We Are at a Major Scientific and Industrial Crossroad

In my last post, I wrote that the promise of medical science has never been greater and I tried to help you understand what I mean by that. That does not begin to explain the importance of the issue. We stand at a major scientific crossroad at this very moment and the path that we take will make all the difference. That crossroad is formed by a combination of the new medical science, other new science and technology, and artificial intelligence (AI). The choice we make will affect every family in America.

I have heard it said that artificial intelligence will have a greater impact on human society than the printing press. I have been working with artificial intelligence to help you learn about the new medical science, the blueprint for the new chronic disease delivery model and answer your questions about both. It is shocking how good AI is already. It is getting better by the day. I am completely convinced AI will have a greater impact than the printing press and it will change everything. It can be an amazing tool for advancement in science and technology or it can be a disaster for all of us. What we do over the next couple of years is critical and right now we are turning in the wrong direction.

The crossroads is not only about medicine. It is about all science. Science and technology advances were a critical part of American greatness after WWII. The U.S. has led the world in science for 80 years and it is easy to believe that was always the case, but that was not true before the war. Europe was the scientific leader. Many scientists came here to escape Germany. The war itself played a role. By 1945, the leading coutries in Europe had been devastated with millions of citizens dead and cities flattened by bombing and shelling. The United States was relatively preserved and became utterly dominant economically, technologically and militarily. American servicemen coming back from the war used the GI Bill to create a surge in college enrollment and a larger number of college-educated Americans, particularly in fields like science, medicine, technology, engineering, and mathematics than ever before.

Visionary leaders in the U.S. government emphasized aggressive funding of basic science including medical science. “During the 1950s, total research and development spending in the U.S. reached nearly 2.5 percent of gross domestic product, the most of such spending on the planet. And it did so by creating an innovative model. Universities around the country, public and private, competed for government research funds. The federal government wrote the checks but did not try to run the programs itself. That competition and freedom created the modern American scientific establishment, the most successful in human history.” Immigration reform in 1965 attracted the best minds from all over the world to be educated and then stay and fuel this engine for our prosperity.

When Americans talk about Making America Great Again, that is the era they are talking about. Those factors combined to make our country the leaders of science, medicine, technology, and industry. The American economy was the envy of the world and kids like me from the wrong side of the tracks had every reason to think they could paint a brighter future for themselves.

Now these forces are now being reversed. Our government is at war with the country’s leading universities and science is under attack, meddling with their internal operations and withholding billions of dollars in research funding. America’s crown jewels of science, the National Institutes of Health and the National Science Foundation, are being gutted. The effects of these mistakes will be long lasting. Scientific research is not something you can just turn on and off.

Here is an example. My team had 180 patients in the landmark ACCORD trial sponsored by the National Institutes of health. This was a study that no private group would fund because it was designed to anwer a question that would not make them more money. There was no financial gain for them. One of the extremely important questions being studied was this: “Does lowering the blood sugar to near normal in high-risk patients with type 2 diabetes using diet, exercise, and any medication approved to lower glucose reduce cardiovascular events and premature death compared with less aggressive usual care.” The planning committee does not even start their work until funding is secured.

The planning phase began in October 1999. They started recruiting participants between June 2001 and October 2005. The ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial's glucose-lowering arm was stopped prematurely in February 2008 because more people died in the intensive glucose lowering arm. The trial answered an important question. It proved that all medicines to lower the blood sugar do not reduce diabetic complications. That led to a requirement that all new drugs for type 2 diabetes prove they have a cardiovascular benefit. If funding had been withdrawn, all that hard work and those important results would have been lost. Every taxpayer has a stake in this research that private industry will not support. It is important that we continue to do studies like this, but if taxpayers pay for it, it should answer questions that are important to everyday Americans.

Other countries are catching up. We are losing our advantage. This is no time to be cutting back. Over the last few years, “China has become the world leader in many key measures of science. China has a larger share than the U.S. of articles published in the leading 82 scientific journals that the Nature Index tracks. In engineering and technology articles, China is also now well ahead of the U.S. In patent applications, there is no longer any contest: China receives almost half of all applications in the world. Even in higher education, China has gone from having 27 universities in the top 500 in 2010 to 76 in 2020 by one measure. The U.S. has gone in the other direction, from 154 to 133.” They are making great strides in medicine. More on that in the next post.

The United States attracted the world’s best and brightest in the past. Just over ten years ago, more than one-third of the Americans who won Nobel Prizes in science were immigrants. Now this is changing fast. “Hundreds of visas are being revoked, students are being rounded up to be deported, and foreign students don’t feel safe and welcome. China has created generous incentives to welcome its best and brightest back home. The best and brighted are choosing to go elsewhere. ”

The best and brightest immigrant scientists helped us win the war. The Greatest Generation further developed our university and research systems to fuel innovation and create the greatest economic engine the world has ever seen. Especially in medicine, we became the leader in developing new drugs and devices. Now all that is under attack in the service of some crazy culture war.

Our universities are more critical today than ever to our ability to compete in the world economy. Many Americans seem to be nostalgic about the old days when America dominated manufacturing, but there is no returning to those days. They are gone with the wind. Even if we could return to the glory days of our dominance in the auto industry, it would not have the effect that most people think. In the 1960s, it took 200 people on the assembly line to produce a car. Today it takes between 10 and 20—a very small fraction of what was needed before. That is because of robotics and automation. Artificial intelligence will just make the probem worse. College and technical education will be critical to our future success.

Automation will be critical to make American automobiles competitive in price. A Mexican autoworker makes $8 an hour. US autoworkers make $60 an hour, but that just begins the story. Benefits for American workers are also the most expensive in the world. Health care costs are part of this national security issue also. General Motors spends more on healthcare than it does on steel. The average annual premiums for employer-sponsored health insurance coverage in 2022 were $7,911 for single coverage and $22,463 for family coverage. US healthcare costs twice as much as in other developed countries. We can lower those costs by doing a better job treating chronic diseases, but our universities and medical schools will be more inportant than ever. We cannot weaken our university system and the research and innovation they bring and solve these daunting problems. Now more than ever, education and training will increase your kids chance of success.

Our system is not perfect. Far from it. It could be better. In medicine, there is too much emphasis on developing the next new thing. Corporate interests have too much influence. There is too much emphasis on the next new drug or device that will increase the wealth of a few and not enough emphasis on bringing together the great treatments available now in an integrated way that serves the people better. But what is happening now is crazy. We are killing the goose tha laid the golden egg.

We need to carefully consider our next moves. The stakes have never been higher for American education, science, and medicine. Automation, robotics, and AI are changing the world in a way that makes nostalgia a fatal diseae. Going back to jobs on the auto assembly line as they were before cannot happen. There are already driverless cabs in Los Angeles and driverless 18 wheelers in Texas. We check ourselves out at Walmart. We order on line. Those jobs did not leave the country, they are just gone. The pace of change is accelerating. These factors in combination will dramatically change the future of science, manufacturing, and medicine. I am convinced the changes that are coming will dwarf the impact of the printing press. We cannot Make America Great Again by longing for the past, we have to face reality, and prepare for the future, especially in medicine. Automation, robotics, and artificial intelligence will worsen economic inequality and we need to be thinking about ways to address that now. Slogans, culture wars, and wish fantasies won’t get us there.