechanisms to counteract physical and emotional stress led to real hope that the aging process could be blocked, and the practice of gene manipulation promised to help increase longevity and avoid genetic proneness to a multitude of diseases-. By the early 1980s even the most conservative medical authorities were predicting that an average human life span of 120 years might be achieved by the turn of the century, and more and more young doctors were turning their interest and energies toward research and away from the treatment of individual sick patients.

As a young, solo family practitioner in the early 1990s Doc had seen the pattern of chaos developing all too clearly. He had been proud of the sign on his door announcing
JOHN F. LONG, M.D., GENERAL MEDICINE
even when almost half his practice time was occupied filling out dreary Medicare forms in quadruplicate, seeking to justify to the federal agencies the studies, treatments, and medications he wanted to prescribe for his patients. But already obvious to him was the ever-increasing number of aged patients passing through his doors. At the same time he was more aware than many of the subtle shift of political power to help maintain the aged in physical comfort and good health in their ever-lengthening sunset years. Political leaders clearly recognized the blossoming power of Senior Citizens' lobbies, and enacted multitudes of costly old-age benefit programs to be financed by taxing the young and producing members of society. At the same time there was a steady loss of interest in population-control programs as the elderly, conservative, status quo attitudes prevailed. Of course it was inevitable that, while health care facilities became more and more widely available to all, the quality of the medical care delivered became increasingly poor, with huge crowds holding the clinics open until late at night, the endless waits to be seen by a doctor—
any
doctor—and the sad but inescapable depersonalization and computerization of medical care as sick people found it ever more difficult to achieve the close doctor-patient relationships once so important to good, concerned medical care. In response to this, an aging national legislature began a vast shake-up of the federalized health control facilities, seeking to triple the number of doctors, establish more family consulting units and provide more doctor-patient contact—a program which, although theoretically achievable, promised to double once again the already staggering cost of government health care services in the nation.

It couldn't go on like that, of course. If Doc in his simple office had foreseen a breaking point ahead, the nation's leaders had foreseen it even more clearly. By late in 1992 several disturbing facts began to surface in the national administration and, by leaks, to an increasingly concerned and frightened public. With all the aging beneficiaries of the medical and geriatric programs, there was an alarming leveling-off of the national economy as an ever-smaller proportion of the population actually
produced
anything. Younger breadwinners were forced to shoulder the spiraling tax burden, yet the total tax revenues began to fall. Money became scarce, outdated medical equipment was continued in use, necessary hospital repairs were postponed, and new hospital construction rumbled to a halt. Perhaps most frightening of all was a secret economic study commissioned by the President, and then unaccountably leaked to the press, that contended that the whole national health care program, supposedly so well funded, was in fact approaching bankruptcy, and predicted that a massive economic breakdown would occur before the year 2010 unless some way could be found to halt the increase in population growth and curb expenditures on medical programs. With an aging Congress and national administration unable or unwilling to do anything to alter the developing pattern, there was a massive public outcry from the younger citizens, and scare headlines appeared in the news media across the country. One liberal Washington newspaper proclaimed:
REPORT PREDICTS DISASTER IN FIFTEEN YEARS; HEALTH SERVICES MAJOR FACTOR,
while a large midwestern paper reported
COMPUTER SAYS COUNTRY GOING BROKE
in two-inch banner headlines. At the same time, sporadic outbursts of violence began to occur, moving in an accelerating spiral into the full-blown national Health Riots of 1994.

It was a time of fear and anguish for the doctors and others involved in health care. Blamed for increasing health care costs, lack of concern, and inhumanity toward their patients, doctors became the scapegoats for an angry and vengeful public, with medical leaders all over the country the victims of public attacks by rioting mobs. An American Medical Association annual convention was mobbed by thousands of angry citizens and was forced to disband in a retreat that became a rout as police and National Guardsmen held back, fearful of involving an entire city in the conflagration. A major New York City hospital was invaded by a mob, the medical and nursing staff slaughtered, and the building set on fire, killing multitudes of aged patients unable to escape the inferno. Across the country, hospitals and clinic buildings were bombed, burned or occupied by renegade bands of reformers—and the cries of the Naturists, who advocated an end to all kinds of professional health care in a back-to-nature-and-home-remedies movement, were heard more and more loudly in the leadership of the rioting mobs. Ultimately the convulsive events involved virtually everyone. The stock market, long uneasy, dropped through the floor in a wave of emotional selling unequaled in sixty years. Labor unions threatened massive general strikes against excessive taxation and old-age benefit programs their workers were forced to support, and as unemployment rose, laborers and executives alike joined in the protest marches and riots aimed at the doctors.

It was in the midst of this accelerating turmoil that a small and mild-mannered man at a Midwestern university dropped a sociological bombshell that was destined to revolutionize the nation's entire concept of medical care in the space of a few short years.

Rupert Heinz was certainly an unlikely candidate for fame of any kind. Doc had met him once, as lecturer at a medical meeting: a shy, tweedy pipe-smoking man who was far happier working out biomathematical formulas in his dusty office at the University of Minnesota than giving lectures—or making headlines. Few doctors even understood clearly just what it was that a biomathematician did, and Heinz himself had trouble explaining —but years of statistical study of the occurrence patterns of certain diseases had led Rupert Heinz to a quietly frightening hypothesis: that the miracles of medical

progress in the nineteenth and twentieth centuries might, in some cases, have ultimately led to more human illness, rather than less.

An early study of Heinz's had dealt with diphtheria, a dangerous throat infection known for centuries as a destroyer, or crippler, of children. Commonplace in the early 1900s, diphtheria had killed as many as one out of every ten of its victims—until widespread vaccination of children in the 1940s and '50s had brought the disease almost to a standstill. A medical triumph, it had seemed, until sporadic outbreaks of a more virulent, drug-resistant form of diphtheria began striking adults in the 1970s, with antibiotic treatment now ineffective and the death rate rising to over 60 percent of all victims. Within another ten years widespread epidemics were sweeping the country and mass immunization campaigns were needed to damp the flame of a dreadful disease running wildfire through a population left naked of any natural resistance.

Rupert Heinz had analyzed this pattern and come up with a frightening thesis: that medical intervention
in itself
had contributed the lion's share to the massive spread of this virulent infection. Without immunizations earlier in the century, natural resistance would have kept the milder disease under control; now even a massive immunization campaign would be no more than a stop-gap, with horrible future epidemics to be expected as new virulent strains of diphtheria developed in the population. Heinz reported his predictions, almost apologetically, in an obscure scholarly journal, and there they remained, largely unnoticed, as the diphtheria epidemics raged on.

A second study, however, dealt with diabetes, and this time Heinz's findings could not be ignored. Throughout most of history diabetes had been a relatively uncommon affliction that was uniformly fatal for lack of any effective treatment. As a disease strongly in- '

fluenced by heredity, the fatal nature of diabetes served as a powerful limitation on its spread. Death often occurred during childhood, and even in adulthood the development of a pregnancy so greatly accelerated the destructive nature of the disease that few children were born of diabetic mothers. For centuries the disease, cause unknown, had remained stable and uncommon, a tragedy for those few who developed symptoms, but with very few of them passing the disease tendency on to their children.

The discovery of insulin in the early 1920s changed all that. For the first time, diabetes could be treated, and more and more victims survived long enough to have diabetes-prone children. By the time of his study in 1993, Rupert Heinz estimated that as many as 40 percent of the nation's entire population carried at least one part of the complex genetic linkage for diabetes, up from 37 percent just ten years earlier. Looking into the future, Heinz quietly predicted that, as a result of medical intervention in detecting and treating diabetes, as much as 85 percent of the population would be carrying some diabetic factors within another forty years, and that some 42 percent would be actively diabetic. His message was simple and to the point: keep treating diabetes the way it had been treated for three quarters of a century and
everybody
would be diabetic or diabetes-prone by the late part of the next century.

When news reporters picked up the story and accused Heinz of doom-singing and rabble-rousing, the man merely withdrew, refusing to discuss his work any further. He had evolved complex biomathematical equations predicting the spiraling incidence of the disease; he
knew
his findings were valid; but he had no solutions to offer. Inevitably his reticence was interpreted to mean that he was concealing something, and soon he was the focus of alarming newspaper headlines:
DOOMSDAY SCIENTIST REFUSES COMMENT ON WORK!

CAN DIABETES BE STOPPED? TOP EXPERT WON'T TALK!
As the storm raged Heinz withdrew still further, extending his studies to mental illness, ulcer disease, hypertension, cancer—the whole spectrum of illness that had been affected by medical intervention over the past centuries. And in each of these areas he found the overall occurrence of these diseases
steadily increasing
as a direct result of medical interference with age-old natural balances.

Of course, it was all only theory, the uncorroborated findings of one man working in a field of science that was inexact at best. For all of the scare headlines, Heinz's predictions might still have been ignored except for the interest of Charles Lafferty, a young sociologist eager to find a way around the grim pattern that Heinz had forecast. Working at Stanford, Lafferty began collaborating with Heinz to develop certain "solution constructs" that might be used to turn the course of history and prevent or minimize the medical and social disasters that Heinz's work predicted. Almost immediately the federal government classified this work as top secret and provided money for the development of a practical Eugenics Control program to curb the transmission of genetically linked diseases, even as the Secretary of Health Control and other official spokesmen were publicly scoffing at Heinz's predictions and denying the implications of his work. But within months Heinz and Lafferty reached a startling and unpalatable conclusion: that a eugenics program alone would not be enough to turn the tide. Even with compulsory sterilization of all victims of diabetes, schizophrenia and a dozen other heredity-connected diseases and the compulsory euthanasia of all identifiably defective babies, the destructive spiral would continue as long as widespread medical intervention continued. Only if
all
individuals who wished to have medical treatment were first sterilized was there hope that the spiral could be broken.

It was this staggering concept that Heinz and Lafferty finally settled upon as a tentative working approach. Eugenics control—weeding out defective genes—and a diminishment of medical intervention had to be inextricably tied together. Health care, in the form of government-run, tax-supported clinics, hospitals and medical staffs would continue to be available throughout the land, providing a high quality of medical care to every citizen, from cradle to grave, who could qualify. And qualification for that medical care would be simple and easy to achieve: the only requirement for treatment of any ailment would be that the patient first be sterilized. Those who wished to have children would, of course, be free to do so—at the sacrifice of any type of legal medical care. Once such a program was instituted, Heinz and Lafferty predicted, the economic crisis centering on health care delivery would be relieved almost immediately, and the program would show measurable eugenics effects within forty to fifty years. By that time it would also show measurable and beneficial impact on population curves; the population crisis would be over. If the program was ultimately applied on a worldwide basis, Heinz and Lafferty calculated, dependence on health care facilities would diminish to a bare minimum within a few decades and world population figures would ultimately be reduced by two-thirds.