Cancer In The Body Politic

Diagnosis and Prescription for an American in Decline

Part I: Diagnosis

Chapter I
The Approach

“It was the best of times,
It was the worst of times.” (1)

The biggest thrill in medicine for me came whenever I sensed that a very ill patient had the potential to become 100% healthy and strong. This was sometimes possible if we could perform a comprehensive diagnostic “work-up,” determine the causes of dis-ease, and embark on a full treatment regimen. I feel that same anticipation regarding the multiplicity of problems accumulated by our country which I will call “Patient USA.”

While we rightfully celebrate the strengths of our nation, especially the industriousness, creativity, and imagination of the people, we know we must be vigilant and work to protect our gains, ever watchful for any early signs or symptoms of decline. To this observer many such symptoms and signs have become apparent.

I began the study leading to this book with five questions: What is really going on in this world and why is our nation becoming more troubled? What should we be doing differently? Why? And how do we accomplish the needed change?

Another puzzle: why have many of the American people often seemed apathetic, even cynical? I believe most of those discouraged people understand and care more than we may think. I believe that the source of apparent apathy on Election Day – at least until the 2004 election – (and the source of the helplessness felt by many and some of the depression, cynicism, anger, violence, and even escapism with illegal drugs and alcohol) is this: They don’t see that we can do anything about all the problems. For example, when government lies or big business lies, or when church bodies sometimes lie, the response often is, “Sure…but how are you going to change that?” Many – perhaps most – people insulate themselves from tough issues because of a fear of risk and failure, or the fear of having to realize that their own government, with the complicity of the media, does in fact often obfuscate the truth.

Let’s start with the givens:

    • We know something’s wrong. We knew well before the presidential elections of 2000 and 2004 that something was dreadfully wrong with America. We knew that the mighty, beautiful nation, which we once were so proud to represent anywhere in the world, was no longer so loved and admired even by neighbors and allies.
    • We know that what’s wrong must be basic – not simply our own mantra of complaints: taxes, schools, crime, health care. No, it feels more systemic than that.
    • For instance, we know that, often, over 50% of eligible voters don’t vote, that many have lost respect for the institutions of government. Many know that our nation has lost much of what our “founding fathers” prescribed for the new United States of America – a government of, by, and for the people.
    • We know that our communities – and our people – have enormous unmet needs: homelessness is up, poverty is up, health insurance coverage is down; quality of education is down; 20% of our children are both poor and hungry. In my city (Rochester, NY) there are schools where 40% of the children have toxic levels of lead in their blood – levels that cause permanent changes in their brains leading to lower IQ, learning disabilities, hyperactivity, and violent behavior.
    • We know that our families are less stable: often two to three jobs per family; high divorce rates; family abuse and neglect.
    • We know that we ourselves are in trouble: depression, over-consumption, constant seeking after probably impossible goals of self-perfection; and we know we use escape mechanisms, from shopping to TV to alcohol and drugs, to shut out real world problems.

Whether we are liberal or conservative, rich or poor, we know we have problems. Let’s explore what these are, their causes, and what can be done about them.

A Method Proposed
To deal logically with such complex areas as these we need a new methodology that is comprehensive, inclusive of all factors. I propose to use the time-tested ways of a medical work-up.
In the field of medicine it is absolutely necessary first to gather the facts – as objectively and dispassionately as possible; then to try to fit them together into a set of diagnoses; to test those ideas; to explore all the possible ways to prevent, treat and rehabilitate; and not ever to stop short in this process because it might seem impossible to reach a cure.
Let’s try it with Patient USA! To not try, to maintain the status quo in a state of intellectual paralysis, assuming that nothing major can be changed, that “there is no alternative (TINA),” that we are impotent and meaningless in the face of the Powers: that would be giving up – then we are courting disaster, individually, locally, nationally, globally.

In Chapter II, we will take the history, concentrating on symptoms. Then in Chapter III we will perform an examination, looking for signs of illness and disability. In Chapter IV we compare these findings to normal standards to determine which are abnormal. That will require a determination of what are reasonable standards or benchmarks for a whole society. If we can agree on general standards and identify which symptoms and signs of trouble are definitely outside those standards – and therefore “abnormal” – then we can proceed with diagnosis. But labeling abnormalities or diagnosing is not enough. Medical science goes on to try to discover what has caused each problem; what steps occurred to reach this stage of illness. That (Chapter VI) is called “pathogenesis.” Once all that is decided it will be possible to outline a course of therapy and write a prescription for America.