Saturday, November 21, 2009

The century of unintended consequences

Where to begin? The phrase "unintended consequences" has been making rounds in healthcare, politics, and other venues of late. It appears most pronounced in healthcare, and has been clearly brought out by the cancer screening debate last week: while taking for gospel that early detection saves lives, we have been subjecting countless people to unnecessary, invasive and sometimes deadly interventions. Oooops, we say, an unintended consequence of our good intentions. You do not have to look far to see others. The mounting problem of antimicrobial resistance due to egregious overuse of antibiotics, mounting data on the downsides of the widespread use of proton pump inhibitors, manifest as an increased risk for C diff diarrhea, pneumonia, and most recently, because of heretofore unappreciated interaction with Plavix, strokes and heart attacks.

Unintended consequences can also be seen in other areas of our lives. The thoughtless experiment of mortgage-backed derivatives and their implosion, the nearly irreversible effects our thirst for fossil fuels on the environment can on the one hand be attributed as unintended consequences. But I have to say, I am not buying it. Letting us all off the hook with this innocent statement is as simplistic as it is dishonest. It is like letting your kid off the hook for stealing a candy from the store because he did not foresee being caught. In fact, even the expression itself, "unintended consequences", is seemingly designed to demonstrate our sudden passive and victim-like situation. "But I did not intend for this to happen, so I am an innocent victim here". Pshaw! Much of what we call unintended could have been foreseen, if we had the will to plan ahead. The issue is that we are not, and are steamrolling ahead from moment to moment with no thought given to long-term consequences.

It is a fact that Nobel laureate Joshua Lederberg predicted in the 1970s that bugs would evolve resistance in response to our antibiotic warfare on them; even then he cautioned against overusing these agents. It is a fact that you cannot keep building a house of cards with imaginary assets without having it collapse. It is a fact that you cannot expect to keep drilling and emitting with one hand, while with the other eliminating vast carbon sinks, without noticeable climate change. It is also absurd to call our lack of viable fossil fuel alternative an unintended consequence: in what closed system can a resource be infinite? And once this resource is inevitably exhausted, what then?

In truth, the entire 20th century has been a cruel experiment in consumerism. Decisions made in the 1920s and the 1950s about converting the US citizens into a race of single-minded consumers were deliberate and well planned. And of course, the intention was clear: to increase the wealth of the few. I am confident that no one explicitly intended for this accumulation of wealth in a few hands to result in an ever-widening gap between the haves and have-nots. But is it so difficult to imagine that this is a not unexpected result of single-minded pursuit of wealth? Over the decades of industrialization, farmers and small-scale merchants, able until then to support themselves independently, abandoned their country seats and their communities to move to the cities to fulfill the shining promise of wealth and happiness unscrupulously promulgated in the name of this relentless pursuit of wealth. When the internal combustion engine became a reality, and as the city populations expanded, the suburban dream was born, isolating people further into their cookie-cutter homes away from organic communities of their ancestors. The last 30 years of the 20th century brought with them the proliferation of technology that has allowed us to work 24/7, be connected (only virtually), and, more importantly, to buy stuff any time of day and night from anywhere in the world. This American dream has left 80% of the US population behind economically, our main fuel source on the brink of disappearance, and American society more unhappy and fractious than any other time in the past century. Our politicians and business leaders unabashedly preach selfishness, greed and lies. All in the name of money and power. Unintended consequences? I think not.

Today, when divisive politics are playing out on Capitol Hill for all the world to see unequivocally our degraded values around social support and responsibility, it is worth pausing to contemplate what we are undertaking today that will result in "unintended consequences" tomorrow. Is it honest to say that the poverty, crime, disease and deprivations in migrant worker shanty towns in Mumbai and Namibia and China and countless other places in the third world, migrants who abandon their rural communities in search of the Western promise, are all truly unintended consequences? Or are they really collateral damage of our sick zero-sum economic game? And just because these consequences were not our primary intent, we cannot wrap up in their cloak of innocence: these consequences were and are entirely foreseeable, convenient or not. We are guilty!

So, while we in-fight about who should have access to healthcare, whether abortion or gay marriage is morally tenable, and what Jesus would do, we have been made accessory to the real catastrophic atrocities -- a growing local and global economic apartheid in the service to our corporate masters. The ones that are bleeding are we and our children. But of course, these are just unintended consequences.

The good news is that we can each do something to mitigate this overwhelming disaster: stop buying crap you do not need! Stop buying it because it is on sale -- you already have enough crap. Think about it: some of the sale prices are not even enough to pay for the fuel it takes to run the machines that made the piece of crap in the first place. And it will probably end up in your trash within the next 12 months anyway. How is this living with the future in mind? Really, before you make your next purchase of anything, think hard: there is no such thing as a free lunch. Chances are, your purchase will only better the bank account of a small minority of people who have produced the item, and in the process contribute to the environmental and spiritual devastation for many. Stop being helpless, stop pressing the lever and stop being a cooperative slave to this insidious juggernaut of consumerism. You will feel better if you can claim intentionality in building a better and more lasting world.                                        

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