Pessimism is necessary in small doses, allowing us to anticipate, adapt to and often avoid failure or danger. It is also an adjuvant for change. (I don’t know what that means but it’s pithy enough to sound smart.) But apocalyptic pessimism, the pessimism that uses every event or fact to confirm certain doom unless we change our ways, is corrosive and unreliable. How do we know?
As Matt Ridley, another professional optimist observes. “For 200 years pessimists have had all the headlines, even though optimists have far more often been right.”
The steam powered train was predicted to bring ruin to England.
The industrial revolution was supposed to bring enduring misery to millions.
The poor will always be poor.
The sky is falling; the ice caps are melting.
We will run out of oil and natural gas.
Drug prices are unsustainable.
If we had followed the pessimists prescriptions (government control or manipulation of wealth, natural resources, population levels and prices) the world would be more like North Korea than North Dakota.
I will focus on the last perennial pessimistic prediction.
We heard and read a lot about drug prices being out of control, skyrocketing, unconscionable, etc.
In every era where new medicines emerge, the same claim is made. Te same bunch of pessimists trot out the same proposals: government price controls and rationing. (Now repackaged as various value frameworks.)
And each time the apocalyptic predictions that new medicines would be unaffordable or would add nothing to our lives or drive up the cost of health care were wrong.
2015 was all about drug pricing because there were so many new and expensive (relative to most consumer purchases) medicines hitting the market. But in fact the high prices – and indeed even the anger about drug prices – are a healthy sign of progress.
It means that diseases that were fatal can be cured for controlled, including Hep C, many cancers and Ebola. It means that more diagnostics are being developed to match people to the right combination of treatments and to monitor health in real time. It means that more investment in new treatments for smaller groups of people will be developed. Nothing sends a signal about the demand for better medicines than high prices.
At the same time, the high prices are forcing drug companies to do something the rest of the health care system will have to do: change business and financial models to make the case for value and increase the pressure to abandon outdated clinical development tools (randomized clinical trials) and find other ways to demonstrate the health benefits of their goods and services.
Prediction is over-rated when it is too precise. But the general trend of medical innovation, the digitization of biology, is part of a broader evolution in how we create and use the things that give us joy, insight and well-being. Our world is better because the footprint for change is getting smaller and faster. In a WSJ op-ed Andy Kessler wrote that “on Dec. 29, 1959, the physicist Richard Feynman delivered a famous speech at the California Institute of Technology titled “There is Plenty of Room at the Bottom.” He predicted almost limitless possibilities if we could “manipulate and control things on a small scale.” He nailed the next five decades of ever-shrinking realms that ultimately produced trillion-dollar markets in microelectronics, nanotechnology and bioengineering through DNA-level manipulation.…The smaller technology shrinks, the bigger the world can grow. Smaller transistors, faster processors, cheaper sensors will all allow innovators to tackle problems with tremendous precision. It’s as if, because there is plenty of room at the bottom, now there is plenty of room at the top.”
We are increasingly able to navigate and understand what Lee Hood calls “the dark matter of human biology.” New medicines are the result of our ability to explore health, wellness and disease at a molecular level.
Here’s a non-pessimistic prediction: the next trillion-dollar market will be new treatments and algorithms that control disease and keep people healthy. You have to try really hard to despair about that!