What would medical education that is relevant for the here and now — for America in the early 21st century — address? It is impossible to teach the content relevant for an entire career. It is important to educate practitioners able to adapt to the changing landscape of medicine. We must consider what the future might hold.
Watching science fiction may serve to prompt future physicians to practice preventive medicine for the planet. She must be capable of recognizing changes in disease epidemiology, which will hinge on large-scale social, political economic and ecological forces — including economic inequality, climate change and war and peace. One needs to know what is coming in order to retool appropriately.
Bill Gates, Jeff Bezos and Warren Buffet own more assets than the bottom half of the U.S. population. The eight richest billionaires in the world own as much assets as half of humanity. We are not too distant from the world depicted in “Elysium” where the elites live far away from the rabble on a massive space station. We are witnessing levels of inequality unseen since the Gilded Age. What shall it be for the up-and-coming doctor? Join the elites in making as much money from the current health care system while the scam lasts? Work for an insurance company and deny your fellow doctors attempts to care for their patients? Work for a pharmaceutical corporation and help your CEO figure out which drug patent to buy so he can jack up the price a hundred-fold?
In Elysium, Matt Damon plays a public health hero. From a car thief (“lumpen”) to an assembly line worker at a robot factory (an ordinary “prole”), he becomes a guerrilla fighter for health as a human right. In this world, we could sorely use a hero of that sort.
Back in this world, the elites and the politicians in their pay seek to further shrink the social commons of health care as a publicly shared resource. Thus, the majority party has sought to decimate Medicaid and the Affordable Care Act, even though it has served to extend corporate health insurance to the uninsured.
In present-day America, we have watched drug overdoses overtake motor vehicle crashes as the number one cause of accidental death. Drug overdoses are now the number one cause of death in under-50 Americans. The economists Case and Deaton point out that mortality rate for non-Hispanic whites in the U.S. has been rising this century and that the rise has been higher in the lower socioeconomic classes. They call excess deaths from suicide, alcohol or drugs “deaths of despair.”
During the latter part of the 20th century, working classes had experienced rising incomes as a result of industrial jobs with wages and benefits defended by labor unions. Under the neoliberal transformation of the global economy, multinational corporations have moved their manufacturing operations to places such as China and Mexico where wages are low, environmental protections are lacking, and carbon is emitted to produce goods shipped or trucked to U.S. consumers. While Wall Street executives came through the Great Recession with their earnings intact or enhanced, American workers found themselves with their houses underwater, their manufacturing jobs exported elsewhere and left with low-paying service jobs. Furthermore, the use of artificial intelligence and robotics will mean that the factory of the future will employ fewer and fewer humans.
While seeking to shrink the social commons, the majority party also denies scientific consensus on climate change. Physicians of the future must prepare for the health consequences of climate change. The great climate change sci-fi film has yet to be made. But Interstellar, in its early scenes, makes an attempt. We await the television adaptation of Margaret Atwood’s MaddAddam trilogy. David Mitchell’s The Bone Clocks concludes with a portrayal of a post-climate change, post-Ebola world. One could argue that Mad Max: Fury Road depicts a parched, globally warmed future, but the backstory in The Road Warrior was a nuclear exchange.
Post-apocalyptic, post-nuclear war sci-fi is commonplace. They include A Canticle for Leibowitz, A Boy, and His Dog, and The Road. The escalation of tensions in the Korean peninsula brings the world perilously close to nuclear Armageddon. As North Korea tests nuclear devices and delivery systems, the U.S. conducts military exercises and draws up plans for pre-emptive strikes. As adversaries go on hair-trigger alert, the potential for and mistakenly launched nuclear exchange increases. The probability of nuclear war thus approaches the probabilities that during the Cuban Missile Crisis. Noam Chomsky points out that the standoffs at the Russian border and in Syria are other reasons why the Bulletin of Atomic Scientists have placed the minute hand of the Doomsday Clock at two-and-a-half minutes to midnight. There was a time that many in medicine deemed the continued existence of human civilization important enough to include “the prevention of nuclear war” in the Hippocratic Oath. How quaint that feels these days.
Seiji Yamada is a family physician.
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