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Six Libertarian Reforms to accelerate Life Extension

Posted: Thu, February 14, 2013 | By: Gennady Stolyarov II



While the achievement of radical human life extension is primarily a scientific and technical challenge, the political environment in which research takes place is extremely influential as to the rate of progress, as well as whether the research could even occur in the first place, and whether consumers could benefit from the fruits of such research in a sufficiently short timeframe. 

I, as a libertarian, do not see massive government funding of indefinite life extension as the solution – because of the numerous strings attached and the possibility of such funding distorting and even stalling the course of life-extension research by rendering it subject to pressures by anti-longevity special-interest constituencies. (I can allow an exception for increased government medical spending if it comes at the cost of major reductions in military spending; see my item 6 below for more details.) 

Rather, my proposed solutions focus on liberating the market, competition, and consumer choice to achieve an unprecedented rapidity of progress in life-extension treatments. This is the fastest and most reliable way to ensure that people living today will benefit from these treatments and will not be among the last generations to perish. Here, I describe six major types of libertarian reforms that could greatly accelerate progress toward indefinite human life extension.

1. Repeal of the requirement for drugs and medical treatments to obtain FDA approval before being used on willing patients. The greatest threat to research on indefinite life extension – and the availability of life-extending treatments to patients – is the current requirement in the United States (and analogous requirements elsewhere in the Western world) that drugs or treatments may not be used, even on willing patients, unless approval for such drugs or treatments is received from the Food and Drug Administration (or an analogous national regulatory organization in other countries). 

This is a profound violation of patient sovereignty; a person who is terminally ill is unable to choose to take a risk on an unapproved drug or treatment unless this person is fortunate enough to participate in a clinical trial. Even then, once the clinical trial ends, the treatment must be discontinued, even if it was actually successful at prolonging the person’s life. This is not only profoundly tragic, but morally unconscionable as well.

As a libertarian, I would prefer to see the FDA abolished altogether and for competing private certification agencies to take its place. But even this transformation does not need to occur in order for the worst current effects of the FDA to be greatly alleviated. The most critical reform needed is to allow unapproved drugs and treatments to be marketed and consumed. If the FDA wishes to strongly differentiate between approved and unapproved treatments, then a strongly worded warning label could be required for unapproved treatments, and patients could even be required to sign a consent form stating that they have been informed of the risks of an unapproved treatment. 

While this is not a perfect libertarian solution, it is a vast incremental improvement over the status quo, in that hundreds of thousands of people who would die otherwise would at least be able to take several more chances at extending their lives – and some of these attempts will succeed, even if they are pure gambles from the patient’s point of view. Thus, this reform to directly extend many lives and to redress a moral travesty should be the top political priority of advocates of indefinite life extension. Over the coming decades, its effect will be to allow cutting-edge treatments to reach a market sooner and thus to enable data about those treatments’ effects to be gathered more quickly and reliably. Because many treatments take 10-15 years to receive FDA approval, this reform could by itself speed up the real-world advent of indefinite life extension by over a decade.

2. Abolishing medical licensing protectionism. The current system for licensing doctors is highly monopolistic and protectionist – the result of efforts by the American Medical Association in the early 20th century to limit entry into the profession in order to artificially boost incomes for its members. The medical system suffers today from too few doctors and thus vastly inflated patient costs and unacceptable waiting times for appointments. Instead of prohibiting the practice of medicine by all except a select few who have completed an extremely rigorous and cost-prohibitive formal medical schooling, governments in the Western world should allow the market to determine different tiers of medical care for which competing private certifications would emerge. For the most specialized and intricate tasks, high standards of certification would continue to exist, and a practitioner’s credentials and reputation would remain absolutely essential to convincing consumers to put their lives in that practitioner’s hands. 

But, with regard to routine medical care (e.g., annual check-ups, vaccinations, basic wound treatment), it is not necessary to receive attention from a person with a full-fledged medical degree. Furthermore, competition among certification providers would increase quality of training and lower its price, as well as accelerate the time needed to complete the training. Such a system would allow many more young medical professionals to practice without undertaking enormous debt or serving for years (if not decades) in roles that offer very little remuneration while entailing a great deal of subservience to the hierarchy of some established institution or another. 

Ultimately, without sufficient doctors to affordably deliver life-extending treatments when they become available, it would not be feasible to extend these treatments to the majority of people. Would there be medical quacks under such a system of privatized certification? There are always quacks, including in the West today – and no regulatory system can prevent those quacks from exploiting willing dupes. But full consumer choice, combined with the strong reputational signals sent by the market, would ensure that the quacks would have a niche audience only and would never predominate over scientifically minded practitioners.

3. Abolishing medical patent monopolies. Medical patents – in essence, legal grants of monopoly for limited periods of time – greatly inflate the cost of drugs and other treatments. Especially in today’s world of rapidly advancing biotechnology, a patent term of 20 years essentially means that no party other than the patent holder (or someone paying royalties to the patent holder) may innovate upon the patented medicine for a generation, all while the technological potential for such innovation becomes glaringly obvious. As much innovation consists of incremental improvements on what already exists, the lack of an ability to create derivative drugs and treatments that tweak current approaches implies that the entire medical field is, for some time, stuck at the first stages of a treatment’s evolution – with all of the expense and unreliability this entails. 

More appallingly, many pharmaceutical companies today attempt to re-patent drugs that have already entered the public domain, simply because the drugs have been discovered to have effects on a disease different from the one for which they were originally patented. The result of this is that the price of the re-patented drug often spikes by orders of magnitude compared to the price level during the period the drug was subject to competition. Only a vibrant and competitive market, where numerous medical providers can experiment with how to improve particular treatments or create new ones, can allow for the rate of progress needed for the people alive today to benefit from radical life extension. 

Some may challenge this recommendation with the argument that the monopoly revenues from medical patents are necessary to recoup the sometimes enormous costs that pharmaceutical companies incur in researching and testing the drug and obtaining approval from regulatory agencies such as the FDA. But if the absolute requirement of FDA approval is removed as I recommend, then these costs will plummet dramatically, and drug developers will be able to realize revenues much more quickly than in the status quo. Furthermore, the original developer of an innovation will still always benefit from a first-mover advantage, as it takes time for competitors to catch on. If the original developer can maintain high-quality service and demonstrate the ability to sell a safe product, then the brand-name advantage alone can secure a consistent revenue stream without the need for a patent monopoly.

4. Abolishing software patent monopolies. With the rapid growth of computing power and the Internet, much more medical research is becoming dependent on computation. In some fields such as genome sequencing, the price per computation is declining at a rate even far exceeding that of Moore’s Law. At the same time, ordinary individuals have an unprecedented opportunity to participate in medical research by donating their computer time to distributed computing projects. Software, however, remains artificially scarce because of patent monopolies that have increasingly been utilized by established companies to crush innovation (witness the massively expensive and wasteful patent wars over smartphone and tablet technology). 

Because most software is not cost-prohibitive even today, the most pernicious effect of software patents is not on price, but on the existence of innovation per se. Because there exist tens of thousands of software patents (many held defensively and not actually utilized to market anything), any inventor of a program that assists in medical, biotechnological, or nanotechnological computations must proceed with extreme caution, lest he run afoul of some obscure patent that is held for the specific purpose of suing people like him out of existence once his product is made known. The predatory nature of the patent litigation system serves to deter many potential innovators from even trying, resulting in numerous foregone discoveries that could further accelerate the rate at which computation could facilitate medical progress. Ideally, all software patents (and all patents generally) should be abolished, and free-market competition should be allowed to reign. But even under a patent system, massive incremental improvements could be made. 

First, non-commercial uses of a patent should be rendered immune to liability. This would open up a lot of ground for non-profit medical research using distributed computing. Second, for commercial use of patents, a system of legislatively fixed maximum royalties could emerge – where the patent holder would be obligated to allow a competitor to use a particular patented product, provided that a certain price is paid to the patent holder – and litigation would be permanently barred. This approach would continue to give a revenue stream to patent holders while ensuring that the existence of a patent does not prevent a product from coming to market or result in highly uncertain and variable litigation costs.

5. Reestablishing the two-party doctor-patient relationship. The most reliable and effective medical care occurs when the person receiving it has full discretion over the level of treatment to be pursued, while the person delivering it has full discretion over the execution (subject to the wishes of the consumer). I see a libertarian approach to healthcare as the one most suited toward ensuring that every person obtains medically necessary care at an affordable cost. 

A libertarian system respects and does not violate the sovereignty of either the consumer or the provider. It is important to make sure that no third party – whether it is a government or a private company – is able to deny the treatment that can save a person’s life.  In other words, there should be no “rationing” of care for which a patient is able and willing to pay and which a doctor is able and willing to provide. Furthermore, there should be no situation in which a political system prevents physicians from exercising their right to provide charitable care free of charge, or care at a deep discount to those who could not afford it otherwise. For instance, Medicare in the United States prohibits doctors who accept its reimbursements from treating patients free of charge. This cost-imposing prohibition, among many other restrictions on the provision of care using innovative methods, should be abolished. 

Consumers should be completely sovereign regarding the healthcare techniques and systems they utilize and the methods of payment they prefer. No person should be mandated to participate in a system of healthcare or payment which he does not personally prefer or consider worth the costs. Experimentation should occur with a wide variety of arrangements for providing healthcare. In the United States, innovative approaches are currently being pursued on the West Coast and elsewhere – with clinics providing basic medical care not on a fee-for-service model, but based on a monthly subscription, which entitles the patient to care as needed, as well as extensive in-person and electronic consultations which are not typical of the labyrinthine medical systems that prevail in the Western world today. 

Other possible approaches could include systems of tiered pricing, where a doctor is free to charge patients of fewer means much lower fees than wealthier patients are asked to pay – or a system where prices for services are itemized and disclosed in advance, as in a menu, so that patients know in advance how much the care they seek will cost. Freedom in pricing and structuring healthcare businesses will also enable the much heavier utilization of rapidly improving electronic technologies at lower cost. It is essential that political barriers do not stand in the way of experimentation by physicians and patients regarding the provision of potentially life-saving healthcare, because just as no central planner can foresee the scientific discoveries that will ultimately save and extend lives, so can no central planner foresee the most efficient ways of delivering such care in an abundant and affordable manner. Forcing people into any system of healthcare – private or governmental – which they do not voluntarily accept will only hold back medical progress and result in widespread tragedy and colossal waste of life. 

In countries where government predominantly pays for healthcare, the most important reform is to render participation in the government system voluntary. The worst systems of government healthcare are those where private alternatives are prohibited, and such private competition should be permitted immediately, with no strings attached. Better yet, patients should be permitted to opt out of the government systems altogether by being allowed to save on their taxes if they renounce the benefits from such systems and opt for a competing private system instead. Over time, the government systems would shrink to basic “safety nets” for the poorest and least able, while standards of living and medical care would rise to the level that ever fewer people would find themselves in need of such “safety nets”. Eventually, with a sufficiently high level of prosperity and technological advancement, the government healthcare systems could be phased out altogether without adverse health consequences to anyone. 

 

6. Replacement of military spending with medical research. While, as a libertarian, I do not consider medical research to be the proper province of government, there are many worse ways for a government to spend its money – for instance, by actively killing people in wasteful, expensive, and immoral wars. If government funds are spent on saving and extending lives rather than destroying them, this would surely be an improvement. Thus, while I do not support increasing aggregate government spending to fund indefinite life extension (or medical research generally), I would advocate a spending-reduction plan where vast amounts of military spending are eliminated and some fraction of such spending is replaced with spending on medical research. 

Ideally, this research should be as free from “strings attached” as possible and could be funded through outright unconditional grants to organizations working on indefinite life extension. However, in practice it is virtually impossible to avoid elements of politicization and conditionality in government medical funding. Therefore, this plan should be implemented with the utmost caution. Its effectiveness could be improved by the passage of legislation to expressly prohibit the government from dictating the methods, outcomes, or applications of the research it funds, as well as to prohibit non-researchers from acting as lobbyists for medical research. 

An alternative to this plan could be to simply lower taxes across the board by the amount of reduction in military spending. This would have the effect of returning wealth to the general public, some of which would be spent on medical research, while another portion of these returned funds would increase consumers’ bargaining power in the medical system, resulting in improved treatments and more patient sovereignty.

A video playlist (5 videos in all) that accompanies the essay is HERE



Comments:

While not a libertarian, i see value in your suggestions.  How can we go about discussing and refining them, and ultimately implementing them ?

By René Milan on Feb 14, 2013 at 9:18am

Aloha All.

  “VUNDABAR!!!!!!!”

By Fred James on Feb 14, 2013 at 10:27am

All I have to say is I couldn’t agree more. The US spends somewhere around 53-58% of it’s annual budget on military expenses. If we took most of that money and turned it into medical research, funding better public education, giving more funding to NASA, and funding more into public services among other things, this country would be MUCH better off. Unfortunately, I don’t see most of the things mentioned above happening without some form of major revolution. I think the only ones people like us who believe Life Extension and immortality is possible can count on is ourselves.

By Eli on Feb 14, 2013 at 12:00pm

Good article. I consider myself something of a libertarian, and I especially like your idea to scale military spending way back, and divert those funds into medical research. I think the govt. does have a role to play in encouraging research and innovation. There is a lot of important research going on at public universities, that probably wouldn’t exist in the private sector, because the research isn’t far enough along yet that it could be seen as potentially profitable. We need to both loosen regulation, and subsidize medical research. Both of these things together will speed up innovation.

By Steve on Feb 14, 2013 at 12:09pm

“The most critical reform needed is to allow unapproved drugs and treatments to be marketed and consumed.”

This is absolute madness! Snake oil salesmen would exploit it no end and customers/patients would be left confused as to what works and what was pseudo-science.

By Reeve Armstrong on Feb 14, 2013 at 12:11pm

Also:

“But, with regard to routine medical care (e.g., annual check-ups, vaccinations, basic wound treatment), it is not necessary to receive attention from a person with a full-fledged medical degree.”

This would be very harmful. And would only lower the public’s trust in medicine.

By Reeve Armstrong on Feb 14, 2013 at 12:14pm

I think you make some interesting insights.While I am not a libertarian,I   would like to see your insights in the political arena,especially number six.
                                          Tom Mooney,
                                    Exec Dir.C.E.L.

By Tom Mooney on Feb 14, 2013 at 12:15pm

“The current system for licensing doctors is highly monopolistic and protectionist – the result of efforts by the American Medical Association in the early 20th century to limit entry into the profession in order to artificially boost incomes for its members. The medical system suffers today from too few doctors and thus vastly inflated patient costs and unacceptable waiting times for appointments.”

Also, doctors often have to spend an unacceptable number of hrs. per week while they are interns. Something you left out is, unless means testing is someday instituted for govt. medical assistance, the system will remain top-heavy. Military spending ought to be cut, and aid to the wealthy should be reduced—the latter will be more difficult than the former: govt. programs for the poor are called ‘welfare’; govt. programs for the upper classes are termed ‘assistance’.

By Alan Brooks on Feb 14, 2013 at 1:32pm

...Correction:

the usual term is Residency- not internship.

Anyway, I was told by a doctor that the reason long hours are forced upon new doctors is the members of the medical boards which decide the number of hours for residencies are doctors or retired doctors—and since they themselves had to do long hours as residents, they want new doctors to do so as well.
Since I only heard this from one doctor, it is uncomfirmed. However even if what I was told is false, the question remains as to why new doctors have to put in such a large number of hours per week.The doctor I am familiar with had to work 16 hours a day six days a week.
Since that time—two years ago—the hours have been shortened, but the hours are undoubtedly still life-consuming.
My hunch is, from all that has been written here and said elsewhere, not only are monopolistic practices a cause for concern, but also traditions such as long hours—16 hrs. a day six days a week was practically a hazing ritual.

By Alan Brooks on Feb 14, 2013 at 6:12pm

One more comment:

So you do not think I’m excessively optimistic, when I wrote,

“unless means testing is someday instituted for govt. medical assistance, the system will remain top-heavy…”

It doesn’t appear at this time such will change. For starters, assisting the well-off is considered rewarding the successful for their success: and that’s hard to argue with.
Helping those in ghettos (which is in fact the correct name for poor, “underclass” neighborhoods) is considered rewarding failure.

So that pretty much leaves military spending.
Morality to one side, we can now see how powerful the cost of ‘blowback’ (i.e. determined enemies fighting back). Several trillions of dollars will be spent on severely disabled veterans of Afghanistan and Iraq who will need to be cared for, for the rest of their lives; and if we want to know who pays for the care, we only have to look in the mirror.

By Alan Brooks on Feb 14, 2013 at 6:29pm

“ghettos (which is in fact the correct name” - i disagree.  The original ghetto began 500 years ago in Venezia and was restrictive, meaning that most people living there were not allowed to leave.  This was the model for many subsequent european ghettos.
Using the term for “poor, “underclass” neighborhoods” is inappropriate and misleading.  Even the poorest modern-day-ghetto dweller can just walk away if he so decides.  70 years ago residents of the ghetto in Warszawa didn’t have that option.

By René Milan on Feb 15, 2013 at 8:50am

“Even the poorest modern-day-ghetto dweller can just walk away if he so decides.”


Yes, but not to live a life—merely an existence. A black in Detroit who walks away from the [ghetto] isn’t going to live a full life as conventional standards define a full life.. however when you abandon conventions, then anything is possible—but not necessarily leading to positive outcome.
Don’t want to excessively generalise on libertarians, but many appear to be souped-up Republicans— status quo oriented people who want more freedom to live the old fashioned life. It is none of my business how they live but the question then arises: are we chasing the past with modern gadgets? which segues back on-topic; it isn’t merely predation in medicine—it is also tradition: in the Midwest I meet a great deal of old men (including doctors) who think the old ways are the best ways even if the old ways are completely dead. If they think a doctor working 16 hrs. a day as a resident builds character, then they hold on to that tradition as long as possible.

By Alan Brooks on Feb 15, 2013 at 7:17pm

Thank you, all, for your comments so far. Some of them will certainly motivate additional writing that delves deeper into the areas I discussed in this article.

René Milan, I hope to cover the implementation of the recommended reforms in future pieces. The biggest obstacle, as we all probably expected, is the political process, which is very much dominated by entrenched special interests. The implementation of reforms would need to involve somehow changing the incentives and circumstances in the underlying society so that the special interests who resist progress will have their influence diminished.

Transhumanists alone (or libertarians alone) are not yet a sufficient critical mass to achieve system-wide reforms on their own. However, in issue-specific coalitions with others (whose composition might shift with the issues), we can make a considerable difference, while also hopefully directing the climate of public opinion along pro-technology paths. Technological improvements themselves might make the task of persuasion easier, generating a virtuous feedback loop.

Steve, I do not think that all publicly funded research can feasibly be discontinued overnight (besides, there are far more urgent areas in which to make cuts), and I would certainly favor preserving all of the beneficial work that currently receives government funding. The question is whether the private sector can undertake the same work in a more efficient, economical, and non-coercive manner. If so, then approaches to privatization should be considered, perhaps in a gradual, stepwise fashion (as is currently being pursued with aspects of the US space program).  Many other reforms may need to occur first – e.g., the abolition of the patent system – before private general research could be feasible on the same scale as occurs with government-funded research today. For the time being, until those reforms occur, you and I would likely favor many of the same specific measures in practice.

By Gennady Stolyarov II on Feb 15, 2013 at 10:43pm

Alan Brooks, I agree that deleterious traditions are another problem in many professions, medicine included. There is a mentality among many established practitioners that newcomers to the profession have to go through the same emotional suffering and stress that the older professionals endured. When dominated by such mindsets, the various certification/licensing and experience requirements cease to be based on knowledge and skill accumulation and indeed turn into hazing rituals.

Yet I remain hopeful that the abolition of both protectionism and institutionalized hazing is possible. Perhaps one way to do this might be to “infiltrate” the various professions with people who are sympathetic to meritocracy, innovation, and humane treatment of newcomers. These people can rise up the ranks and gradually replace those who hold entrenched traditional mindsets.

By Gennady Stolyarov II on Feb 15, 2013 at 10:53pm

Sounds good, Gennady. Keep in mind it isn’t only special interests, it’s also unspecial interests, people who don’t think there’s enough evidence their old ways are finished; besides, they have much invested in the old ways. Point is, they vote for politicians who go along with them, and support in general the retro.
Every sane old-fashioned person I know is wealthy and has the latest things and services, the best medical care. But they want to maintain the Hollywood backdrop of the Old at all costs even to themselves. In Russia you have the Kulaks who today may (some) be financially well off but cling to Mother Russia’s old ways; and there are still zeks in prisons—as in America.

By Alan Brooks on Feb 17, 2013 at 5:25am

... in other words, politicians, attorneys, lobbyists, etc. are the special interests;
the backward uninformed public = unspecial interests.

By Alan Brooks on Feb 17, 2013 at 2:03pm

I’m a libertarian, and also a realist. None of these measures is likely to get implemented in the US within the next 20 years. It’s far more likely that a seastead (Blueseed or one of its future franchises in particular) would offer the jurisdictional freedom to try out freedom from the FDA and patents, and patient sovereignty.

By Dan Dascalescu on Feb 24, 2013 at 9:48pm

I agree with most all of what the author here says, only qualifying the software copyright issue in saying that software copyright/patents should be limited to no more than 2-3 Moore generations. Any copyright or patent on software thats more than 5-6 years old is well nigh pretty useless in protecting any market, as the software it protects is obsolete.

By Mike Lorrey on Mar 14, 2013 at 1:49pm


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