Saturday, July 11, 2009

The Hills are Alive; or Organic Trans-Plants...

Penned June 25th, 2009

After twenty-seven years of perfectly satisfactory life in Canada, economic conditions led me pursue my career to the United States of America. To some, this may seem an act of hypocrisy, to others, a great opportunity, but to me it was just logical. I needed a stable job, and I got one. It just so happens to be in San Diego County, rather than the Kootenays or the BC mid-coast I would have preferred. So it goes.

Thus, I currently find myself in Palomar Mountain, California. Palomar Mountain rests about 45 kilometres northeast of, and about 1700 metres above San Diego. Palomar literally means ‘pigeon coop’, which is strange, since I have yet to see one on the hill, amid the healthy populations of turkey vultures, brown hawks, and bald eagles.

Other than the wildlife, there are several things of note on the mountain. One is Palomar Observatory, which houses the Hale telescope, which from 1948 until 1975 was the largest in the world (with a 5.1 m focal length!). The next is Palomar Mountain State Park, which offers fantastic views of the valley below, when it isn’t obscured completely by mist (which, in my opinion is more impressive, since the floor of clouds gives a decidedly heaven-like impression). The last is isolation, which draws the certain breed of people that give the town its unique cultural flavour.

On this topic, it should be noted that there aren’t many people on the mountain. Basically, the ten of us on this project from out of town represent about 5% of the population of the area. Of the permanent residents, only one is an attractive young lady, whose parents are missionaries and whose place of employment is the Christian Conference Centre a ways away. This could be a terribly long contract.

The remaining 199-odd residents fall into four general categories. The first is the true mountaineers, whose pappies were born on the mountain, grand-pappies were born on the mountain, great-grand-pappies were born on the mountain, great-great-grand-pappies were born on the mountain, and so on. A number of these families have been on Palomar for six generations, and have no intention of leaving.

The next group is retirees, who moved up to get away from the bustle of the city below. They are nice people, but are horrifically boring, enjoying mostly satellite television, and, well, that’s about it.

The third group is the weekenders, who live down in the city and come up Saturday morning for margueritas in the sun (it is sunny here 99.83% of the time- even at night). I would like to get to know some of these people more, so maybe we could arrange a time share. Then I could potentially take care of their house on the hill during the week, and when they come up on weekends, I could sleep in their place city-side at night, while lazing all day on the beach. No takers, so far.

The final, and by far most interesting group, are the crazies. Now, I don’t mean these people are bat-shit crazy, but they’re not just you and me crazy, you know? These are the kind of people that choose to live on a mountain because they are leery of society, and realize that you get much better rifle range from an elevated position. Now, these people aren’t essentially violent, but they do have a somewhat excessive fear of authority, and correspondingly vote for the Republican Party due to its doctrine of small government (while ironically pushing for stronger armies, and more cops on the beat). Far from being stand-offish, I’ve found these people to be the most willing to share their illegal fishing spots with me, an outsider, and are probably the ones best equipped to help me if I roll a vehicle into a ditch. The crazies, overall, represent probably 10% of the people on Palomar, but make up 90% of the character of the mountain. And Jim, for one, just happens to be one of these characters.

Jim is an engineer, of sorts. He originally studied physics, and later biotechnology at Berkeley. He has worked for numerous biotech firms, as well as running his own consulting company, and over his career has done numerous contracts for NASA, among other reputable organizations. His work is largely of the design variety: he makes metal bits that go inside people to make them better. There can be no doubt. Jim is brilliant.

When I first met Jim, he was drunk. Not plastered, but certainly good and drunk, what with some slight slurring, and excessive volume of speech. It was 9:30 am. He told me that though he had registered for the program for which I work, he had changed his mind, and no longer wanted in. He didn’t want any representative of the government on his property. I told him I understood, and we continued chatting a while about the role of the State, which led into a longer conversation about a number of topics. This eventually culminated in Jim showing me around his home office, a very impressive affair, which included a complete computer-controlled machine shop, a vintage radio (with jazz on), and a fridge full of Coors. He showed me the stupefyingly complex designs for his newest project, a prosthesis, designed to help those with musculature problems in their latter years. I was duly impressed.

Health sciences led to health care, and Jim and I got to talking about socialized medicine. Like many people on the mountain, Jim isn’t enthusiastic about the idea of publicly funded health care. Far from wanting to deny anyone access to services, he was concerned about people’s health being put in control of the government, the potential inefficiencies of such a system, and individuals’ ability to choose their physicians; the kind of arguments often heard regarding the topic. The kind of arguments that are getting thrown around quite a lot in America, these days.

Of course, the subject of health care is all the rage these days in the U.S. of A. President Obama is pushing for support in both Democrat and Republican camps to construct a universal health care system for the people of the United States. As a human being prone to reckless behaviour, I support this move, since as a US resident I am currently paying a stupid amount for health insurance. I assure you, it sucks.

What I question, however, about President Obama and his health care plan is the wisdom of his timing. Currently, in both Canada and the United States we are waiting on the wings of the largest relative retirement cohort in history. Now, I’m happy to see my parents’ generation take a break from middle managing and buying minivans, but what I’m not so stoked about is their general health. Of course, as people age their health tends to deteriorate. And as this happens, the costs to take care of them are bound to increase. Because of this, in every constituency of the OECD, health care costs are rising faster than the growth of the economy (even ignoring these current tough times). That means that soon, if not already, we will not be able to pay for the health care that the baby boomers require. This forces a real, honest to goodness dilemma. We either ring up unheard amounts of government debt (literally trillions in the US), or we limit the scope of our health care services, potentially leaving those with the most expensive services unassisted.

Now, I don’t want to see mine, or anyone else’s parents die. Death isn’t fun, and the void left behind by the departure of someone we love hurts, and never disappears as long as we’re around. But at the same time, it must be acknowledged that everyone certainly will die. We all want to have our families with us for as long as we can, but if we are spending literally hundreds of thousands of dollars, expending large amounts of scarce resources to extend someone’s life for just a few more years, we can justifiably start to wonder if maybe we could be saving a lot more people’s lives by investing those resources elsewhere. No one wants to think of it in these terms, but perhaps the greatest good isn’t served by trying to maximize people’s quantity of life just before the end.

I’m not going to question the use of ibuprophen for joint pain, or vaccinations for crippling diseases, or antibiotics for infections. I’m only calling for a reexamination of our desire to use medical skill and science to fight tooth and nail against the natural disposition of our bodies to break down as we age. I mean, we begin to age the moment we’re conceived, but from the age of eighteen onward, it’s a pretty much downhill battle. However, instead of living healthy lives to let our bodies do what they do best (which is live), we tend to ignore them until they start to fall apart at fifty or sixty, then expect our children to pay the debts for cobbling our bodies back together with artificial hearts, lungs and livers, because we feel entitled to live to eighty or more. To me it just doesn’t make sense. There has to be a breaking point. A point beyond which we have to say, ‘this is ludicrous’, and make some tough decisions. Tough decisions like the United States is facing right now. Like whether or not it should adopt a universal health care system, what form it will take, and how it is going to pay for it.

The tendency when weighing life versus dollars is to assume the former is sacrosanct and that the latter is ‘just money’. But the reality of the matter is that money and time are one and the same. Money isn’t free, and the time you dedicate to earning it comes at the expense of something else, like, for example, spending time with your family. So if you’re paying to extend dad’s life so you can spend more time with him (your family), but missing out on time with your children (your family) because you have to work more, is it really the best thing to do? What if you factor in the effect that extra work and financial stress has on your own life expectancy, and how that will affect the time you have with your family when you get old?

I’m certainly not saying that anyone should be denied a life-saving surgery because they don’t have the cash in the bank. That’s not fair, and in no way does it contribute to a happier, healthier or more functional society. But I do think that we should differentiate between true life-saving technologies, and life-prolonging ones, and use them accordingly.

These issues are never black and white, and the more you look into them, the greyer, and more muddled they become. I’m still a fan of universal health care, and I think there should be a strong social safety net to catch those who fall off the fringes of society. But I’m certainly concerned about what’s going to happen in the future given the rocketing cost of health care with an ageing population, and increased global economic constraints. Sadly, I have little expectation that there will be much health care accessible to me in my old age. I just don’t think there will be capacity bankroll it. The flipside of this coin is the impetus for me to actually take care of my body, and get as much life as I can out of it by giving it what it needs to do what it does best. I know it sounds crazy, but I’m going to eat right and exercise. I may not live to eighty, but that’s okay. I’m sure I’ll have a good run.

So in the end, I must admit that I’m opposed to what Jim is doing. And no, Jim isn’t making the next false kidney, or designing a drug to replace the spleen. I’m fact, Jim’s invention could neither be considered a life-saving, nor a life prolonging health care technology. So what is it that Jim is working on?

Jim is designing an artificial sphincter. That’s right, a device to keep human digestive wastes inside until an appropriate toilet can be reached. Prototypes are currently being tested on pigs, and, if successful, they will be available as implants for humans. Now, I want to deal with unwanted faeces as little as the next guy, but I’m concerned about what Jim is doing. Why?

I’m not opposed to Jim’s work based on any of the ideological or financial concerns raised above. I don’t feel that the invention will make people live longer lives than they are entitled to, nor am I afraid that artificial anuses will send the American empire into bankruptcy. No, my leeriness regarding Jim’s invention comes from a completely different place altogether. My issue is this: There are already so many regular assholes in the world today, I really don’t think there’s any need to be making more of them.

But then, I'm still young...

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