Philadelphia Reflections

The musings of a physician who has served the community for over six decades

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(1) Medicine at the Two Ends of Life: First year of Life, and Last Years of Life.

Benjamin Franklin founded the Ivy League's University of Pennsylvania, but he was surely no academic. He was a practical man, looking for practical results, and some of the fiercest battles he fought concerned the direction and purposes of his University, especially the nature of its mission. At a time when most Ivy League Universities were mostly divinity schools, he would not Pennsylvania tolerate it that way for his own, and to this day the University of Pennsylvania has no divinity school, although it does have something very close. If there had been such a thing in his day as a Nobel Prize, he would have won it for his achievements in electricity. In the centuries-long journey from divinity school to occupational credentials, Franklin's position and the general academic position have drawn marginally closer together. The first academic course in science was only taught around the time of the Civil War. The term "philosophy" would now be used as a word for "science", and a Doctorate of Nuclear Physics would puzzle most physics majors, even though they aspire to achieve that Ph.D. degree. The American Philosophical Society is quite definitely a scientific society, and most definitely was founded by Benjamin Franklin. These were not idle arguments in the Age of Reason.

To speak more practically, a great bulk of scientific achievement consists of experiments to reduce complexity, and ultimately to reduce costs. No doubt there are scientific discoveries of new fields, and probably the greatest prestige attaches to those who uncover some totally original feature. But the surprising bulk of the effort is devoted to simplifying and reducing costs. If a scientist employed by a big company should discover some cheaper way to do something more simple, he will be rewarded, and it may well make his career. If he discovers how to solve a mathematical equation in significantly fewer steps, his accomplishment is described as "elegant". That's the nature of science, to accomplish a goal, no matter how complicated. To make it profitable, you cut out a lot of the fumbling and get right down to the nub of a solution, with fewer steps, and cheaper materials. If you are unsatisfied with this generalization, just compare some random salaries of chemical engineers, with theoretical chemists.

There's even a story they tell in England about Franklin and King George. It seems lightning struck the steeple of St. Paul's Cathedral, and quite naturally the King consulted with Franklin about a lightning rod since Franklin lived a few blocks away. The King wanted a brass ball on the top of his church. Franklin made the rare miscalculation of openly disagreeing with the King. "No, your Majesty, it should be an iron spike. " The English implies the story depicts a foreign printer telling the King what to do and was, therefore, himself a fool. The American version of the same story would have it the King was a fool to tell the greatest living expert on lightning rods what was what about lightning rods. The founder of the American diplomatic corps probably would never have chosen such words, but "Who the hell do you think you are, telling me what is best in lightning rods", would probably summarize it. Well, America and Great Britain fought an eight-year revolution over this difference in attitudes, and so it seems likely Franklin and the Trustees of the University he founded, used stronger words that are now reported in alumni magazines.

The moral of all this is, no matter how silly the argument seems to strangers, the protagonists sometimes feel strongly enough to make trouble for those who do not accord their views proper deference. The fact Franklin acted in such an out-of-character way, is probably proof of how strongly he really felt about it.

So, to sum it all up, it is an American trait to acknowledge start-up costs but to surmise that in the long run, it's cheaper to eliminate a disease than to count the cost of curing it. No one knows whether research will lead to eliminating the cost of disease, but most Americans will presume it will, and most Americans will somewhat minimize the time it will take to accomplish it. We imitate the attitudes we suppose our mentor must have had, and indeed he may well have had them. The logic of the matter will only take you so far. At the rate we are going, I feel we might eliminate most diseases within the span of the next century. I feel medical costs a century from now will be -- not just could be --eliminated except for the cost of childbirth and death. You may disagree; no one knows. That's why participation in a long-term program to deal with the matter, should remain voluntary until the outcome is clear. In matters like this, everyone tends to overstate his case. Therefore, no one is entitled to force others to swallow their doubts.

Originally published: Tuesday, April 18, 2017; most-recently modified: Thursday, May 09, 2019