Sunday, December 30, 2012

Three Things We Don’t Know About Physics (I)

As a science fiction writer and a devotee of science, although an English major,1 I am a person of immense technological optimism. I believe that, for all the scientific understanding humanity has gained in the past couple of centuries, and all the technical advances that make our lives easier, better, and more powerful than those of previous high civilizations, we’re still only scratching the surface.

I’ve been involved in recent discussions on social media about this. When Facebook friends disagree,2 they point out that we understand a tremendous amount of what’s going on in the physical world, and that past revolutions have not so much been a true overturning of past knowledge as its refinement and deepening.3 In planetary motion—our view of the stellar and interstellar world out there—the work of 17th century geniuses Johannes Kepler and Sir Isaac Newton is still relevant and is only advanced by the work of Albert Einstein. In quantum theory—our understanding of the building blocks of energy and matter—the work of 20th century physicists Max Planck, Niels Bohr, Werner Heisenberg, and many others has yet to be superseded.

While I do not deny this, I’m still uneasy about the state of our knowledge in three basic areas: the nature of gravity, space, and time. We can use these terms in sentences; we understand and can measure their effects quite accurately; we can use the measurements in equations. But as to their essential nature, what they are, we are still in doubt.

I am not one of those who insist that some things humans were not meant to know, either because our minds cannot encompass ultimate reality or because the truth is reserved to a higher order of being. I do believe that our mind—which evolved over time in relation to our physical senses and the nature of the world we can see, hear, taste, smell, and touch—places limits on how we usually think. But many humans can overcome this. Certainly Einstein showed this kind of imagination when he proposed “thought experiments” such as chasing a beam of light.


We know that gravity is some kind of force. It plays well in the basic physics equation governing force (F), where F=ma, or mass multiplied by acceleration. In that equation, gravity is an acceleration of whatever mass you’re dealing with. A pitcher’s arm also exerts force in throwing a fast ball. The measured force is equal to the mass of the baseball (a regulation 5 ounces, or 142 grams) multiplied by whatever acceleration may be required4 to arrive at the ball’s final, measured speed over the plate.

We understand what’s going on in a pitcher’s arm. Muscles are contracting in a way that whips his arm around. His fingers are clenched to cage the ball, then let it go at the point of maximum acceleration. And the interaction between his fingertips and the ball’s covering—which imparts whatever spin he puts on the ball—is governed by the electromagnetic forces in skin and leather that account for friction. We understand the underlying mechanism of a fast pitch very well.

But what’s the underlying mechanism of gravity? We detect no mechanical interaction, no muscles, no arm, no fingertips. In physics, gravity is considered a field force, like electricity and magnetism, which can create “action at a distance” without requiring physical contact between the atoms or particles involved.

But what does the word “field” really explain? To say that a force acts over a field suggests there may be a limit to its effective range. However, the fields governing two of the fundamental physical forces, electromagnetism and gravity, are assigned infinite ranges—that is, there’s no telling how far a photon may travel, or how far away from a galaxy you must travel before you stop feeling its pull, however faintly. You can write equations governing a force field’s strengths and its effects. But the mechanism by which they accomplish this is a lot less obvious than that of an arm hurling a baseball.

Einstein’s theory of General Relativity pictures gravity as a curvature of spacetime. An body with mass m1 exerts a gravity field that curves space around it, so that the path of an body with mass m2 which is traveling near the first object at a distance of d1 is deflected toward it by a distance of d2.5 I think I can understand that.

A planet like the Earth bends local space so that a satellite launched at a certain speed, rather than traveling in what we think would be a straight line, instead travels in a closed curve, an orbit around the planet’s center of mass. A star like the Sun bends local space so that planets travel around it in closed curves called ellipses. Stars create such strong bending force that they can even curve the path of a light beam.6 Galaxies create such strong distortions in spacetime that they can act as lenses of the light from more distant galaxies. I can intuitively understand motion in curved space.

But what about two objects standing still in relation to each other? When I stand on the Earth’s surface, I may be flying through space with the planet’s rotation and its revolution about the Sun, but with respect to the center of the planet, the two of us are not moving. Yet, according to the measurement of gravity, I am continuously accelerating toward that center at a rate of 32 feet per second per second (32 ft/s2, or 9.8 m/s2). I am accelerating without a change in relative speed. It might make perfect mathematical sense, but it leaves something to be desired in terms of common sense. In fact, if you think about it, gravity in this particular case really messes up your sense of time and distance.7

Quantum Mechanics has a different interpretation of gravity. According to its Standard Model, all forces and fields are represented by an associated particle. Electricity and magnetism are associated with the photon. The strong nuclear force—which holds protons and neutrons together in an atomic nucleus—is associated with the gluon. The weak nuclear force—which accounts for the decay of subatomic particles—is associated with emission or absorption of W and Z bosons. These particles have all been measured and detected. But the particle associated with gravity, called the “graviton,” remains hypothetical. According to the Standard Model, it should have an infinite range, a mass of 0, and a spin of 2—but it just hasn’t been seen.

Another particle, the Higgs boson, associated with mass, has also remained unseen—until last July. This particle is so massive that it supposedly hasn’t been around since the Big Bang. But scientists at the European Organization for Nuclear Research (CERN), after many experiments involving highly energetic particle collisions and comparison of the data, believe they see trails of particles already decaying from a more massive particle that may indeed be the Higgs. Although the Higgs particle no longer exists naturally in the universe, its associated field accounts for how the various particles acquire mass. When we understand that trick—as opposed to simply being able to use the word “mass” in a sentence or use its value in an equation—we may be closer to understanding gravity.

Until then, while we can manipulate electricity and magnetism and observe the interaction of particles in a nuclear explosion, we are powerless over gravity. We know it exists and can measure its effects. But our understanding of the “pitcher’s arm” remains highly theoretical, mathematical, and abstract. In fact, until we can deal with gravity on the same terms as electromagnetism and the strong and weak nuclear forces, our physics remains broken between General Relativity’s spacetime and Quantum Mechanics’ array of particles.

I expect great things when we finally have a working definition of gravity. If that understanding follows the pattern of our knowledge of electromagnetism and the strong and weak nuclear forces, then soon after we define gravity we will be able to build technical applications that either capture and sequester live gravitons or manipulate spacetime in closed gravity curves. We will fly without wings and float up to heaven.

Gravity is, in my view, the first of the three things we don’t yet understand. Next week, I’ll tackle the other two—which seem to be intimately related to gravity: the structure of space and the nature of time.

1. Truth in advertising: I studied English literature at the university and my liberal arts math requirement was fulfilled by Philosophy 1, Introduction to Logic. But since then I’ve consistently worked in technical organizations—pharmaceuticals, applied biotechnology, engineering and construction, an electric and gas utility, and an oil refinery—and have had to learn a lot of math and science to keep up with the engineers and scientists. I’m an aficionado if not a practitioner of science.

2. Yes, you can have interesting discussions on Facebook. It’s not all pictures of kittens and ironic motivational posters.

3. One Facebook friend, an entrepreneur and expert in rocketry, aerospace, and orbital solar energy, has posted that he believes we know about 80% of what’s going on in the physical world, leaving 20% to be discovered. My response has been that those proportions depend on what you think constitutes the 100% of what there is to know—and hence the subject of this meditation.

4. Acceleration may be the hardest part of all this to understand for the mathematically challenged, because acceleration makes two references to time. Acceleration (a) is the change in velocity (v) over a measured period of time (t). That first component—your velocity or speed—is expressed as distance traveled divided by time elapsed (d/t, as in “so many feet per second,” or ft/s). The change in velocity during acceleration represents progress from the object moving at one speed, its initial velocity (vi, which may also be zero), to moving at a higher speed at its final velocity (vf). All of this is expressed as a fraction, a=(vf–vi)/t. Solving the equation and accounting for the “per-second” of that final velocity and the “per-second” of the acceleration yields the result in distance per-second-squared.

5. By extension, one imagines that all forces which work through fields must somehow alter the properties of supposedly “empty space” over their effective range.

6. Yes, the photon is supposed to be without mass, and therefore not subject to gravity’s effects. But that’s the “rest mass,” as if a photon ever stood still. The photon’s momentum at the speed of light gives it “apparent mass” and lets it participate in gravity equations.

7. I had fun with this in my recent novel The Children of Possibility when describing one possible method of traveling through time.

Sunday, December 23, 2012

Getting Serious About Gun Control

Following the mass murders perpetrated with firearms most recently in Connecticut and Oregon … and earlier in Colorado, Arizona, Virginia, Utah, and elsewhere, some at schools, some at shopping malls, some in theaters and at political rallies … we get an outpouring of pleas, arguments, and rants for more gun control. And then the counter-arguments and opposing rants from the Second Amendment and reasoning along the lines of “when swords are outlawed, only outlaws will carry swords.”1

Being a rather logical and obvious person with an inclination toward radical thinking,2 I find all this distressing. I dislike half-measures. I despise symbolic actions. If you are going to Canterbury, then go to Canterbury—or not. Don’t edge down the road toward Greenwich and Eltham, pretending you only want to go there and no further. And don’t take us all to Canterbury by half-measures, death by a cut here and a slice there, as if the ultimate stopping point—death—were not your intention all along. If you mean to remove guns from our society, then say so and plan effectively.

If you want to stop mass killings by crazed, suicidal shooters—and you think it’s preferable to remove readily available guns from society rather than to promote better identification and treatment of crazed, suicidal people—then let’s get serious about this. One more background check, one more registration form to complete, one more prohibition on a certain style or feature or type of firearm will not accomplish the purpose. Trying to legislate by focusing on the particular weapon used by the last mentally unstable person who reached out for the weapon at hand is simply ludicrous. And trying to prepare the American people for a complete gun ban by advocating limits on magazine capacity or additional background disclosures is like trying to go to Canterbury by making day trips to Greenwich.

This country is saturated with guns. The numbers quoted in recent news stories, blog postings, and rants are so diverse that one is left questioning whether anyone knows or they’re all just guessing. A quick stroll around Google on the question “Number of guns in the U.S.?” comes up with dozens of ways to parse the data: number of firearms applications, percentage of gun owners, average number of guns per so many people, number of guns confiscated at airports3—but no solid, believable numbers. So pick a number. Two hundred million guns? Two guns for every three people?

The actual number doesn’t matter. It’s a red herring. No one is keeping count. And the solution is not going to be rounding up the guns by sending out letters to gun owners, collecting the hardware, and matching serial numbers to registrations. At this point in our history and relationship with firearms, the only solution is a total gun ban and draconian measures to prevent their future ownership and use. Here are the required dimensions to make such a ban effective.

1. Repeal the Second Amendment. Hold a constitutional convention and make disarmament a priority. The concept of a civilian militia is meaningless in the nuclear age. The concept of a person’s right to own and carry military-style arms is dispensable in a society where hunting is a little-practiced and dubious pastime unnecessary to the supply of meat on the table,4 and technology has rendered firearms of every type much more lethal than the flintlock pistols and muskets of the 18th century. If these 27 words5 are all that keep alive antique notions of armed cowboys riding the plains and dealing out frontier justice, then let’s abolish them.

But what about natural rights? What about personal freedom? You have the natural right and personal freedom to live an orderly, nonviolent life. You do not have the right to defend yourself with violence because society, in the person of the state, reserves to itself the sole right to defend its citizens, as it reserves the sole right to dispense justice and deliver punishment. By disarming the populace, the state creates the greatest safety and opportunity for all to live orderly, nonviolent lives.

Ah, but what about that phrase “security of a free state”? Doesn’t that suggest the civilian populace needs arms to protect against an overweening government? Isn’t civilian disarmament the first step in every tyranny, from the Soviets to the Nazis and the British National Health Service? Well, yes—except that, whatever weaponry the man in the street can afford and acquire, the government can afford better (courtesy of your taxpayer dollars) and will have an incentive to acquire. In an arms race with Caesar, the average plebian is always going to be outmatched and outgunned. But the notion of defense against tyranny leads to my second point.

2. Disarm the country. No, I mean really. Don’t just take firearms away from law-abiding citizens. Force criminals of all stripes to surrender their weapons. And disarm the government, too, on the grounds that once the people are disarmed, public servants do not need to be heavily armed, either.

Disarming law-abiding citizens is simply a matter of calling in those registered guns. And that will be totally ineffective. Instead, offer an amnesty period of 90 or 120 days during which anyone can turn in any gun to be melted for scrap on the spot. No questions asked. No recording of serial numbers to link the weapon to previous crimes. No suspicion or detention. Just “Thank you, sir. Thank you, ma’am. And cook it, Joe!”

As part of the amnesty period, pass and enforce stringent laws against gun ownership. Discovery of a gun among personal effects or on private or institutional property is an automatic felony leading to automatic confiscation and destruction of the weapon, plus loss of liberty and loss of the property involved. Keep a gun in your car—the car will be impounded and sold. Keep a gun in your home—the house will be acquired by the state under court order and auctioned off. Keep a gun at a business, school, or other public place—and that property will be closed until it can be reorganized and put under new management. Have a gun in your immediate possession, and you go under detention for ten years. We don’t have to put you up in a nice jail or prison, either. You will wear an ankle bracelet, your movements will be tracked within a court-defined perimeter, you will lose all civil rights, and your life will become subject to any number of surprise searches and inspections. In short, gun owners automatically become criminals subject to state supervision as well as effective non-citizens. These rules will not be subject to negotiation, plea bargaining, mitigating circumstances, or other weaselly technicalities. Touch a gun, lose your rights.

That’s just for owning a gun. Use a gun to threaten or harm another person or institution, and you face comparatively harsher punishment. Since we’re trending away from the death penalty in this country, let’s not talk about automatic, summary executions. But certainly the loss of property and freedom associated with gun ownership might be extended to lifetime status. We might also enact laws that provide for exile—if another, more violence-tolerant country will have you.

In the discussion of disarmament, many law-abiding citizens will be made nervous by the requirement that they must surrender their defenses while criminals may do as they like until caught. Law abiding citizens will also feel naked while every public servant—every off-duty policeman, retired policeman, FBI analyst, TSA agent, prison guard, unlicensed security guard, “private investigator,” “security consultant,” and anyone else who can claim justification for carrying a weapon—is allowed to go armed. But under this disarmament plan, no one gets to own or carry a gun. It works for the British, whose bobbies are armed only with moral authority and a whistle.

For those who worry about tyranny and “a free society,” the amnesty and sanctions must extend to public servants in all branches of government. In a society where the most lethal weapon available is a knife or bludgeon, or perhaps a bow and arrow, the police, the FBI, the Secret Service, the Coast Guard, and anyone else operating domestically should be able to exercise their moral authority with just batons, tasers, and judo holds, along with modern surveillance and forensic techniques for observing, predicting, and punishing crimes. Rapid-fire killing weapons should be totally unnecessary.

Soldiers, aviators, marines, and others on active duty overseas will need to be armed to meet the threat offered by their designated enemies. They may train with firearms within our borders under the same conditions that they currently train with bazookas, Stinger missiles, and nuclear bombs: the weapons or their simulation may be used on the range and in practice; otherwise they are kept under lock and key with strict inventory control until the combat unit departs the United States on foreign deployment. If we can keep plutonium and hospital supplies of pharmaceutical-grade opiates off the street, we can seal army bases against proliferation of firearms and ammunition.

3. Disarm the culture. Removing weapons is a first step, but it must also be supported by removing the desire for and glorification of weapons and the violence they support. We’ve already gone a long way in this country to make smoking socially unacceptable by not only limiting places were smokers may practice their vice but by also curtailing its glorification in movies and television.

Screenplays, teleplays, books, video games, and magazines will all need a rating system. No, wait—that would just tell you where the glorification and titillation of gun violence is available. As with smoking, we need eradication programs, education on the dangers and potential damage derived from firearms and other forms of violence, and censorship of the media to prevent gun violence from being depicted in any way, positively or even negatively.

Moreover, remaking society’s attitude toward guns means controlling and eliminating the simulation of guns as well. Not just real firearms, which rely on projectiles propelled at certain high velocities under the impulse of explosive gases derived from chemical reactions, regardless of caliber or mechanism of operation. The ban, confiscation, and penalties must be extended to simulated guns like toy guns, cap guns, pellet guns, BB guns, paintball guns, zip guns, rail guns, and anything else that pushes out a bulletlike projectile—or pretends to—regardless of speed, lethality, or intended use.6

It can be done. We can make the fascination with guns and violence socially unacceptable. We can make the ownership and use of guns, along with threats and displays of violence, subject to crushing legal sanctions. We can make the meanest streets as polite and carefully orchestrated as a Victorian drawing room. Of course, then we’ll also have to stop paving our streets with bricks and decorating our gardens with nice, round river rocks.

Because the same conundrum will still apply: when rocks are outlawed, only outlaws—and mentally unstable people—will throw rocks.

1. Truth in advertising: I own several pistols, favoring the .45 semiautomatic for its power and compactness. My mother was a sharpshooter and member of her school rifle team. My grandfather was a gun collector as well as the county judge. When I was in high school in central Pennsylvania, the first day of deer season saw every boy but me, and more than half the girls, go out for their buck, using high-powered rifles similar to the military M1 Garand. I don’t hunt and only shoot at the range because I believe familiarity with serious weapons is everyone’s responsibility as part of preparing for life in a violent and uncertain world. I also routinely practice karate, which I learned at the university, and that practice includes the quarter-staff and short swords as preparation for improvising non-edged weapons. I’ve also taken fencing lessons to have familiarity with swords, and judo and aikido lessons to understand other styles of self-defense. I study military strategy and tactics. All of this gives depth to my books and writing, among other things. However, if the government decided tomorrow to confiscate my handguns, it would not diminish me in the slightest. The prepared mind of the warrior is paramount; the choice of weapon is secondary.

2. I mean “radical” in the nicest possible way, and shorn—with disdain—of any association with the covert agendas of progressivism, socialism, the Communist Party, or 1960s campus politics. I use the word in the meaning derived from its Latin root, “radix,” the source of our word “radish,” and itself meaning—curiously enough—“root.” You examine its roots to know a thing. And to kill a weed, you must pull it up by its root. To get to the root of a thing is to pierce its plantlike heart. In that sense, I am a radical.

3. I guess this statistic falls under the category of “Oops! Forgot I had that one on me!”

4. If people really, really want to kill live animals for fun, food, and pest control, let them use weapons requiring some skill and stealth: bow and arrow, atlatl, knife, bare teeth.

5. “A well regulated militia being necessary to the security of a free state, the right of the people to keep and bear arms shall not be infringed.” That’s it. That’s all it says.

6. For now, we’ll except bows and arrows, crossbows, slingshots, and throwing knives, as they require some personal skill and are not susceptible to rapid-fire use. However, some countries—most notably Britain—and certain jurisdictions like New York City have extended their gun bans to all weapons and their use, similar to the Transportation Security Administration’s banning of nail files and screw drivers as potential weapons. I say, let’s first get the firearms off the streets and out of the culture, then we’ll see what other weapons need to be controlled. The trouble with a total weapons ban is that certain common tools are too easily wielded as weapons. The kitchen knife is an essential tool—try cutting meat with a potato peeler. And construction would virtually cease without the hammer, nail gun, circular saw, and other handy weapons.

Sunday, December 16, 2012

Getting Serious About Global Warming

First, truth in advertising. I am what modern progressives call a “global warming denier.” This is not to say that I deny the climate is changing—it has certainly changed over the course of recorded human history and even earlier.1 What I deny is that we are experiencing an abrupt and unprecedented warming period caused solely by human activity, specifically the burning of fossil fuels in the context of the rise of technology and western civilization. I have various reasons for this belief.2

Correlation is not causation. This is a principle in science, captured in the logical fallacy post hoc ergo propter hoc, or “after this therefore because of this.” Yes, carbon dioxide levels have increased in the atmosphere. Yes, temperatures seem to have risen in the 20th century. But carbon dioxide is a weak greenhouse gas, affecting heat radiation much less than either water vapor or methane, which are also present in the atmosphere. And other causes could explain the temperature rise.

One is the sun. Sunspots are directly related to solar output—more spots means more radiated energy. The number of sunspots at the peak of each eleven-year cycle, which have been recorded over the 23 cycles since spots were first noticed in the 17th century, has been gradually increasing as the sun recovered from a Maunder minimum, when very few spots were observed at all. The maximum of these increasing peaks seems to have occurred in cycle 23, at the start of the 21st century, which also coincides with the greatest recorded warming. The current cycle, number 24, may be much lower. And long-range predictions are for a much less active solar output in future cycles.

Another possible explanation lies in the tendency of weather stations to be located in or near cities. The recorded temperature rise in the late 20th century also coincides with a worldwide trend toward controlling the temperature of our indoor environments. Anyone who has stood next to an air-conditioner knows that to make the indoors cooler, you must expel heat to the outdoors. This and the longer-range urban heat island (UHI) effect—where cities are warmer than the countryside because their infrastructure includes heat-radiating pavements and building materials that retain daytime solar radiation—may contribute to the recorded temperature rise in the Industrial Age.

However, both sunspots and urban heating are also cases of correlation, not necessarily causation. For me, the origin of any change in climate may be suggested but cannot be proven except by massive experimentation. And tinkering with the climate in such experiments would likely change the nature of the conditions originally to be observed.

Computer models are not proof. All of the projections of where the recently observed warming trend will lead are based on computer modeling. Computers are not magical machines which never make mistakes, and even the most thoughtful and comprehensive models are not reality. Weather is an incredibly complex system, full of variables and influences that often conflict with and cancel each other. If it is difficult to predict weather patterns out for more than a few weeks, it is much more difficult to predict climate changes out for a century. There are too many variables we don’t understand, too many patterns we have observed for only a couple of hundred years.3

Every model makes certain assumptions and tries to control certain variables in order to avoid the chaos of this complexity. Even with the best will and intention of remaining perfectly neutral in choosing these assumptions, so as not to influence the outcome, the model make still has to make some choices. Models always come with margins of error and probability. They are rough guides, not predictions. And the more complex the system to be modeled, the more error-prone the model will be.

Consensus is not science. Much political talk about climate change mentions the “scientific consensus.” Like belief, the word “consensus” has no place in science. Until the late 1700s, when Antoine Lavoisier demonstrated the role of oxygen in respiration and combustion, the scientific consensus held that an element called phlogiston was released in a fire. Until the late 1600s, when Newton demonstrated his laws of motion, the scientific consensus held with Aristotle that objects fell to earth because they were attracted to the center of the universe, which happened to be this planet.

The only scientists who speak with authority on the matter of climate change are the tight-knit group of those who are actively sampling climate data and making models, and not all of them agree with the results of the most popular models. Ten thousand geologists, astrophysicists, sociologists, and linguists who happen to concur with the dominant view do not make it so.

But I’m willing to have an open mind. Even though I believe the case for looking ahead to the year 2100 and confidently predicting a rise in temperature of 3°C and a rise in sea level of 6 meters is far from proven, and even though I believe the resulting conditions won’t mean the end of productive human life, merely a change in the patterns we know today,4 let’s agree that carbon burning is a real problem and that we must do something serious about it starting now—if now isn’t actually too late.

But let’s also agree that the solution won’t be achieved by polite half-measures like driving a Prius, adjusting the thermostat, or remembering to turn out the lights when you leave a room. If we want to avoid the catastrophic predictions of the climate models, we’re all going to have to sacrifice. A lot.

Our civilization isn’t based largely on carbon burning because coal companies and oil companies are greedy and vicious and have duped the rest of us into doing a bad thing. We burn carbon because it’s a chemically active element that enthusiastically makes and breaks atomic bonds and releases large amounts of energy—less than the burning of hydrogen and oxygen, to be sure, but more than almost any other element. We humans arrived at burning fossil carbon deposits after millennia of trying the renewables: burning wood, grass, and various animal waxes, fats, and dungs for light and heat, or turning wheels with dammed up water and catching the wind for motive power. These energies drove the Egyptians, Persians, Greeks, Romans, and other cultures to a certain level of technology and quality of life. But it wasn’t until western civilization discovered the energy density of coal and oil that we could begin applying science and technology to solving life’s problems.

Today the U.S. economy generates more than 50% of its electricity from coal burning, and more than 90% of our transportation depends on oil. While cleaner-burning natural gas can substitute for either of these resources,5 and natural gas is becoming more available in this century because of hydraulic fracturing of deep shale deposits, using natural gas means we are still dependent on fossil carbon. To break from carbon completely requires our technology to endure a double-whammy. First, we would have to replace half of our existing generation with solar, wind, or biomass—sources that are less energy-dense and so would require more infrastructure and inputs than the coal-fired power plants they replace. Second, we would have to increase our electric generation overall, because electricity—whether by beam, wire, or battery—is the obvious replacement for petroleum in our transportation system.6 Our electric grid will have to deal with much higher demand from less energetic resources.7

I’m not saying it can’t be done. The transition can be effected over time, both by building new infrastructure and by reforming the way humans now use energy. My own favorite solution is to use photovoltaic satellites to harvest solar energy from orbit—where the radiation intensity is about ten times stronger than on the planet’s surface—both to fill the energy grid and to electrolyze seawater into oxygen and hydrogen for use as a motor fuel. These systems would be relatively inefficient but they would have the advantages of continuous operation, no moving parts, low maintenance, long operating life, and pure capital investment without operating or fuel costs. For a path to this, see my novel Sunflowers.

But over the short term, in the next ten to twenty years, which is when we will have to remake the world’s—not just the U.S.’s—energy infrastructure if we are to avoid catastrophe in the year 2100, the transition will not be gradual or seamless.

If we have to take down 50% of the U.S. electric supply over the next five or ten years—as some scientists and politicians have proposed—that means halving the amount of energy available. Unless you already have a roof made out of photovoltaic tiles, you would be faced with getting by on half the electric energy you use now. Think of the utility offering you the choice of service either mornings or evenings, or on Monday-Wednesday-Friday vs. Tuesday-Thursday-Saturday. And no falling back on lighting candles or using a gas-powered generator, as they do in Baghdad when the power’s out, because those sources would put huge amounts of carbon into the air. For the rest of the time you can either sleep or go for a walk. Think of being allowed to buy gasoline at the level of a World War II “nonessential use” ration card: four gallons a week. That’s fine if you ride a scooter and get 90 mpg, terrible if you drive an SUV and get about 17 mpg.8 For the rest of us, the choice is to cram onto inadequately designed buses and public transit systems. Air travel, railroads, and similar long-distance transportation would go under similar rationing.

Achieving an adequate response to global warming would require the federal government to assume wartime powers in peacetime. It can be done. America did it in the 1940s. England put up with wartime rationing until well into the 1950s. You could say the Soviet Union put up with conditions even more extreme during most of the 20th century. And places like Afghanistan, Ethiopia, Angola, and Mongolia live with vastly reduced carbon footprints to this day.

As far as I’m concerned, the economic catastrophe of dealing with global warming is worse than the prospect of wheat farming in northern Siberia and Saskatchewan, enduring an orderly evacuation of Florida and Louisiana, and paying for eventual redevelopment among the Hudson Valley highlands. Over the next four generations we will have time to adjust, ameliorate, compensate, and relocate. … And maybe the horse won’t sing after all.9

1. Indications from recorded history suggest warming periods in Roman times and the late Middle Ages (the latter perhaps coinciding with the collapse of Mayan civilization in Mesoamerica and other native American populations in the U.S. Southwest due to drought), and of cooling periods in the early Dark Ages and at the start of the Enlightenment in Europe (particularly the “Little Ice Age” of the 17th and 18th centuries). These indications would tend to prove that weather patterns shift every couple of centuries. We also have the fact of the corpse dated to about 3,300 B.C. in the Ötztal Alps, from a man who lay down in a hollow, died and was covered by snow that became a glacier, and was exposed by the melting of that glacier in 1991. The question, for me, is not whether human carbon burning caused the melting, but what forces caused that hollow to be free of ice 53 centuries ago.

2. And yes, the word “belief” has no place in science, which depends on observation, hypothesis, and proof through experiment. But as the following examples suggest, belief has a lot to do with the interpretation of what’s really going on with our climate.

3. Much discussion of climate change focuses on the fact that polar sea ice is visibly melting in our satellite surveys. But we’ve been watching with satellites for only about forty years, and scientists have been visiting and recording conditions in the polar regions for less than two centuries. If there are long-range cycles associated with glaciation and sea ice, we haven’t been around long enough to understand them.

4. It would be a catastrophe if the temperature and the sea rose all at once, but they won’t. Humanity will have about 90 years to adjust to fading property values in Florida, Louisiana, Bangladesh, and Vietnam and to relocate from high-value coastal cities whose waterfronts today command billions of dollars in real estate prices. Two hundred years ago, much of that land was swamp. A hundred years from now, much will lie out beyond the seacoast. But higher carbon dioxide levels and a warmer planet will provide benefits, too: accelerated vegetation growth, improved use of lands now lost to tundra and freezing winters, and lower costs for heating and snow removal. One man’s catastrophe will be another’s opportunity.

5. Cleaner burning means two things. First, breaking the hydrogen bonds around the carbon atom in methane and then replacing them with the oxygen bonds in making carbon dioxide yields more heat energy that simply forming the oxygen bond when burning coal. So natural gas produces less carbon dioxide for a given energy yield. Second, methane as a gas has none of the residual slag (i.e., non-carbon material) in unprocessed coal that puts fly ash and radionuclides into the atmosphere.

6. I have seen presentations about growing genetically modified algae in tanks that would produce and secrete an oil-like lipid that could be refined as fuel. One estimate suggested that an algae farm the size of the state of Maryland, placed under the brilliant sunshine of the Nevada desert, could replace all of the U.S.’s energy needs. I see only two problems with this. First, algae need carbon dioxide to grow, and adequate amounts would not be available in the ambient atmosphere over a Maryland-sized set of ponds; the operators would have to capture the gas elsewhere and pipe it into the pond. Second, the one thing conspicuously missing from the Nevada desert is water. Depending upon the algae’s tolerance for salt, the operators would have to pump brackish seawater in from the coast, and perhaps take the extra step of desalinating it, all at a great expense in energy. Most of these alternative energy schemes are still at the stage of conceptual engineering—which means that the proponents have worked out the basic theory, but we’re a long way from solving the practical problems.

7. What about nuclear power? Don’t get me started on nuclear! Everyone thinks utilities went off nuclear power in the 1980s after the partial meltdown at Three Mile Island. Actually, utilities stopped ordering new nuclear plants in the early 1970s, when the true economics of the fuel cycle became clear. Having been told in the ’50s and ’60s that nuclear generation would be “too cheap to meter” because of its low fuel cost, utilities started massive building programs. What became evident by the late ’60s, however, was that the combined carbon and electrical energy inputs required for mining uranium ore, purifying it to the uranium oxide called “yellowcake,” converting that to uranium hexafluoride gas, concentrating the gas in centrifuges, converting the concentrated gas to metal pellets, and assembling those pellets into fuel rods—all consumed more energy than could be obtained by fissioning the unstable uranium inside the rods. Add in the high capital cost of the power plant with all its safety measures and the problems of storing or reprocessing the hot spent fuel, and the resource becomes uneconomic. People keep proposing new designs and technologies hoping to make nuclear attractive, but it remains a complicated way to burn diesel fuel out in the desert so as not to create carbon-dioxide pollution along our coasts and rivers.

8. President Obama has talked about how gasoline prices “would necessarily skyrocket.” But that’s economically backward. Finding ways to raise the price to restrict use will simply penalize the poorest among us, force those in the middle class to make canny tradeoffs between the residual value in their SUVs and the price of fueling them, and leave the richest unaffected. If you really want to restrict the use of a commodity, you set an artificially low price and then diligently prosecute any supplier who charges more. If the federal government mandated a price of 50 cents per gallon, it would drive the oil refiners out of business. Of course, we would experience a brief black market in super-priced fuel. But the infrastructure of refining, transporting, and dispensing gasoline and diesel oil would be harder to conceal than the manufacture, smuggling, and sale of potable alcohol during Prohibition.

9. Larry Niven and Jerry Pournelle’s wonderful novel The Mote in God’s Eye attributes to Herodotus the story of a thief brought up before the king. He bargains with the king to spare his life if within a year the thief can teach the king’s favorite horse to sing hymns. When the thief is taken back to jail, another prisoner tells him what a fool’s bargain he has made, because the horse will never sing. But the thief says a lot can happen within the year: the king might die; the horse might die; or he himself might die. And maybe the horse will sing.

Sunday, December 9, 2012

Asymmetry and Imbalance

The human mind likes things to be neat, orderly, symmetrical, balanced, complete, and tied up with a bow. Our logic and mathematics reek of symmetries, equivalences, and balances. They assure us that the world is stable, strong, secure, and not likely to collapse anytime soon. And they’re wrong.

In algebra, and in all the math and science calculations that follow from it, one side of the equation must, by definition, always equal the other in all respects and in every detail. There are no loose ends, no factors unaccounted for, no missing participants or forces. And if the mathematician or physicist should find some factor or force he can’t quite explain, he is allowed to add a constant—what schoolboys would call a “fudge factor”—that makes the numbers balance anyway.

Although constants are usually numbers whose values do not change despite circumstances—the most famous being π or “pi,” the ratio of a circle’s diameter to its circumference, always 3.1416…—some constants are not so obviously derived nor easily calculated. Einstein famously added to his original theory of general relativity the “cosmological constant”—Λ or “Lambda,” equivalent to an energy density in empty space. He did this because the pull of gravity otherwise skewed his assumption, which was everyone’s assumption in those days, that the universe was in a steady state of unchanging dimension, neither collapsing nor expanding.1

A business ledger maintained under double-entry bookkeeping matches every penny of assets—cash on hand, daily receipts, invoices awaiting collection—with some equal and opposite liability—investor funding, bank debt, salaries and rents, bills waiting to be paid. While the amounts vary from day to day, every entry must balance some other entry in the overall picture of the company. And here too we find a fudge factor: “good will,” which usually arises in negotiations for selling or buying the company. Good will is a totally intangible asset, presumed to represent the value which customers place on a brand or the esteem in which they hold the company itself. Good will as an asset balances actual cash outlays for things like non-product advertising, donations to public charities, and “corporate citizenship” programs.

If you think about this too much, your head starts to hurt. What, if anything, in the world we know and the universe beyond it is actually in balance, so that all forces cancel out and every debt is paid?

Look at the Sun or, for that matter, every other star. The Sun represents a state of stability and balance upon which we depend not only for our daily lives and the ultimate source of all the energy our civilization uses, but also for the continued existence of the Earth as a working proposition and human beings as a species.

Stars are a wonder of apparent balance. As the minute perturbations within a cloud of interstellar dust and gas shift the molecules this way and that, gravity takes hold and begins to draw them together. Given a big enough cloud, gravity will eventually take over and pull all the molecules into a ball. They might ultimately collapse right down into a dense solid, or even to a mass of collapsed atomic nuclei called neutronium, or—with enough mass doing the pulling—into a black hole … except that, along the way, the friction of those jostling molecules creates heat, which pushes back against gravity. Eventually, the compression at the center of the mass forces the lighter molecules to fuse into heavier molecules, a nuclear reaction that creates even more heat. When the pressure of gravity pulling down ignites a fusion reaction in the central core, creating a huge amount of thermal energy pushing outward, a star is born.

But stars are not stable and immutable. Some stars are so unstable that they cycle their energy output in a matter of days or weeks. Although humans have always assumed that our Sun was stable and immutable, astronomers are finding out more and more about our own star, and it’s not a simple picture.

Temperature variations within its layers give rise to convection cells, and their roiling of the plasma in turn creates a magnetic field. This field has the shape of the big loops around the ends of a bar magnet, with a positive pole at one end, negative at the other. Because of the star’s spin and the resulting alignment of those convection cells, the magnetic field usually sits on top of the axis of spin. But a magnetic field is a real thing, not an imaginary force, and sometimes one of those convection cells will capture a loop of the magnetic field and drag it outward and down, away from the slower-spinning axial regions toward the faster-moving equatorial regions of the star. The result is disruption in the star’s surface layers which appear as dark spots, called sunspots.2 These misalignments rise and fall in recognizable eleven-year cycles. Solar astronomers and climatologists are now detecting that even these shorter cycles seem to strengthen and weaken in longer cycles of perhaps two to four centuries. We live under a long-duration variable star.

From our observations of other stars, we know that every star has a life cycle and a destiny, governed by its mass. The life of a star is dictated by the amount of fuel it contains and the mass pressing on its core, forcing it through various cycles of fusion reaction: from hydrogen atoms to helium, helium to carbon, carbon to oxygen, and on up through neon, magnesium, silicon, and iron in the most massive stars. Eventually the readily available fuel comes to an end. Oh, the star still might have traces of lighter elements lingering at its core, but they are not enough or are too widely separated to fuse efficiently, and there is not enough gravity pressure to force them to react. The star reaches the end of its balancing act. Gravity wins, and the star collapses in a nova or supernova, blowing off its outer layers and compressing its core.

If stars are ultimately unstable, holding to only a temporary balance, so is the universe itself. If the Big Bang theory is correct, the universe in which we live was born in a messy explosion that left variable densities of matter that formed galaxies, galaxy clusters, and deserts of relatively empty space in between. Not only was the distribution of matter in this universe asymmetrical, it’s also becoming apparent—at least in some theories of cosmology—that the types of matter in the universe are also asymmetrical.

Everything we can see in the galaxy around us—stars, glowing clouds of gas, veils of dust—is apparently the one type of matter which we can detect and with which we can interact. But from the way the stars in a galaxy spin—locked in position, as if they were painted on the solid surface of a phonograph record, rather than freely interacting, like objects floating on the variably spinning surface of a whirlpool—astronomers have surmised that a much larger amount of material must generate this extra gravitational force. They call this extra material “dark matter,” because we cannot otherwise detect it.

And the apparent fact that the galaxies around us—both in our local neighborhood and out at the edge of the universe—are all flying away from each other, not at a steady rate but under some acceleration, suggests that there is a kind of energy in the vacuum of empty space, “dark energy,” that we cannot otherwise detect or measure.

Although stellar collapse, galactic spin, and universal cohesion are forces in apparent balance, these effects are only snapshots over a span of time. That span may be huge in terms of individual human experience, but fleeting on a cosmological scale. And these apparent balances fall apart at the farthest reaches of human understanding.

At the most human scale, too—within the framework of our bodies—we find apparent balance. As we grow from a single-cell fertilized egg into a fully functioning organism, the processes of cellular division and diversification necessarily outpace the processes of cell death by a huge margin. But then we reach a stasis point, sometime in our late twenties to late forties, where cell birth is matched by cell death. New cells are created by replication of the DNA apparatus and bifurcation and division of cell membranes, creating two cells, each with a starter set of materials. Old cells die, wither, and their components are phaged or scavenged away by implanted chemicals, organelles called lysosomes, and other bodily processes. For a time, these processes are in balance. For a time, too, our metabolisms are in balance: our hunger matches our food intake; our bodies either use the energy we consume immediately or store it away against a future time of need or starvation. Life as we know it is a temporary reversal of the ultimate dispersion of matter and energy into chaos that physicists call entropy.

But eventually the human body’s balance breaks down. The telomeres on chromosomes are worn away and replication is no longer possible. Heavy metals and other debris from dead cells are no longer effectively removed from the body and begin to collect and poison the tissues. Bones, ligaments, and connective tissues become worn. Appetites lag or go awry. Cell death exceeds cell birth. The body begins failing. We fall apart.

Nothing stays in balance forever, not stars or galaxies, and not our bodies. We might overcome the asymmetries for a while, but then they reappear. And this leads me to a curious thought—one that goes beyond science and observation and gropes toward the deeper nature of reality.

What would happen if forces were always in balance, if gravity and heat energy within stars remained in stasis, if cell birth and cell death within bodies could be so designed to remain in perfect equilibrium, if the universe were truly a steady-state machine, neither expanding nor contracting? What would happen if the world we know and everything in it were to function like a giant equation, with all the constants in place, or like a massive enterprise run by double-entry bookkeeping, with all the intangible assets fully counted?

I think … nothing. No, I don’t mean a little nothing, in terms of life going on placidly as before. It would be a huge, zero-sum NOTHING. The world as we know it would not exist.

With no unevenness in the tension holding forces in play, from stars to the universe to the chemical processes that we collectively call life, there would be no change, no progress or regression, no creation or destruction. Time would have no meaning, because there would be nothing, no activity, to measure. Probability would have no impact, because there could be no possible alternative outcome in any encounter. The world would freeze solid, like an ice crystal, like a diamond, like a standing wave in a beam of light at a single, everlasting frequency. The universe would hum on a single note, unchanging, forever.

Oh, worse than nothing! With no imbalance of forces, the Big Bang—assuming that’s how the universe really began—would never precipitate. No outpouring of light and chaos, no crystallization of matter, either light or dark, into the clumping of galaxies. The random gravitic swirls in a gas cloud that precede a star’s formation would never budge. The temporary flux of chemical activity that precedes the complex reactions that we collectively call life would never occur.

We owe our existence to imbalances, asymmetries, uneven distributions of mass and energy, fudge factors that were never allowed for in the original equations, and random exchanges that screw up the bookkeeping. The human mind might crave order, balance, and symmetry and want everything tied up with a bow. Thank Finagle or God or Whomever, things just don’t happen that way.

1. After Edwin Hubble detected a red shift in the light of distant galaxies and suggested that the universe was expanding, Einstein abandoned the cosmological constant and called it a mistake. Now, with more recent observations suggesting that not only is the universe expanding, but the expansion is accelerating, the cosmological constant is back in favor—along with the concept of “dark energy” and the notion that the vacuum of space is not nothing but instead a highly structured something.

2. Sunspots appear darker than the surrounding area of the photosphere because the loop of the magnetic field suppresses the convective flow of energy from lower levels to the surface. One would think that being pocked with these cooler sunspots would mean the Sun is giving off less energy. But the suppressed spot transfers its heat into the surrounding area, causing that part of the photosphere to glow more brightly than the cooler spot. The Sun when filled with sunspots actually puts out more energy than the blank-faced Sun.

Sunday, December 2, 2012

When You Call 911

We had a medical emergency at home about nine o’clock in the evening on the Wednesday before Thanksgiving. I won’t go into the medical details, which are private and not really relevant to this posting, but I do want to recount our experience with calling 911 and dealing with our town’s emergency medical technician (EMT) team, which as in most towns is run by the fire department.

Our popular culture is filled with examples of how most city services—and indeed any local, state, or federal bureaucracy—are run by incompetents. To quote from a desperate Sarah Connor in the first Terminator movie, “Don’t put me on hold and don’t transfer me to another department.” There’s a reason for this perception, one that I understand as a writer of fiction: if everything goes smoothly, there is no story. If you can pick up the phone and get medical or police help in a matter of minutes, then you as the main character are not thrown back into an atavistic struggle for survival, requiring all your daring and resourcefulness to achieve a resolution. Getting jacked around by the 911 operator or the cop on the beat or the emergency room nurse is the starting point for many a fictional urban adventure.

I’m glad to say that—at least from my research sample of one, and my intuition based on that experience—incompetence is far from the norm in the real world.

From the first seconds of the call, I was impressed with how calmly efficient the operators were. The first person who answered 911 asked what the problem was. Upon learning that my issue was medical rather than crime, accident, or fire related, she transferred me to the EMT department. She not only transferred me, but she told me she was transferring me and why. Now, from the comfort of your chair, you may think that’s obvious. But when you’re standing by the phone and seconds are ticking away, it’s reassuring to be told what’s going to happen, rather than just hearing click-click!

Making You Part of the Solution

The EMT operator immediately introduced himself—not by name, like some customer services representative, but by function. That made it instantly clear to me who was speaking and why. He then asked me to explain the problem, and I stammered out a sentence or two. Being a writer, I tend to think in story form and begin at the beginning. As soon as he knew what kind of trauma and what part of the body were involved, he took over and began asking specific questions. On reflection, I recognize them as being part of a decision tree, a diagnostic technique. Unlike an old-fashioned doctor, who might try to impress you by saying “edema” instead of “swelling,” the EMT operator used plain language, common descriptions, and simple, direct, one-at-a-time instructions. Our exchange was maximized for clarity.

More than that, the exchange was maximized for time. He made me take action and save minutes by asking about things I could check, answer, and settle before the actual medical team arrived on site. He gave me simple directions for administering in-home first aid and preparing the person in distress for the team. All of this was delivered in a calm and authoritative voice, designed and no-doubt practiced through training to minimize stress and produce simple, direct action.

He told me exactly how soon the EMT team would arrive, so I’m sure he was in contact with them by radio and giving them information from my call. He also told me to prepare for their arrival by unlocking the front door, turning on the lights, securing any pets, and gathering up the patient’s medications. There wasn’t any reassuring blather about “You’re in good hands, sir,” while I was expected to stand by, waiting helplessly. They made me part of the solution, and that maximized the efficiency of the medical response and was reassurance in itself.

Performing a Manual Ballet

The two young men who arrived from the fire department—although they might as easily have been women—walked through the door with exactly the equipment they needed. This was no doubt due to the operator’s describing the nature of the emergency. They located the patient and moved the person quickly to just the right place and position to administer help.

Out of the four cases they were carrying came just the right equipment and medicines. What impressed me was that the two men didn’t have to confer with each other at all. There was no “Well, what do you think?” and “You do this while I’ll do that.” Their focus was on the patient. One took vital signs and performed the kinds of sophisticated tests you see in a hospital.1 The other administered medication, first aid, and common supports like oxygen and an intravenous drip. All of this medical technology was coming out of just those four cases.

Their movements were a fascinating manual ballet. They never fumbled or got in each other’s way. They never paused. It was clear they had trained and worked together to perfect these techniques. And I sense that they weren’t prepared for just this particular emergency. For any one of a dozen bad things that can happen to you, these men had the solutions and the routines for optimum delivery of treatment in minimum time.

As with the EMT phone operator, their voices, their questions and instructions were a curious mixture of brusqueness and compassion. They didn’t waste any time on the social niceties. I never learned their names, because names weren’t important. Their instructions to me and to the patient, their explanations about what they were doing and what would come next were delivered in calm, professional voices that lacked any sense of urgency or hysteria. Yet they were encouraging and gentle in their tone and their touch.

When the ambulance with a stretcher2 arrived to take the patient to the hospital, it appeared to be from another place or another department. It wasn’t at all clear that the two teams even knew each other, yet they worked together seamlessly. They told me where the patient would be taken—which was the regional center for that kind of trauma—and exactly what I needed to bring in support.

And as the ambulance team wheeled the patient out, the EMTs secured the area, repacking their equipment and policing up sterile wrappers and packaging. They and the clutter of the treatment process were gone as quickly, quietly, and efficiently as they had come.

This might have been an unusual occurrence. Certainly, it was unusual for our family, which has been blessed with good health. But I could easily see how well trained and practiced these young men—and, I’m sure, women in similar situations—were at their jobs. Their execution was perfect in thought, word, and deed.

From that, I apply simple logic. I don’t live in a special town—a good one, but not a rich community with high taxes and expectations of elaborate services. And I am not a special person, so that operators and public servants hear my name, get all kinds of giddy, and pull out the stops to impress me. It’s clear to me that this kind of sober, efficient, encouraging treatment is the norm in well-run communities rather than the exception.

This recent experience underscores my basic belief that most people are serious about their jobs, take pride in their work, and care about serving clients and customers.3 It’s easy to picture public servants as fools and incompetents, filling jobs in a government that’s the employer of last resort, and to depict them that way in popular fiction. But in the world I inhabit the popular stereotype turned out not to be the case. And for that I am truly thankful.

1. If you haven’t been around doctors and hospitals lately—lucky you!—you would be amazed at how computerization, cellularization, Bluetooth, and disposables have compressed, compacted, and miniaturized the nature of emergency medicine. Everything that touches the patient’s body and bodily fluids is plastic-wrapped, sterile, and disposable. The added cost is a guarantee of standardized service and minimized potential for infection.

2. Like all modern medical equipment, the stretcher is a marvel of technology: collapsible, expandable, flexible, maneuverable, and designed to fit in tight spaces and around corners. And it’s painted international emergency yellow, so it can’t be confused with anything else.

3. I see this even at the Department of Motor Vehicles. If any government function is less involved in making life-and-death decisions and more involved in following rules and pushing paper, I can’t imagine it. And yet the people at the DMV—at least in California—make an effort to streamline the process with plentiful online services, a system of appointments, and good on-site communications. They may be bureaucrats, but they have a sense of purpose and demonstrate efficiency.

Sunday, November 25, 2012

Thoughts on Public Health Care (II)

Last week I discussed my personal thoughts about the question of publicly providing for health care. That discourse examined three issues: (1) the parallel situation with public education in America, (2) the lack of choice available in all publicly provided systems, and (3) the unsuitability of insurance as a business model in an environment of rapidly improving medical knowledge and practice. Insurance is an inappropriate way to pay for routine health maintenance and a really bad way to take care inevitable processes, like dying.

4. Health Care Will Become More Effective—and More Complex

Of course, “inevitable” is just a state of mind. If you think medicine has advanced since the 19th century, you ain’t seen nothing yet!

The sequencing of the human genome in 2000 was originally intended to find “genes,” the A-C-G-T combinations that code for proteins, the building blocks of cells. This effort assumed that all three billion base-pairs in the genome were just the parts list. What we learned in the process was that protein-coding occupies only about 10% of the genome. The far larger and more complex story is that the other 90%—rather than being the leftover “junk” of evolution, as we first thought—is actually the internal mechanism for timing the expression of those proteins, controlling the differentiation of cells in the body, directing its development from a fertilized egg to an adult human being, and coordinating the daily operation and maintenance in all the different cell types. The larger part of the genome is an assembly and instruction manual riding along with the parts list.

Life scientists at universities all over the world are now working eagerly and productively on two fronts. First, they are linking proteins and their coding to various cellular functions and diseases. Second, they are figuring out the assembly manual so that we can understand how humans develop and grow. When we know the latter, we will be able to program the body’s repair kit—the various stem cells associated with each tissue type—to grow new tissues and replacement organs.1 And then we will quickly advance from simply growing replacement parts, to fixing any genetic defects that may have damaged the original organ, to adding genetic enhancements so that the new organ functions better than before.2

People who worry about medical privacy and the possibility that insurance companies will deny a person coverage because of his or her inherent genetic propensities are simply not seeing the bigger picture. Genetic defects will be eradicated or compensated as a matter of routine practice, probably in the womb if not before conception. Accidents and diseases that now cause disfigurement and disability will no longer be life-changing events but mere temporary inconveniences. Aging will become optional, and its debilitating effects will be corrected as they occur. Medicine might not be able to repair a case of sudden accidental death—or not right away—or eliminate death’s ultimate arrival, but we’ll all go into old age as healthier, happier, and stronger individuals.

What do I mean by “all”? Surely, this new medicine will just be a perk for the super-rich, won’t it? In the meantime, the rest of us proles will struggle along with perfunctory care and shoddy medicine, won’t we?

Well, no. Once we have perfected the techniques for chemically manipulating stem cells and growing them on armatures that are mass-produced from proteins or other inert materials—and true, these techniques will first be tried out on the rich—the rest is just a matter of grunt work. Medical technicians will sample your tissues, isolate the stem cells, apply the appropriate reagents, take a prefabricated armature off the shelf, and put the whole works into an incubator. The most complex part of the medicine, requiring real hands-on expertise, judgment, and timing, will be the surgery that cuts out your old heart, kidney, spleen, or whatever and installs the new one. Getting a new heart will be about as complicated as getting a new titanium hip or knee replacement today.

In this environment, medicine becomes less expensive. It’s only “personalized” because it starts with a person’s own copy of the genome as coded in his or her stem cells. But as we know more about the body and its processes, about how each person’s genome guides his or her susceptibilities and propensities according to universally recognized patterns, medicine becomes less an art of diagnosis and discovery and more a science of observation and application.3 The mystery and the chance—and the heartbreak—go away, because we understand human bodies the way a mechanic these days understands your car. The processes become routine, simple, and inexpensive.4

What will we do with all these superannuated citizens? Since they’re stronger and healthier—we’ll put them to work. The problem in developed societies today is not over-population but under-reproduction. Smart, educated, busy people have less time for children and, with the Pill and other means of contraception, children become a decision for the future rather than an unexpected consequence of conjugal relations. In this environment, life becomes more precious, not less. We will cherish each new child and work to make its health and education complete. We will value the knowledge and experience of older people at the peak of their productivity and try to prolong their best years. Quality, not quantity, will become the human mantra.

In this environment, medical care advances far beyond being a response to an insurable catastrophe. Health maintenance, physical repair, and improvement of the body become a necessity of living, like education to improve and prepare the mind.

5. The Affordable Care Act Pushes Insurance Over the Cliff

If insurance is the wrong business model to pay for the new medicine, the Affordable Care Act is the perfect antidote. When it was first proposed, the insurance companies supported the legislation because it mandated that all citizens buy health insurance, whether they expected to need it or not. That way, healthy young people would pay premiums that covered the costs of caring for sick and old people. The insurance companies saw a bonanza of new premiums and came aboard.

But the act also does two things that insurance companies don’t like and wouldn’t support under the normal business model. The first poison pill is treatment of pre-existing conditions. Even if you’re sick or have a bad prognosis through a history of obesity, smoking, or lousy genetics, the insurance company has to take you on and then pay out for your treatments—which are now a matter of certainty rather than actuarial chance. The second pill is community rating. No matter how sick you become or how high the costs of your care, the insurance company can only charge you the same premium as everyone else. These are gifts to the patient at the expense of the insurance business model.

Add to these pills the fact that the legislation lets the government define the menu of benefits that an insurance policy must offer. As we’ve seen in implementation, these mandates now include routine maintenance practices like contraception and chemical abortion. Pretty soon, at the whim of government regulation, the business model becomes broken no matter how many healthy young people are paying premiums for catastrophic services they don’t expect to need for years.

No one can force the insurance companies to stay in business if they are losing money. So, for the uninsured, unemployed, or self-employed people whose insurance company happens to leave the industry, the legislation offers a state insurance pool, similar to Medicare and Medicaid, with funding shared between the federal government and the states. The bet, in the view of those who desire an end-result of single-payer medicine, is that insurance companies will eventually give up or go broke, and then the federal government and the states will have to step up and fund the entire system of providing medical care.5

It would probably not be legal, or even workable, for the government simply to close down the insurance companies one night and start funding health care through taxes the next morning. But the Patient Protection and Affordable Care Act sets up circumstances that accomplish this slowly, over time, with a maximum of apparent personal and corporate choice and a minimum of fuss. You’d call that pretty sneaky, if it wasn’t all out there in plain sight.

There are probably other potential systems for funding health care that would work better at a state, county, or community level—which is the way we handle education in this country. However, with the results of the national election, those won’t be proposed or tried now. And that probably makes no difference in the long run.

One way or another, health care as a societal obligation is no longer a matter of personal luck and a strong constitution. Advances in the life sciences are already taking medicine out of the realm of insurance and into the sphere of everyday expectations and necessities. Staying healthy and growing old while maintaining your strength and abilities will be like obtaining an education and ongoing training through state-funded schools, colleges, and training programs. Claiming the bonanza of scientifically boosted medicine will be like tapping into any of the other national infrastructures that are dominated by science and technology: the energy grid, transportation systems, food supply chains, the internet, and communications systems.

All of these complex networks are designed to provide good service and a rich lifestyle at low cost. They’re what’s keeping this continent-wide whirligig we call the United States functioning smoothly. Health care as a right of citizenship will be no different.

1. The concept of organ “transplants”—which involve taking a fully grown organ from one person and donating it to another, with the requirement of suppressing the recipient’s natural immune system so that he or she will not reject the foreign tissue—becomes a rapidly passing phase of our current medicine, rather like leech craft. Instead, it will become so much easier to grow a new organ from a person’s own cells, which already have all the right chemical signatures. These “implants” will become a huge part of medical practice. And the whole business of matching donors with recipients, fraught with issues of desperate need, fairness, and compensation, will wither away.

2. And I won’t even speculate on the issue of “designer” genes, so that new organs and tissues confer particular preferences beyond the normal human range—like the desirability of orange- or silver-colored eyes, or the ability to see in the dark by detecting ultraviolet or infrared radiation.

3. Consider that, today, prescribing a medication to treat a condition is a matter of the doctor’s experience and judgment—and luck. The active ingredient in any medicine is selected and developed according to a drug researcher’s particular theory of the disease. The medication is then tested in clinical trials against a limited number of people—usually about 3,000 at the third-stage trial. The medication remains under prescription, with strict requirements for reporting adverse effects, until about a million patients have used it. But not every medicine works for every patient. Genetic differences control how an individual responds to the disease, or to the medicine’s operative chemistry, or to its recommended dosing. In the future, we’ll know how those genetic differences interact with the disease process and the therapeutic process. Prescriptions will then be targeted not only to the disease but also to the patient’s genetic inheritance. The practice of medicine will become much more effective.

4. Of course, it will help if the patient is already mindful and careful about lifestyle and health. Yes, we’ll be able to replace lungs damaged by years of smoking, but complete replacement of smoke-damaged arteries will be a little trickier. And it’s easier to replace a liver if you don’t have to cut through cubic centimeters of belly fat to find it.

5. Under the Affordable Care Act, health insurance does remain the primary responsibility of employers. But the legislation offers them the alternative of paying a fine for every employee they fail to cover—usually at a much lower rate than the cost of insuring the employee in the first place. This fine becomes a tax to defray the expenses in the state insurance pools to which the newly uninsured citizens will have to apply.

Sunday, November 18, 2012

Thoughts on Public Health Care (I)

My conservative friends are not going to like this posting. Come to think of it, neither will my progressive friends. But here are my thoughts, from what I conceive to be the political center, on the issue of public health care.

With the Supreme Court decision in June and results of the national election this month, the Patient Protection and Affordable Care Act of 2010 will stand as the law of the land. Whatever the details of this legislation, some of which are still being worked out, its import and I believe its intention are to move the country to a single-payer system of publicly provided medicine. (More next week on how a bill requiring universal insurance coverage achieves this.) This will align the United States with the health care systems used in most of the rest of the world—if those governments address the issue at all. But is this really such a huge departure for our country?

1. We Publicly Pay for Education

Health care and education are two of the personal-, family-, and society-level necessities that cannot be supplied on an ad hoc basis—not in the way that you can build houses one at a time, or provide dry clothes and hot meals adequately from any number of possible supply channels. Unless you’re a parent providing home schooling, or a tribe wandering in the wilderness and teaching its young to hunt and fish, you need a complex infrastructure to educate a generation of people: locally situated classrooms, a plethora of introductory books on different subjects, teachers trained to present those subjects, and a supporting network that extends beyond the purely local level to decide on and shape the curriculum, approve the books, train the teachers, and accredit the institutions.

From our earliest days, Americans have agreed that providing basic schooling is a community function, because raising a generation of literate adults with a common base of knowledge is essential to democratic government. Grammar schools and high schools have always been public. Yes, certain communities also host parochial schools and elite “preparatory” schools, which are privately funded, but these have functioned in addition to the local public school for families who felt the need of something different or better. And those families still pay the taxes that support the public school. Higher education—at the college level and above—started out as a collection of privately or religiously backed institutions. In the middle of the 19th century, however, states began funding land-grant colleges and “normal schools” (i.e., for educating teachers) as public institutions.1 Today, public colleges and universities are a big part of the education mix.

Health care is not that different from education, in that it requires a complex infrastructure of hospitals, clinics, testing laboratories and services, primary care physicians, treatment specialists, researchers, medical technicians, nurses and orderlies, and administrators, as well as pharmaceuticals and medical supplies, and a supporting network of teaching hospitals, training programs, accreditation, and drug and equipment manufacturing. Even if personal health is not properly a community concern—as we agree that educating the young should be—providing for people’s various health requirements and caring for them when they are sick and injured is a hugely complex business. And we can all agree, I think, that any society functions better when people are healthy and strong.

At current reckoning, health care in the U.S. represents at least 14% of the national economy. That’s why many people hesitate to turn our patchwork of private providers (doctors’ practice groups, for-profit and religiously funded hospital organizations, insurance companies, and drug and equipment companies) and public providers (Medicare and Medicaid funding, community hospitals, county clinics, and various national institutes managing health issues) over to a single government system operated at the federal level. When all the eggs are in one basket—who’s watching that basket?

2. You Get What You Pay For

Right now, the average American experiences health care in a world of choice—well, some choice. Most people get health care through their employer, and most employers offer a variety of insurance plans with varying options about coverage, copays, premium costs, provider lists, and other pieces of the puzzle. If you don’t have coverage, then you take whatever you can get from an emergency room visit or the charity of a public hospital. No one, except the truly rich, gets everything he or she wants.

When you buy something for yourself, you get to make choices. You weigh what you’ll pay against what you ideally want, what you actually need, and what makes the most sense to you. When you get insurance through an employer, the company is paying part of the insurance premium, so the options are more limited. You can buy the gold-plated health plan with all the bells and whistles, but you’ll pay more out of your own pocket for it.

Advocates of a single-payer system—universal health care provided at government expense—tend to forget about the choice side of the equation. When a third party pays the piper, you dance to his tune. When you eat at public expense, you don’t get to choose between steak and chicken. Under a single-payer system, you may have a strong, bonded relationship with a certain doctor, but he or she might be assigned elsewhere. You may be in pain and need a new hip now, but resources are limited and so you might have to wait. You may be a vigorous, healthy 78-year-old with a lot still to contribute, but if you get cancer after the mandated cutoff age for aggressive treatment, then you will get only palliatives and hospice care.

If health care in America follows the British model, where private insurance and religious-based or for-profit medical providers are permitted to function, then you will be able to exercise choice by paying more outside the system—in the same way that parents can choose to put their children in a parochial or private school. If the system limits competition from private resources, as in the Canadian model, then you will accept the choices made for you by bureaucrats in the state capital or in Washington, DC.

3. Insurance Isn’t the Right Business Model

In the early days, certainly at the beginning of the 19th century, only two kinds of people went to doctors: the rich and royalty. With their theories about the four humors, bleeding, and black bile, the most that doctors were really good for was setting broken bones or stitching up wounds. For the rest of human ailments, their practice involved administering placebos, watching, and waiting. Oh, surgeons could cut out a large tumor or amputate a mangled limb in extremis. And hospitals were filthy places where you went to recuperate or die—and usually the latter.

Not until the melding of science and medicine—which began with the germ theory of disease in the late 19th century and progressed to antibiotics with the discovery of penicillin in 1929—did medicine gain a solid and respectable footing. But still, for most people, health was a matter of good luck and a strong constitution. Serious illness and injuries were considered natural catastrophes, and death usually followed quickly.

It made sense, in this medical environment, to insure yourself against the catastrophes. You took out hospital insurance, also called “major medical,” against surgery or an acute condition like cancer involving a long hospital stay. But for routine aches and pains, fevers, and the occasional broken bone, a family would pay out of pocket to visit their neighborhood doctor.2

In the 1930s, while building what became Hoover Dam, the Henry Kaiser organization set up the first comprehensive health care system—Kaiser Permanente—which tended to their workers’ complete medical needs through a network of dedicated facilities and physicians that was paid for through insurance-style premiums. Providing complete medical services through insurance at the workplace became an employment perk during World War II, because health insurance was not subject to federally imposed wage caps. Gradually, with the rise of Health Maintenance Organizations in the 1970s, the emphasis moved from catastrophic coverage to complete medical coverage. This was generally a good thing, because regular checkups and preventive care were now encouraged and paid for, but the transition had some bad consequences, too.

Insurance is a means of alleviating the potentially crippling costs of an unexpected catastrophe, such as your house burning down, crashing the car, or a family member becoming badly hurt and needing surgery and months of therapy. Insurance is not meant to pay for routine and expected expenses like replacing the roof, painting the porch, or changing the oil and tires. To be sure, medical checkups, routine diagnostics, booster shots, and birth control all have to do with a person’s health, but they are not unexpected expenses and therefore not properly paid for by insurance. If you insist on paying for these services through insurance premiums, then you are no longer making an actuarial bet—like betting that the house won’t burn or that you’ll stay healthy—but instead you are simply structuring your monthly expenses through an exotically complex and costly method of payment.

And even if you are perfectly healthy, eventually you will die. In the early days, this was a fairly uncomplicated process. Some part of the organism was damaged by disease or injury, began to break down, the patient failed to thrive, and—on a time scale dictated by the nature of the disease or damage—further living became impossible and you said good-bye. Now, through the miracles of modern medicine, we can hold off that final act for an unnaturally long time and can even keep a brain-dead shell breathing and pumping blood in perpetuity. If you had to pay for such “heroic measures” out of pocket, you would eventually call it quits and succumb to the inevitable. But so long as someone else is footing the bill out of premiums you’ve been paying all along—why spare the expense?

It’s commonly understood that about 50% of the medical costs a person consumes are incurred in the last six months of life. From a personal point of view, the natural feeling is “Why not stick it to the insurance company? We’ve been paying the bloodsuckers all these years!” But from a societal point of view, “Why spend these resources on the dying, who ultimately can’t be helped? There are more important medical needs to be served!”

Insurance is a bad business model for paying out monthly expenses. It’s a really lousy model for trying to delay or override the inevitable.

So that’s the background to my thoughts on public health care. Next week I’ll explore where I think medicine is going in the future and why a better system of paying for it will become inevitable.

1. I went to a former land-grant university, Penn State.

2. This was back in the days when a doctor, lawyer, or other trained professional expected to earn a solidly middle-class living. Doctors still made house calls and charged for their services according to the wealth of the community in which they lived. Training as a physician was not considered a sure route to a six-figure income, high society, and a vacation home in the Hamptons. Hospital stays cost a lot back then—more than a local hotel room, certainly—but they were not like moving into the Waldorf Astoria with concierge and room service.

Sunday, November 11, 2012

Not With a Whimper

… But with a sprained ankle. That’s the way life ends—or at least how it starts the final and irrevocable slide.1

As I grow older, the one thing I’ve learned that the young have still to discover is how adaptable and accommodating the human body, the human mind, and many other aspects of human life can be. If you maintain your body and brain, keeping both flexible and strong through daily exercise, challenging reading, animated conversation, complex music and puzzles, and occasional stress tests that require you to move outside your comfort zone both physically and mentally, then you can find health, a measure of happiness, and peace of mind. If you live within your means, save some money, buy insurance, and prepare for the unexpected, then your household can survive any number of economic shocks.

But that’s not actually my point in this posting. “Adaptable and accommodating” can also mean just the opposite: the body gradually shapes itself and its potential to whatever becomes your everyday way of life. I’ve been to that comfortable place, seen others go there before me—and now I’m trying to come back.

The young are, for the most part, gifted with healthy bodies, supercharged metabolisms, clarity of mind, and a future full of possibilities. Life is a golden promise. But what they don’t yet know is that life is also a succession of idle minutes, passing days, repetitive stresses and choices, accumulating habits, and suddenly passing years. The cigarettes, the drugs, rich foods, and other treats we once consumed only at parties and on special occasions eventually find their way into our fingers and our mouths every day. The book we put aside to watch a really stupid television show, because we were just too tired, becomes a dusty stack on the bedside table. The workout that we skipped on Monday is soon skipped on Tuesdays and Wednesdays, then for a week at a time, and eventually forgotten. The unpaid balance that we once tolerated on our credit cards “just for this month,” because payday fell a week after the “due by” date, slowly becomes the balance we carry from month to month and expect to pay off someday. Life has a way of catching up with us and becoming real, the norm, the expected.

And we adapt to and accommodate our changed reality. We carry the physical and mental debits because our resources are, of course, still boundless. We schedule our day around that little hangover which lingers in the morning. We carry the extra pounds because they really don’t slow us down that much.2 We pay the finance charges on our cards from month to month because we’re making more money now and we need more things to match our lifestyle.

Life has a way of creeping up, however. Soon we’re taking a glass of wine or whisky at lunch to chase the hangover that will otherwise fog up the afternoon. We have trouble bending over to tie our shoes and instead buy a pair of loafers we can slip into standing up. We take the elevator, even if we’re only going up a floor or two, because the stairs would leave us out of breath. We’re paying finance charges on the credit cards that have gradually become a noticeable fraction of the monthly rent.

My point is that we adapt to these stresses, we become comfortable with them. They are part of the life we lead. And meanwhile, silently, invisibly, without even a whimper, the boundless resources we once enjoyed in youth—and thought we could rely on in a crisis—are eaten up with the need to support these daily deficits. We go from being able to climb the steps of a picturesque lighthouse or the medieval towers of Bologna,3 to being winded by the stairs in a friend’s home. We go from running marathons to being unable to walk five miles if the car breaks down. We can still carry the weight, the strain of drinking and smoking, the cost of the debts—but we have arrived on a knife edge.

And then the unexpected happens, the jolt that takes us out of our daily path: we sprain an ankle, get stranded with a broken fuel pump, lose the roof to a freak windstorm. And what would have been an inconvenience in our youth becomes a life-and-death situation. We can no longer move our bulk from the chair to the table to the bathroom, no longer walk to find a payphone, no longer absorb the added cost to keep our house.

It’s certainly not the case that shedding our vices, losing the weight, and paying off the cards guarantee we’ll live forever. Everybody dies of something. But you don’t have to die of something silly like turning your ankle or running out of gas.

What applies on a personal scale also applies on a national scale. Like a person who’s become careless about credit card debt, our country has relied on deficit spending because we’ve always been able to cover the finance charges. The current mountain of national debt—$16 trillion and counting—won’t sift down like snow and smother us softly, so that we go out with a whimper. Instead, we will face a crisis—one more war we cannot avoid, an earthquake that shatters the infrastructure of an entire region,4 or some other unexpected national crisis—and the debt will suddenly become unsustainable. Our resources will have been eaten out from the inside, and the collapse will be fast and unavoidable.

We don’t necessarily want to live forever. But we also don’t want to die of something stupid. That would just be embarrassing.

1. The reference, of course, is to T. S. Eliot’s poem The Hollow Men and its last line about the way the world ends: “Not with a bang but a whimper.”

2. If you think about it, an extra fifty pounds is like packing two suitcases and carrying them strapped around your middle and across your buttocks. Most of us resist the effort to carry those two suitcases for a mile through the airport, yet we carry that much weight around with us every day.

3. It’s 498 steps to the top of the Asinelli Tower. I could climb them twenty years ago. Oh, what a view!

4. As I’m writing this, the East Coast is still recovering from the super storm called “Sandy,” with billions of dollars in damage repairs ahead of us. I woke up wondering if this is the sprained ankle that our economy has been shuffling towards for a couple of years now.