What Does Profound Stagnation Look Like?

Economic stagnation = no development of new goods and services. Stagnation in the field of health has been so long-lasting and widespread that it is hard to see. I have never read a good description of it. Michael Moore thought the state of our insurance coverage was scandalous, and made Sicko; but much more harmful is the stagnation.

Here is what it looks like. Americans have many health problems. Obesity. Diabetes, closely connected to obesity. Mental illness, especially depression. Drug and alcohol addiction, a kind of self-medication. Allergies and autoimmune disorders, such as arthritis. Economic progress, lack of stagnation, would be coming up with and disseminating effective solutions to these problems.

When a helpful innovation arises, what happens? As Jane Jacobs pointed out in The Economy of Cities (1969), stagnation is in the interests of the powerful. As long as things remain the same, they remain powerful. Power also generates complacency; although the most powerful have the most resources, they are unlikely to find or develop the solutions. (Example: General Motors.) Within the health industry, Harvard Medical School professors are powerful. Here’s what happened when Dr. Erika Schwartz gave a lecture there:

When I gave my lecture on bioidentical hormones at Harvard on February 2, 2009, . . . I asked the chairman of the department of ob-gyn, Isaac Schiff, MD and the rest of the physicians in the audience, “ How come Suzanne Somers and Oprah are the ones to teach the public about bioidentical hormones? What has the medical profession done with the information of the Women’s Health Initiative study?  Nine years later and women are still suffering and the medical establishment has not stepped up to the plate to help women find safe solutions to menopausal symptoms. Why are bioidentical hormones still controversial?” They had no answers.

That’s what stagnation looks like. It’s unsurprising that Oprah would publicize the innovation; her power is not in the health industry. She has nothing to lose. That Newsweek runs a cover story complaining about Oprah’s publicity for “risky advice” shows that top editors at Newsweek fail to see the stagnation in health. Innovations are always called “risky” by someone in power. Stagnation in health is probably the most important news story of our time. The health problems that have stacked up unsolved — obesity, mental illness, and so on — affect everyone every day.

Here’s another example of what stagnation looks like. The current Business Week cover story is about innovation, and the lack thereof. One of its examples involves health. What’s revealing is how minor the innovation is.

To see both the reality of the innovation shortfall and its potentially happy ending, look at Organogenesis, a small company in Canton, Mass. Back in 1998, Organogenesis received approval from the Food & Drug Administration to sell the world’s first living skin substitute. The product, Apligraf, was a thin, stretchy substance that could be grown in quantity and applied to speed the healing of diabetic leg ulcers and other wounds that had stayed open for years. . . But there were several big problems, recalls Geoff MacKay, the company’s current CEO . . . By 2002 the early enthusiasm for Apligraf had vanished, along with the money. . . .  Shortly after, MacKay took over at Organogenesis with a clear mandate to straighten out the company’s manufacturing, logistics, and sales, and turn this tarnished product into a moneymaker.

And that’s what he did. . . . Organogenesis is fulfilling the promise of 1998—a decade later.

A product that helps diabetic leg ulcers heal — without curing diabetes. In a cover story about innovation, a trivial innovation is the big example of successful innovation. This is another way stagnation is visible: Low standards for what is important innovation.

6 Replies to “What Does Profound Stagnation Look Like?”

  1. Seth,

    Many of the health problems you cite are themselves the result, or rather the undesirable side effects, of innovation. There has been no lack of innovation in reducing the price of pure carbohydrate delivered to the human bloodstream–the US has done a better job at it in the last few decades than Carnegie did with steel. Side effects of this innovation: obesity and diabetes. Similarly, there’s been tremendous innovation in the “purification” of our food, resulting in the loss of beneficial bacteria. Likely result: increased allergies and other maladies.

    Billions of dollars are invested annually in “curing” these diseases through “innovation.” The results may be disappointing so far, but that’s not the same thing as stagnation. The most elegant cures to these diseases would not be innovation, but rather innovation’s opposite: a return to the way we used to live before these diseases became epidemic (e.g. the other changes you’ve made to your diet other than SLD). True innovation should be in prevention. That’s much harder to do, and MUCH harder to monetize, and probably accounts for our lack of progress more than stagnation per se.

    If you want want to achieve innovation through prevention, maybe the place to focus on is the legal, tax, and regulatory side, which is how smoking was reduced in this country.

  2. Nadav, thanks for your comments. All those health problems are due to innovation. Go back 100,000 years, none of them existed, I’m sure. I fail to understand the difference between “lack of progress” and stagnation. I agree about prevention. I say just what you say: far too little emphasis on prevention. What you may not see is that prevention doesn’t require going backwards. There’s nothing ancient about drinking flaxseed oil as I do. Go back far enough people didn’t even eat fermented food — they just ate food that wasn’t fresh.

    While some prevention involves reducing or removing poisons (such as cigarette smoke), other prevention involves figuring out what are the necessary nutrients. No legal ruling or tax code change will be much help with that.

  3. Thank you for your reply, Seth. I think what I missed is that there is a difference between stagnation on the medical level and stagnation on the level of society as a whole.

    If you asked a medical researcher if we are living in an era of stagnation or innovation he/she would say “No way, we’re living in a golden age of innovation.” E.g. the new CEO of Organogenesis, or the psychiatrist you saw interviewed on Larry King who said today is the best time to have a mental illness because of all the breakthroughs.

    If you asked an average citizen whether we’re living in an age of stagnation or innovation, you’d get the opposite answer: “None of my eight great-grandparents were obese, so why am I and why can’t I lose weight? None of my ancestors ever heard about diabetes so why do I have it and why do I have so much difficulty living with it? My grandparents all had tough lives, while I grew up comfortably in the suburbs–so why do I get chronically depressed and they don’t?” Etc.

    I guess the difference is between inputs and outputs. Medical researchers measure innovation by measuring inputs–dollars invested in research, grants awarded, medicines approved, etc. Normal people care about outputs: how much sickness and suffering per capita persists?

    Now that I’m looking at it the right way, I see what you’re saying about Jane Jacobs (I would cite also Mancur Olson, a very Jacobs-esque economist). In the area of disease, we have stagnation/lack of progress because the medical establishment benefits greatly from the “spend a lot to cure/manage rather than a little to prevent” status quo.

    BTW, last Thursday I attended a talk in which Tyler Cowen addressed whether the internet was good for society. An audience member complained that the internet made people less healthy because it replaced exercise. Neither Tyler nor I had a chance to make an obvious counterpoint, which is that the internet also gives individuals tremendous opportunities to IMPROVE their health. Case in point: Seth Roberts and Tyler’s gums! The internet makes me optimistic that this medical stagnation can be addressed. If the internet could kill off most of America’s largest newspapers, whose founding families were as close to an aristocracy as we’ve had in this country, I believe it could also go up against the medical establishment.

    Sorry for the long comment.

  4. Although the public has been conditioned to believe that we are living in an era of perpetual ‘medical breakthroughs,’ in fact we are enduring a period of long-standing medical stagnation. Even the FDA has recently expressed alarm over the slow pace of new drug developments. Lupus, cystic fibrosis, multiple dystrophy, multiple sclerosis, type 1 diabetes, a host of autoimmune diseases, half of all cases of heart disease, and half of all cases of kidney failure are not only incurable but also not preventable by any lifestyle modifications. To take just the case of type 1 diabetes, insulin injection is a tragically ineffective treatment for this disease, but after more than 80 years of scientific development, this is still all that is available. But insulin was discovered several years before the first flight across the Atlantic, while we are now 40 years past the first landing of men on the Moon, and yet type 1 diabetic therapy has remained stagnant. Generally, if you compare the state of medicine 50 years ago with that of any other field of science or technology, you will find that medicine has progressed much more slowly than other areas.

    Obviously monetary interests have played a great role in this stagnation. The major pharmaceutical companies make huge profits by not curing anything, since while a cure can only be sold to patients once, an incompletely effective treatment can be sold again and again, generating profits forever from a captive patient population. Doctors also have a vested interest in not curing any diseases, since they make their money today primarily by ‘managing’ incurable illnesses. If innovation were not suppressed by the medical societies and their ally, the FDA, old doctors with established reputations would suddenly find themselves on an equal footing with everyone else just learning about some new treatment, and those now charging inflated fees for their superior experience with old treatments would lose their competitive advantage.

    The licensing restrictions for new drugs and treatments are also absurd, since they require any novel approach to disease to prove that it is ‘safe and effective’ before anyone is given the freedom to try it for himself. But since the current treatments for many serious diseases have already been proved to be unsafe and not very effective — such as insulin therapy for diabetics — why are patients being denied the freedom to control their own bodies, their own health, and their own chances of a better medical future by freely experimenting with new remedies whether some Washington bureaucrat has approved them or not? In a free country decisions about how you wish to preserve your heath or save your life should be up to you, not the government, especially when it is owned by the pharmaceutical intersts and the American Medical Association, whose massive campaign contributions have bought its obedience to them.

  5. Well put, Luitpoldt. I’m not sure I agree with your last paragraph, however. I believe all serious diseases from which Americans suffer, such as the ones you name, are due to the wrong lifestyle — e.g., the wrong diet. You don’t need FDA approval to change your diet. I don’t need FDA approval to try different doses of flaxseed oil or different amounts of fermented foods. Nor do their manufacturers need FDA approval to sell them. Nor do I need FDA approval to write about them.

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