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The school of thought called ‘declinology’ has been growing in influence over the last decade
The French-American historian Jacques Barzun’s magnum opus From Dawn to Decadence: 500 years of Western Cultural Life was published in 2000. The author was then 93 years old; he wrote five more books before his untimely death at the age of 104. By “decadence” Barzun did not mean moral turpitude caused by over-indulgence. Instead, he used the word to mean that “the forms of life seem exhausted; the stages of development have been run through. Institutions function painfully. Repetition and frustration are the intolerable result.” Barzun concluded that the rich, powerful societies of the West had become exhausted through a combination of secularism, individualism, consumerism, inequality, and globalisation.
Barzun’s influence is obvious in Ross Douthat’s new book The Decadent Society: How we became the victims of our own success. The author, a conservative-leaning New York Times columnist likens America’s chronic decline to that of the Roman Empire. American civilisation, Douthat argues, peaked with the moon landing in 1969. Since then the US – along with the other rich nations of the West – has stagnated: Politically, culturally, economically. Medicine and healthcare are afflicted by the same malaise.
“No major new type of antibiotic has been developed since the 1980s and the age of blockbuster drugs seems to be over.
Pharmaceutical companies across the 1990s and 2000s spent more money on research, but approved fewer and fewer new medicines, with the predictable result that research and development spending has been declining throughout the 2010s. In most developed countries, life expectancy is increasing more slowly than it did 50 years ago; in Germany and France it has flatlined; in the United States and the United Kingdom, it has lately gone into reverse.”
Moore’s law is the observation that the number of transistors in a dense integrated circuit doubles every two years. Eroom’s law (Moore spelt backwards) states that drug discovery is becoming slower and more expensive. The cost of developing a new drug doubles every nine years. In January 2020 (just before the pandemic) the WHO warned that the lack of new antibiotics was now a crisis, which “threatens global efforts to contain drug-resistant infections”.
In 2014, four leaders of American biomedicine wrote a paper for Proceedings of the National Academy of Sciences entitled ‘Rescuing US biomedical research from its systemic flaws’. The authors, who included Shirley Tilghman (molecular biologist and former president of Princeton) and the Nobel laureate Harold Varmus, wrote that “the biomedical research enterprise is on an unsustainable path”.
Over the last decade, countless papers and symposia have addressed waste in medical research and the replication crisis – the indisputable fact that most scientific studies are never repeated, or replicated, to confirm that the findings are real. Despite all this hand wringing, little progress has been made; some pessimists have concluded that the problem is unfixable. More than one Nobel laureate has remarked that the culture of contemporary research stifles creativity. The hyper-competitive careerist environment has frightened off that “small and sporadic crop of the heroically gifted”.
Maybe the cause of this stagnation is more prosaic. Nearly all the low-hanging fruit was picked during medicine’s golden age in the mid-20th century. Although the triumphs of this era led to a vast expansion of both healthcare and medical research, the non-communicable diseases of old age and degeneration have proved more elusive than the infectious diseases (such as smallpox) that were conquered during the golden age. On June 26, 2000, Bill Clinton, announcing the completion of the first survey of the entire human genome, predicting that it would “revolutionise the diagnosis, prevention, and treatment of all human disease”. The project was a major achievement, but we’re still waiting for that revolution. “Recent medical progress,” writes Douthat, “has come primarily in the fight against rare conditions that affect small populations, rather than big killers such as cancer, heart disease, and Alzheimer’s.”
Ross Douthat is not a lone crank: The school of thought now called ‘declinology’ has been steadily growing in influence over the last decade. Spotting parallels between contemporary decadent societies and the late Roman Empire (shared obsessions include food and pornography) has become a new intellectual parlour game. Kurt Anderson wrote an essay for Vanity Fair in 2011 lamenting the stagnation of American culture. “Try to spot the big, obvious, defining differences between 2012 and 1992. Movies and literature have never changed less over a 20-year period.
Lady Gaga has replaced Madonna, Adele has replaced Mariah Carey – both distinctions without a real difference.” But what about the internet and all the new technology that it spawned? Douthat is unimpressed: “Over the last two generations, the only truly radical change has taken place in the devices that we use for communication and entertainment”. Or, as the Silicon Valley tycoon Peter Thiel pithily observed: “We were promised flying cars. We got 140 characters”.