May 26 JDN 2460457
The following vignettes are about me.
Well, one of them is about me as I actually am. The others are about the person I would have been, if someone very much like me, with the same medical conditions, had been born in a particular place and time. Someone in these times and places probably had actual experiences like this, though of course we’ll never know who they were.
976 BC, the hilled lands near the mouth of the river:
Since I was fourteen years old, I have woken up almost every day in pain. Often it is mild, but occasionally it is severe. It often seems to be worse when I encounter certain plants, or if I awaken too early, or if I exert myself too much, or if a storm is coming. No one knows why. The healers have tried every herb and tincture imaginable in their efforts to cure me, but nothing has worked. The priests believe it is a curse from the gods, but at least they appreciate my ability to sometimes predict storms. I am lucky to even remain alive, as I am of little use to the tribe. I will most likely remain this way the rest of my life.
24 AD, Rome:
Since I was fourteen years old, I have woken up almost every day in pain. Often it is mild, but occasionally it is severe. It often seems to be worse when I encounter certain plants, or if I awaken too early, or if I exert myself too much, or if a storm is coming. No one knows why. The healers have tried every herb and tincture imaginable in their efforts to cure me, but nothing has worked. The priests believe it is a curse from the gods, but at least they appreciate my ability to sometimes predict storms. I am lucky that my family was rich enough to teach me reading and mathematics, as I would be of little use for farm work, but can at least be somewhat productive as a scribe and a tutor. I will most likely remain this way the rest of my life.
1024 AD, England:
Since I was fourteen years old, I have woken up almost every day in pain. Often it is mild, but occasionally it is severe. It often seems to be worse when I encounter certain plants, or if I awaken too early, or if I exert myself too much, or if a storm is coming. No one knows why. The healers have tried every herb and tincture imaginable in their efforts to cure me, but nothing has worked. The priests believe it is a curse imposed upon me by some witchcraft, but at least they appreciate my ability to sometimes predict storms. I am lucky that my family was rich enough to teach me reading and mathematics, as I would be of little use for farm work, but can at least be somewhat productive as a scribe and a tutor. I will most likely remain this way the rest of my life.
2024 AD, Michigan:
Since I was fourteen years old, I have woken up almost every day in pain. Often it is mild, but occasionally it is severe. It often seems to be worse when I encounter certain pollens, fragrances, or chemicals, or if I awaken too early, or if I exert myself too much, or when the air pressure changes before a storm. Brain scans detected no gross abnormalities. I have been diagnosed with chronic migraine, but this is more a description of my symptoms than an explanation. I have tried over a dozen different preventative medications; most of them didn’t work at all, some of them worked but gave me intolerable side effects. (One didn’t work at all and put me in the hospital with a severe allergic reaction.) I’ve been more successful with acute medications, which at least work as advertised, but I have to ration them carefully to avoid rebound effects. And the most effective acute medication is a subcutaneous injection that makes me extremely nauseated unless I also take powerful anti-emetics along with it. I have had the most success with botulinum toxin injections, so I will be going back to that soon; but I am also looking into transcranial magnetic stimulation. Currently my condition is severe enough that I can’t return to full-time work, but I am hopeful that with future treatment I will be able to someday. For now, I can at least work as a writer and a tutor. Hopefully things get better soon.
3024 AD, Aegir 7, Ran System:
For a few months when I was fourteen years old, I woke up nearly every day in pain. Often it was mild, but occasionally it was severe. It often seemed to be worse when I encountered certain pollens, fragrances or chemicals, or if I awakened too early, or if I exerted myself too much, or when the air pressure changed before a storm. Brain scans detected no gross abnormalities, only subtle misfiring patterns. Genetic analysis confirmed I had chronic migraine type IVb, and treatment commenced immediately. Acute medications suppressed the pain while I underwent gene therapy and deep-effect transcranial magnetic stimulation. After three months of treatment, I was cured. That was an awful few months, but it’s twenty years behind me now. I can scarcely imagine how it might have impaired my life if it had gone on that whole time.
What is the moral of this story?
Medical progress is real.
Many people often doubt that society has made real progress. And in a lot of ways, maybe it hasn’t. Human nature is still the same, and so many of the problems we suffer have remained the same.
Economically, of course we have had tremendous growth in productivity and output, but it doesn’t really seem to have made us much happier. We have all this stuff, but we’re still struggling and miserable as a handful at the top become spectacularly, disgustingly rich.
Social progress seems to have gone better: Institutions have improved, more of the world is democratic than ever before, and women and minorities are better represented and better protected from oppression. Rates of violence have declined to some of their lowest levels in history. But even then, it’s pretty clear that we have a long, long way to go.
But medical progress is undeniable. We live longer, healthier lives than at any other point in history. Our infant and child mortality rates have plummeted. Even chronic conditions that seem intractable today (such as my chronic migraines) still show signs of progress; in a few generations they should be cured—in surely far less than the thousand years I’ve considered here.
Like most measures of progress, this change wasn’t slow and gradual over thousands of years; it happened remarkably suddenly. Humans went almost 200,000 years without any detectable progress in medicine, using basically the same herbs and tinctures (and a variety of localized and ever-changing superstitions) the entire time. Some of it worked (the herbs and tinctures, at least), but mostly it didn’t. Then, starting around the 18th century, as the Enlightenment took hold and Industrial Revolution ramped up, everything began to change.
We began to test our medicine and see if it actually worked. (Yes, amazingly, somehow, nobody had actually ever thought to do that before—not in anything resembling a scientific way.) And when we learned that most of it didn’t, we began to develop new methods, and see if those worked; and when they didn’t either, we tried new things instead—until, finally, eventually, we actually found medicines that actually did something, medicines worthy of the name. Our understanding of anatomy and biology greatly improved as well, allowing us to make better predictions about the effects our medicines would have. And after a few hundred years of that—a few hundred, out of two hundred thousand years of our species—we actually reached the point where most medicine is effective and a variety of health conditions are simply curable or preventable, including diseases like malaria and polio that had once literally plagued us.
Scientific medicine brought humanity into a whole new era of existence.
I could have set the first vignette 10,000 years ago without changing it. But the final vignette I could probably have set only 200 years from now. I’m actually assuming remarkable stagnation by putting it in the 31st century; but presumably technological advancement will slow at one point, perhaps after we’ve more or less run out of difficult challenges to resolve. (Then again, for all I know, maybe my 31st century counterpart will be an emulated consciousness, and his chronic pain will be resolved in 17.482 seconds by a code update.)
Indeed, the really crazy thing about all this is that there are still millions of people who don’t believe in scientific medicine, who want to use “homeopathy” or “naturopathy” or “acupuncture” or “chiropractic” or whatever else—who basically want to go back to those same old herbs and tinctures that maybe sometimes kinda worked but probably not and nobody really knows. (I have a cousin who is a chiropractor. I try to be polite about it, but….) They point out the various ways that scientific medicine has failed—and believe me, I am painfully aware of those failures—but then where the obvious solution is to improve scientific medicine, they instead want to turn the whole ship around, and go back to what we had before, which was obviously a million times worse.
And don’t tell me it’s harmless: One, it’s a completewaste of resources that could instead have been used for actual scientific medicine. (9% of all out-of-pocket spending on healthcare in the US is on “alternative medicine”—which is to say, on pointless nonsense.) Two, when you have a chronic illness and people keep shoving nonsense treatments in your face, you start to feel blamed for your condition: “Why haven’t you tried [other incredibly stupid idea that obviously won’t work]? You’re so closed-minded! Maybe your illness isn’t really that bad, or you’d be more desperate!” If “alternative medicine” didn’t exist, maybe these people could help me cope with the challenges of living with a chronic illness, or even just sympathize with me, instead of constantly shoving stupid nonsense in my face.
Not everything about the future looks bright.
In particular, I am pessimistic about the near-term future of artificial intelligence, which I think will cause a lot more problems than it solves and does have a small—but not negligible—risk of causing a global catastrophe.
I’m also not very optimistic about climate change; I don’t think it will wipe out our civilization or anything so catastrophic, but I do think it’s going to kill millions of people and we’ve done too little, too late to prevent that. We’re now doing about what we should have been doing in the 1980s.
But I am optimistic about scientific medicine. Every day, new discoveries are made. Every day, new treatments are invented. Yes, there is a lot we haven’t figured out how to cure yet; but people are working on it.
And maybe they could do it faster if we stopped wasting time on stuff that obviously won’t work.
Human Economics 