Healthcare spending in the developed world is going through the roof. Big business and bad diets are getting the blame. But the taboo truth is we are all getting sicker, says Eamonn Dywer, and medicine itself may be responsible.

As Obamacare wheezes its way over the finish line, a pro-market British think tank has opened the battle lines on health care costs at home.

“The NHS should not be immune from the drive to cut public spending,” the report said, and suggested slashing beds by 25 per cent.

Under New Labour, NHS spending had ballooned from £35 billion to over £104 billion. Yet perversely, polls have found people do not believe this has improved the delivery of health care.

The disparity between increased spending and standstill service delivery has been blamed on parasitic pen pushers and middle managers. When politicians talk about cuts to the NHS they allude to a magic scalpel that razors away the fat and leaves the muscle lean. Undoubtedly, disasters such as the NHS IT system (£12 billion pissed down the drain and counting) and billions more on consultants have made the NHS much less efficient. Because the NHS is free at the point of use, we tend not to think of it in terms of healthcare costs.

However, in real terms, healthcare costs have been rising worldwide. In America, spending on health care now represents 16 per cent of GDP. Obama’s stated aim in passing health care reform was targeting spiralling costs.

The poison diets and ageing population of the developed world are important factors in this. But one of the reasons for increased spending on medicine is counter-productive. The more advanced medicine becomes, the more it costs. Let’s say a procedure becomes cheaper; more people can afford it, and costs can actually increase overall – a kind of Jevon’s Paradox. While individual procedures and treatments may become cheaper or more efficient over time, as medicine finds ways of treating conditions that were previously untreatable, overall costs increase.

But one underlying reason for rising health care costs is taboo: as a result of over a century of advanced medical intervention, we are becoming more genetically unfit.

A bitter pill to swallow

Take Type 1 childhood diabetes. Untreated it is a lethal condition, causing diabetic kino-acidosis. In 1922, in one of the most famous moments in medical history, the inventors of insulin injected 50 dying children on a ward. So dramatically effective were the results that ‘before they had reached the last dying child, the first few were awakening from their coma, to the joyous exclamations of their families.’

As a result of insulin’s discovery, sufferers can live a full reproductive life. What was once a death sentence is now an inconvenience. Unfortunately, susceptibility to the disease is genetically inherited, and it has grown increasingly prevalent over the 20th century. In America, an estimated 5-10 per cent of the population now have diabetes. It is arguable that at least a factor in this increase is ‘genetic drift’ – the process whereby inherited characteristics neutral to selection become increasingly prevalent.

W.D. Hamilton, one of the 20th century’s leading geneticists, was deeply concerned by the rise of diabetes and other genetically inherited diseases. In his essay The Hospitals Are Coming, he took these concerns to their natural conclusion:

“If everyone was diabetic, the operatives in the factory making insulin had better not join in any general strike or they may end up killing themselves along with the rest of us. In the midst of such a crisis, the only survivors would some lucky people on a South Pacific island who had never had any medical attention and so were still competent.”

The issue with rising healthcare costs is that there is literally no limit to them. In Hamilton’s nightmare vision of a genetically unchecked future, he imagines a global economy that has become a planetary hospital, a ‘super organism’, in which the least feeble and sick are the orderlies and technicians.

The counter to this argument is exemplified by Richard Dawkins’ The Extended Phenotype. Dawkins rejected his academic ideologue’s pessimistic view. Inasmuch as a beaver’s dam is an expression of a beaver’s genes, medical infrastructure is an expression of mankind’s genes. We may be becoming more ‘genetically unfit’ if we view our health stripped of hospitals and medication, but why make the distinction? Dawkins would argue the caesarean section is as much an expression of our genes as the natural birth.

But what can stop the increasing portion of the economy dedicated to tending to increasingly ill patients? Dawkins would argue that we will find technical solutions to genetic crises. Along with geneticists like John Maynard Smith, they point to hypothetical ‘germ-line’ solutions in which boffins correct dangerous mutations and maintain the fitness of the human race.

Technological breakdown

There are however, a huge number of obstacles to gene therapy. Scientists have now been trying for decades to discover the genetic causes of diseases. What they have found is that in almost no cases are single genes responsible for traits. Even popular science writer Steve Jones, President of the Galton Institute (formerly the Eugenics Society) has abandoned hope of discovering more than a tiny portion of life’s secrets from our genes.

By definition, if we can’t work out the language that life has been coded in, we cannot hope to programme it ourselves.

While these science-fiction, techno-fix solutions remain so much hot air, the reality of rising healthcare costs continues unimpeded. The obvious solution, which Hamilton openly supported, is some form of eugenics. It’s a word that almost immediately evokes Nazi death camps. Yet before the Second World War, prominent members of the Eugenics Society included John Maynard Keynes and Neville Chamberlain. It was common among intellectuals on the left to ruminate on the future genetic stock of their ‘race’.

Of course, ideas of racial purity and superiority have become hopelessly outmoded. Indeed, Hamilton argued for interracial marriage as way of improving the human race’s fitness. But the basic, intuitive premise of eugenics remains relevant. With the removal of natural selection from our species, what ‘other processes that are more merciful and not less effective’ shall we replace it with?

Modern eugenics is not just restricted to China. It is carried out on a daily basis in the developed world. The vast majority of women whose foetus shows susceptibility towards Down’s syndrome opt to end the pregnancy. It is common for Jewish couples to take genetic tests before marriage – and to call off the nuptials if they don’t get the all clear. Both are classic examples of negative eugenics.

Nor is it a modern solution; the pre-Christian peoples of the Inuit, the Native Americans, and the Sami people of the North had stable, healthy populations. Missionaries were horrified to find they would kill unwanted or sickly babies through exposure.

As someone concerned with unprecedented near-term catastrophes such as Peak Oil, climate change and overpopulation, I think we have much more pressing crises to solve than the long-term health of the species. But the designers of the permanent societies of tomorrow need to think seriously about how they can break the arms race between modern medicine and genetic deterioration. If you believe advanced technology is not the answer to all our problems, then you may need to find solutions that seem unpalatable to our society of today.

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