The Year's Best Science Fiction & Fantasy 7

IN TOMORROW’S LITTLE BLACK BAG by James Blish

An observer of the s-f scene once commented that science fiction-writing was less a means of livelihood than a way of life. It could as easily be said that s-f is not so much a kind of reading as a way of thinking.

Reginald Bretnor and Robert Heinlein (notably, in The Science Fiction Novel) have advanced the proposition that this identifying fundamental of science fiction is not the specific science content, but the writer’s awareness of science, and in particular of the scientific method.

To utilize this discipline — (observation, hypothesis, experimentation) — in fiction it is necessary, first, to get the best reliable information whether on weather, whales, witches, or whatever; then, to relate data and drama in such a way as to obtain a story line; finally, to devise the most useful environmental situation against which to play out the drama.

One might approach the same area of definition from another viewpoint, and say that the identifying factor in s-f is the interaction between man and his environment. “Mainstream” writing ordinarily confines itself to situations resulting from man’s reaction to only one phase of environment: his fellow-men. “Straight fantasy,” by definition, deals with unreal — fantastic — environmental factors. S-f, specifically, considers the effect on/of a human being of/on a realistically modern or logically predictable future environment (physical, technical, natural, or manmade).

Part of that physical environment for each man is the body his subjective self inhabits. Mr. Blish, who writes science fiction by night (as a way of life), is by day (for a livelihood) a public relations man specializing in the highly esoteric field of institutional drug promotion. Out of this combined background, he considers some of the possibilities inherent in our persistent efforts to modify, amend, and improve our own fleshly surroundings.

With a few notable exceptions, science-fiction authors talk very little about the biological sciences, and still fewer ever mention medicine. This is odd, for the history of modern science fiction coincides almost year for year with the world’s most spectacular medical revolution.

During this period, the contents of the doctor’s little black bag changed completely, and so did the nature of his practice. In 1926, that bag contained nothing that was curative, and the doctor’s practice was limited largely to relieving symptoms and hoping that Nature would do the rest. (That in itself was a revolutionary change; in the Gay Nineties, the bag contained poisons like calomel and the practice consisted in killing the patients with drastically applied ignorance.)

Today, curative drugs are so common and so potent that even physicians find it difficult to keep up with them. (As for science-fiction authors, one had a physician character remark, “If penicillin won’t cure it, I’m afraid nothing will,” although penicillin is, and was then, a “narrow-spectrum” antibiotic, effective against about 20 diseases — as opposed to at least four others that were, and are, effective against more than 100.)

In all civilized countries, infectious disease has been reduced to the category of a nuisance. Of course, it will never be eliminated completely, because bacteria are enormously prolific, and enormously necessary as the organisms of natural decay; furthermore, the natural habitat of many of the most virulent of them is the soil, with man as only a secondary host. Nevertheless, once they find their way into the body, it is possible to knock them out quite quickly. Yet, I am unable to think of a science-fiction writer who predicted this, or anything like it.

The virus diseases are next on the list. They are enormously tough, but a number of them are already no longer important; even polio has been licked in posse, and measles — which is no joke in adults, for it can be permanently disabling — is about to be.

The whole clouded area of mental disease, too, has been cracked wide open in two areas: chemistry and electroencephalography. The tranquillizing drugs are emptying state mental hospitals at a phenomenal rate; the BEG men are providing us with our first concrete clues about how the brain as an organ actually works. Nothing quite like this has happened since the days of Vesalius. The early anatomists, who laid the foundations of scientific medicine, were primarily artists; the early psychotherapists, like Freud, were primarily poets. Neither group ever cured anything, but each opened up a previously forbidden area of investigation. Both were retired to the sidelines when really hardcore knowledge began to be available, and that is happening to all the “talk” psychotherapies now, from pure Freudian-ism to splinter Scientology.

I could go on like this for quite a while, but I am more interested by another question: Where do we go from here?

The guesses that follow ought to be read only as those of a modestly informed layman; I am not a physician or a research scientist. I was trained as a biologist and have worked in or around the pharmaceutical industry for fifteen years, but these are nevertheless the guesses of an observer, not a participant.

First of all, then, it seems to me that some factor has already snapped off the switch on the fountain of “wonder drugs.” Since 1950, the pace of new drug discovery has slackened almost by half. This is true even in the United States, which since World War II has led all the rest of the world combined by about three to one in this field. No research director that I talk to is optimistic about reversing this trend.

One good reason for this is that all the obvious leads have been exhausted, and all the easy discoveries made. After penicillin, for example, showed that micro-organisms manufactured chemical weapons against each other, it was an obvious step for Waksman and his associates at Rutgers to set up a screening program to find another such productive microbe. In four years they had streptomycin, working with a very limited staff and a small stipend from Merck. When a large company puts its whole organization and a million dollars into such a screening program, this happens faster: Pfizer found, tested, and marketed Terramycin all inside a single year.

Several hundred antibiotics are now known, but only about a score have any medical significance, and of these the most recent five are chemists’ modifications of a 1946 discovery. The soil-screening system worked beautifully, but nothing further of startling importance can reasonably be expected of it now. In the meantime, the expenses involved in such research have risen in inverse proportion to its fruitfulness, so that one important company has now spent more than five million dollars on it without coming up with any antibiotic it thought worth marketing. It seems safe to predict that this company, and probably others, will shortly shut the whole project down for good.

This is not to say that the industry as a whole is quitting. Far from it. Last year more than $238 million (exact figures aren’t in yet) was spent in pharmaceutical company laboratories, and that’s more than a quarter of the country’s total budget for medical research.

But the questions now confronting the scientists are far tougher: cancer, heart and vascular disease, the arthritides, functional diseases like diabetes, and other illnesses of the kind generally lumped under the category, “degenerative” —including old age itself. Nobody yet knows what causes any of these, and so they are all being attacked more or less at random. The complexity of the life processes being what it is, this random attack is very much like trying to figure out how to play the piano by the noise it makes when you push it down the back stairs.

It is more than possible that most of these mysterious breakdowns of the human organism are the result, in one way or a dozen ways, of wear and tear — or, in short, old age itself. A year ago, G. Harry Stine, riding a trend-curve well beyond Cloud-Cuckoo-Land, predicted that after the year 2000 everyone then alive would live forever, but this, to put the matter kindly, is nonsense.

Nobody can live forever, because: (1) The longer you live, the more likely you are to meet with an accident; (2) The Second Law of Thermodynamics decrees that all things run down eventually; and (3) The universe itself is wholly unlikely to last forever. (Besides, what would we all eat?)

This writer was extrapolating from the increase in life expectancy at birth which has undoubtedly taken place. A baby born A.D. 1214 couldn’t hope to live beyond the age of 30; the same baby today could expect to live to the age of 70. But it’s important to note that the reason why the figure for the Middle Ages was so low is that so many babies did, in fact, die in early infancy. The age to which a man could live was as great then as it is today; Roger Bacon, who was born in 1214, lived to be 84, and he spent 14 of those years in the bowels of a medieval prison!

Nothing medicine has accomplished so far has raised the possible lifespan of one single man, not by so much as a year. It has raised the probable lifespan of large masses of men, which is a very different thing.

I incline to believe that the possible lifetime of a single man can be extended, at least to 150 years. No mammal but man has so long a childhood and so short an adult life; there is doubtless a findable physiological reason for this, and if it can be found, it can be corrected. (The means may have to be social; some very tentative recent research suggests that it may depend upon the age of the mother when the child is born. If this turns out to be true, the teen-agers will love it.)

But there is never going to be such a thing as an immortal man (I am talking now about the body, not the soul, about which I have no opinion). Everything wears out, without exception — and in challenging the degenerative diseases, medical research may well find itself attempting to give aspirin to the second law of thermodynamics.

I hope nobody will interpret this as pessimism, for I remain perfectly prepared to predict for men a possible lifetime of several thousand years. (In fact, I’ve written four novels from this assumption.) It seems to me that several trends in current research, now being actively prosecuted by both industry and government, point in this direction. They are:

(1) Permanent protection against all forms of infectious disease — and possibly against some forms of non-infectious ones, such as cancer — may be achievable with a drug which provokes the body into generating a non-specific immunity, This is necessary for true longevity because it obviates the possibility that a man’s life might hang from the thread of the availability of some specific anti-infective drug at some specific time. Several such drugs are already known; their common drawback is that they are highly toxic in themselves. It is only a matter of time before that drawback is eliminated.

(2) It may also be possible to eliminate atherosclerosis, a circulatory disease which causes almost 90 per cent of all cardiovascular deaths… and these are the most numerous of all the kinds of death today. Present research is aimed at interrupting the synthesis of a fatty substance called cholesterol in the body — a much more promising approach than eliminating it from the diet, since only about 25 per cent of serum cholesterol can be traced to what you eat. Again, there is a drug which does interrupt this internal synthesis, but it has drastic side-effects; and yet again, these can surely be eliminated sooner or later.

Given the success of both these approaches, there would be very little left to threaten a true longevity but accident. They are real approaches and the pharmaceutical industry, among others, is hotly at work on them.

In the meantime, the vast multiplication of curative agents which has occurred in our century has brought to the fore another problem which can only be touched upon here: the population explosion, which is the result of our having given our fellow men death control without the corresponding check of birth control. What is needed here, as everyone is now aware, is a cheap, simple oral contraceptive, inoffensive to anyone’s religious beliefs, which can be taken safely without a prescription and preferably at any time. The two oral contraceptives that are available now have just about every possible imaginable drawback: they require prescriptions, they are very expensive, they must be taken upon a regular schedule, they produce rebound pregnancy if they are neglected, and furthermore they must be taken by women, who probably won’t be able to find them in their pocketbooks much of the time. What is needed is something as simple as aspirin, which can be taken at need, by men. I think it will be found.

A second consequence of the curative drugs in today’s little black bag is an unprecedented increase in the urgency of accurate diagnosis. Antibiotics which cure or arrest more than 100 diseases have a tendency to mask what is wrong with the patient before the doctor can decide what really is the trouble, thus leaving behind a potential reservoir of future trouble. This can happen, for instance, when the patient has tuberculosis. The early stages of this disease often masquerade as pneumonia, and may be suppressed very quickly by penicillin and streptomycin, a common combination; but the TB is not really defeated and will come back. Or, a secondary infection resulting from early, undetected cancer may be cured by antibiotics, leaving the cancer undiagnosed and farther along in its course than it should be.

New diagnostic tools of many kinds, particularly those involving radio-active isotopes, are rapidly coming into use, and they are badly needed. Eventually, it should be possible to take a patient into the laboratory and produce a complete metabolic profile of his state of health, involving every organ, tissue, cellular and biochemical system he owns; when this is feasible, diagnosis will have become an exact science.

This, too, I think will happen. It cannot happen a moment too soon.

And after that, it will be up to the social scientists — if there are some real ones by that time — to figure out what we are going to do with a universally healthy population that lives an average lifespan of several thousand years.