long lives

Many things can be argued about the beginning of the 21st century, but one is undoubted: people lived so much longer than before.

It was shown by a figure that was then imposed: they called it “hope” or, more clearly, “life expectancy”.

Despite its splendid name, life expectancy was a statistical calculation: technicians and programs averaged the age at which people in a certain geographic space died, and thus predicted how many years those born there at that time might last.

Life expectancy was a basic figure that said the most basic thing: to live or not to live.

Life expectancy meant delaying death for longer—which was still inescapable.

For centuries life expectancy had remained more or less constant.

Until the middle of the 18th century, it was rare for him to exceed 35 years of age;

It was true that the large number of boys who died weighed heavily on that account: two out of five did not reach adulthood.

Life expectancy was an average: an attempt to describe a group by filing down its particularities.

But still, it was a brutally telling average—although, like all numbers, it was used for any deception.

It was easy to say, for example, that in 1950 "humanity's life expectancy" was 46 years and in 2020 it was 73. It was easy and, although the figure may seem lower now, it represented an extraordinary advance.

But saying it meant not saying, for example,

For that, economic differences were central, but others also acted: lifestyles, climate, pressures, various cataclysms and other shocks.

In those days the five countries with the greatest hopes were, in that order, Japan, Switzerland, Spain, Singapore and France, who were over 83 years of age;

the five with minors were Swaziland, Lesotho, Sierra Leone, Chad and the Ivory Coast, who were around 50: more than 30 years younger.

(The average human being —they said then, even though they knew the average human being didn't exist— was 31 years old, and the average African —who didn't exist either— was under 20, and the average Italian or Spaniard was over 45. It was another way of saying the same.)

And if the differences between countries were dramatic, the internal ones were almost more ferocious: in the United States, in 2020, for example, a white man expected to live seven years longer than a black man —because then blacks had less money to treat themselves and take care of yourself and eat well, and more chances of dying violently.

In Russia, for example, a man expected to live 10 years less than a woman—because then they were still drinking and smoking and binging much more than they were.

In France, for example, so

, the gentlemen of the richest 5%, who earned more than 6,000 euros, expected to live 13 years longer than the poorest 5%, who earned 500. And so on.

Life expectancy was a foolish indicator: he talked, sang, yelled so many things—but it's not true that that was the reason he stopped using it.

And beyond those inequalities, most people were living much longer than before.

(It was precisely this observation, some said, that made the differences even more odious: when you couldn't, you couldn't; now that you could, not doing it was pure violence.)

***

None of this denies that medical science and technology have advanced as never before.

Although the most developed practical medicine was in a moment of transition: the doctor's job no longer consisted, as it had been for many years, of reviewing his patient and evaluating his symptoms to deduce, thanks to his knowledge, the possible diagnosis.

At that time, a doctor was —with marked exceptions— an operator who asked for studies and more studies and could define that in a significant percentage of cases the combination of such and such a result implied this or that ailment.

Medicine was already a statistical practice: it was the same thing that machines would do soon after, still limited by the limitations of storage, updating and processing of the human mind.

But in those days, in the RichWorld, people visited medical services more than ever before.

For millennia, doctors —or various healers— had been characters who were only consulted in extraordinary circumstances.

In 2020, the proliferation of specialists, health centers, various therapies —and fear of disease, one of the topics that the public searched for the most on the Internet (see chapter 19)— made an average citizen of rich country saw some doctor eight to ten times a year.

Therefore, the number of doctors grew enormously: rich countries had an average of 4 per 1,000 inhabitants;

the poorest did not reach 0.4: 10 times fewer doctors per person.

But, globally, their number had multiplied like never before.

There were more than 10 million worldwide—and the World Health Organization suggested that there were four or five million more to go.

The United States, with 4% of the population, concentrated 8% of the doctors and 17% of the nurses.

(A secondary consequence of this increase in the number of doctors was the social decline of the profession: most of its practitioners ceased to belong to the wealthy bourgeoisie and became middle-class employees, civil servants who did not always make ends meet. .)

No country had as many doctors per inhabitant as Cuba —which exported them— with more than 8 per 1,000, although Italy followed closely behind and France, Greece, the United Kingdom, Georgia or Israel were around 6 per 1,000 inhabitants.

Chad, Niger, Liberia or Somalia could have, if anything, one tenth of a doctor for every 1,000 people.

And something similar happened with hospital beds: the European average was 4 per 1,000 inhabitants;

the African average, less than one.

In the poorest countries, the shortage of doctors and facilities remained serious: one of the main causes of death of their population.

Access to medicine whenever needed was still a RichWorld privilege.

Field hospital in Java, Indonesia, following the 5.6 magnitude earthquake that struck the island on November 22, 2022. Dasril Roszan (Getty Images)

(But the diseases were still related to magic. There were no ways to predict them from the genetic map and, thus, nobody knew which ones could touch them and their appearance was interpreted as an improbable chance or the design of some even more improbable superior being. In In any case, there was no previous roadmap and the anxiety produced by this ever-present threat was, according to some historians, an extremely vicious circle: it caused many of the diseases then in circulation.)

Inequalities in health care not only shortened the lives of individuals;

they also produced different diseases.

“Civilization is dying of a heart attack.

Or, at least, that is what people from countries that consider themselves to be the most civilized, the richest are doing more and more, ”wrote a joking commentator in those days.

And it was true that in Sweden or Germany 39% of people died from cardiovascular diseases;

in Kenya, for example, only 11%.

It wasn't because they had stronger hearts;

they died before other things.

Diarrhea and other gastric ailments, HIV, tuberculosis, malnutrition, malaria and all those children who did not manage to reach the age of five.

In the Rich World, on the other hand, old age—the exponential increase in the number of old people—was the most direct consequence of sanitary improvements,

***

In those days, old age was a new puzzle, of never-before-seen proportions.

Around 1960, some 3,000 million people lived in the world and 150 million were over 65: 5%.

In 2022, out of 8,000 million, 800 were over that age: 10% of the population.

Twice as old: sometimes the numbers seem mute;

others scream.

The increase, especially in rich countries where retirement and pensions were an acquired right of those who turned 65, complicated many things: if too many people lived too long there was no way for the relatively young people who still worked to support themselves with their works their breaks (see chap.15).

But, in addition, there was a complication that we could call ontological.

With the extension of old age and the increase in the number of old, the contradiction became more evident: even in the best possible conditions, these men and women became much more fragile than a few years before, they lived much worse.

It was evident that, from a certain moment on, all his faculties, physical and mental, diminished and nothing replaced them: growing old was pure loss.

Treatises were written trying to understand why nature, usually so wise, had engineered a process in which people only degraded.

"No matter how much we try to disguise it with tribal ornaments, growing old is losing strength, faculties, hope, grace."

It took them a long time to understand that the error was in attributing old age to nature: that this state was not a natural occurrence but a human invention —or, someone pointed out, a “human error”.

That wild people used to die when they were no longer able to reproduce—when they were no longer useful to the pack—that a man who couldn't hunt or a woman who couldn't chew didn't last long.

Old age, then, that path of sheer loss, was not a fault of nature;

it was another consequence of human pride.

Inventing old age was a long process that implied, among other things, controlling the factors that prevented it: first there were hungry beasts, extreme cold, hunger, poisonous plants;

then the wars and massacres, rotten water, infections, viruses, childbirth.

The extension of lives was a great goal and an extraordinary effort of civilization that, for centuries, had given very little results until, in the 20th century, technical changes achieved an explosion of years.

And yet in 2022 old age was still that incomplete novelty: scientists had made people live many more years, but they had not yet learned how to make them good.

An elderly woman pushes a cart with food on November 1, 2022 in Ukraine.Carl Court (Getty Images)

Against old age or, better said, against the aging of the body, and in favor of that culture of the self that was one of the main brands of the time, there was then an unprecedented development of all kinds of techniques destined to preserve and improve meat. personal.

Until then, bodily exercises had always served to prepare the performer for certain physical activities: hunting, sports, war.

At the beginning of the century they began to be used —frenzied, without measure— to shape the body of each person and adapt it to the tastes and fears of the time.

Gyms full of equipment and instructors flourished —where people of all ages and conditions tried to resemble the dominant models—, live or virtual group or personal lessons, and even those servants of the most privileged who called “

”: someone who worked the body of a single client.

The exercises were complemented by many other operations: diets, potions, surgeries.

In short, it could be said that at no other time in history have so many done so much for their bodies.

They didn't know it, of course, but it was their pinnacle: the increasing digitization of all aspects of life made them more and more superfluous.

***

In any case, it was true that health had progressed more than other necessities.

During the 20th century, medicines appeared that seemed inescapable —aspirin, antibiotics, anesthesia, the contraceptive pill— ​​and revolutionary techniques such as radiography and ultrasound,

, organ transplants and laser surgery.

But most experts agreed that nothing had prolonged lives as long as improved hygiene.

Around 1920, the vast majority of homes did not have their own bathroom connected to sewage networks;

the increase in those connections saved millions.

But in 2020, although the inhabitants of rich countries did not even imagine it, the other half of the world still did not have sewers (see chapter 2).

The half that had them lived very differently: people still defecated and, after millennia, had figured out ways to do it in hygienic spaces;

thanks to a mixture of increasingly developed sewage techniques and cheap labor, the bathrooms of those who had toilets were almost clean places.

The half that didn't have shit much like their great-great-grandparents: About 1 billion people used to do it outdoors.

In a world that boasted of its “globalization”, the lack of bathrooms was such an eloquent example of uneven development: while in the Rich World shitting was the most private and hidden activity, in the Poor there were many people who had always done it. made with others, in open fields or common latrines.

What for some was an absolute taboo was, for others, the custom.

“Surely I would not have looked at it if it hadn't been for the sun: the sun came out so red, deep in the background, dazzling, but in the backlight, like Chinese shadows, scattered across the field in very irregular lines, two or three dozen bodies in squatting shit in the early morning.

The image was not fixed: one got up, one arrived, someone raised an arm in effort.

Each body did not matter much: together, they composed my first landscape of India”, said a report from the time, curiously self-referential.

And billions of people also did not imagine that water should be “obtained”.

The water, if anything, had to be "paid" at the end of the month, but having it consisted of opening the faucet or faucet or pen.

Meanwhile, one person in four —almost 2,000 million— continued to live without drinking water in their homes, and had to go look for it somewhere more or less nearby, a spring or, if anything, a river.

That gesture that for so many was absolutely natural—opening the tap and letting the water run—for so many others it was a dream, and diarrhea and other sanitary diseases continued to kill more people than all the wars combined.

Seen from here, it is surprising that so many, in times not even that far away, were not aware that their world was two worlds.

Hygiene, even so, had improved enough to influence the reduction of another statistical item that was very much in vogue at the time: the much talked about "infant mortality."

Children were particularly sensitive to sanitary conditions.

The example of the evolution of London after the "Industrial Revolution" of the 19th century was classic, when half of the boys died before the age of five and, thanks to drinking water and sewage, these deaths were reduced to "only" one fifth of live births.

The same was reproduced in many corners of the planet during the subsequent century and a half;

It is also true —it has been said— that in many corners it was not like that.

So infant mortality—the proportion of children born alive who did not reach the age of five—was another indicator of the huge differences.

Still in the middle of 2020, around the world, 30 out of 1,000 boys died before the age of five.

They could be as many as 100 in Afghanistan, Somalia or the Central African Republic and, of course, they were less than three in most rich countries.

The conditions of childbirth, access to medicines and health care, the diet of their mothers, their own diet or the lack of it —among other factors— produced these abysmal differences.

***

Medical techniques, meanwhile, continued to improve.

And they continued to show too clearly the inequality in the distribution of health: the difference in resources between rich and poor countries was absurd.

An obvious example was transplants.

Organ transplantation was, then, a relatively new technique: the first liver transplant—between twins—had been performed in 1954, the first heart in 1967, the first lung in 1983, the first hand in 1999, the first with a full face in 2010. Transplants still consisted of the insertion of the organ of a dead person —which, of course, greatly limited its possibilities and had forced medical associations to redefine death as “brain death”,

(At the beginning of 2022, an unexpected event began to change that panorama: for the first time in history, a man received the heart of a pig. It happened in the United States; the organ came from pigs specially bred and tuned for human use. The The event did not receive much attention at the time—it was another of those events whose importance the world only understood some time later—but it broke ground that, for a time, was well traveled and saved many lives.)

Even with these difficulties, transplants grew a lot —in certain places.

That year, without going any further, the United States and Europe, with 800 million inhabitants, had performed 65,000 operations of the most common transplant, liver: 1 for every 12,000 inhabitants;

That same year in Africa there had been 800 operations: one for every 1,500,000 inhabitants.

They were more than 1,000 times less, which can be explained when the primary inequality is considered: the health expenditure of each society.

Between the 11,000 euros per person and per year that the United States dedicated to him or the 7,000 from Switzerland, Norway or Germany, on the one hand, and the 70 euros —yes, per year— from Niger, Burundi or Ethiopia, the difference could not be more brutal.

It goes again: the United States, for example, spent 170 times more on the health of its inhabitants than The Gambia.

Every American could pay for his health in two days what a Gambian could pay for the whole year.

Although, of course, within the United States—which still did not have universal health care—the differences were stark as well.

In Europe, meanwhile, the free public health systems that had been formed in the years of redistribution—increasingly deteriorated—continued.

In almost all other countries the difference between public care - often almost non-existent - and private care used to be a matter of life and death.

When talking about health expenses, the maintenance of hospitals, the acquisition of medical machinery and the salaries of professionals were taken into account, but above all, the consumption of medicines.

RichWorld was full of pills.

Between the United States and the five most prosperous countries in Europe —650 million inhabitants, 8% of the world population— they bought 54% of the medicines on the planet, but the new-rich countries increased their consumption at a forced march and the pharmaceutical industry endlessly expanded.

In 2019, just before the plague, almost one and a half million euros entered, 60% more than 10 years before: few sectors had had that level of development.

There were, in that business, several peculiar features.

For starters, the fact that each new remedy was the exclusive property of those who invented it.

It was discussed: the pharmaceutical companies argued that the research costs were too high;

They were told that often the researchers had worked for years in state institutions with public funds, but the patents they obtained were completely private.

It was discussed: there were those who argued that if a remedy was necessary to save lives, no one had the right to withhold it under the pretext that it belonged to them.

In fact, already then, several populous countries rejected this imposition: both India and South Africa or Brazil authorized the manufacture of "generics" —remedies equal to the "original" ones that did not pay their patent, either because it had expired or because a state decided don't do it.

In many cases they began to export them and other countries of the MundoPobre took advantage of them.

In Rico, the patents of the big pharmaceutical companies continued to be rigorously respected.

Those companies defined medicine according to their interests.

For example: as a remedy that had to be taken regularly was much more profitable for them than one that acted punctually, they had developed all kinds of therapies that involved the continuous intake of their products.

The world—and especially RichWorld—was gorged on pills: almost five million million doses consumed each year.

(It was a druggy world. Or, rather, the RichWorld was: there, an average adult took between two and four pills every day. There were “remedies” for almost everything: people didn't have to check what they did—their meals , their habits, their laziness—because some drug would solve it. And taking medicines became a habit. Until then, people took them when they had a problem —one day, two days, five— and stopped when they were cured: taking a pill was the sign of an anomaly, a disturbance. On the other hand, in those days the majority swallowed the same medicines morning after morning, night after night, every day of their lives. Medication became a habit; the pharmacy, a destination usual.)

But a trend that would be confirmed in the following decades and that would change many features of the pharmaceutical industry was already beginning—albeit in a very minority—: it was what some would call “ad hoc medicine”.

After centuries where diseases were treated in a generic way —everyone who suffers from such a thing must take such a drug—, medicine has learned to assist each person according to the particular characteristics of their body and their illnesses and to produce preparations for that. specific.

Which was particularly effective in combating the most feared disease of those times, the one that was then called “cancer” —and which was, in reality, a set of so many evils that this designation only showed its ignorance.

Until then, therapies for the various "cancers" used to attack diseased cells and healthy cells alike.

It was then that specialists in several countries began to look for —and found— ways to specifically attack the sick.

For that, of course, they first had to improve the analysis tools to determine what kind of cells were causing the perturbation;

then they were able to create—and introduce into the patient's body—elements that would directly attack the troublemakers.

That ad hoc system was a revolution, and it became the beginning of a new era for medicine.

Which, in those days, was just beginning, and would still take a few decades to become fully established - although, of course,

***

Meanwhile, they planned various threats.

The most agitated was the "antibiotic crisis": doctors, scholars, various organizations used to warn about the fact that more and more bacteria resistant to the antibiotics in use were appearing, and that there would come a time when these would stop working and It would produce a catastrophic situation: doctors would no longer have a way to contain infections and the world would return to its pre-Fleming state, in which any small wound —or operation— could be fatal because it was infectious.

The big pharmaceutical companies, to all this, did not do much: antibiotics were difficult and expensive to develop and, above all, they did not fall into that category of permanent remedies that made them earn the most money.

Something similar happened with other essential drugs that the big companies had not finished developing.

A vaccine against malaria, for example, seemed essential at a time when this tropical disease killed half a million Africans every year.

But it was a poor market, which did not announce great benefits, and the vaccine had been unsuccessful "in process" for decades.

In 2022 it was announced that, after 30 years of experiments —and an expense, in that period, of 200 million dollars— in two or three years there would be a more or less efficient vaccine.

The great vaccine of the moment, on the other hand, received many billions and was solved in less than a year: drugs to combat the

(see chapter 7) were the demonstration that, if they wanted, they could.

Because this plague affected both the poor and the rich —and the global economic system— and because its benefits were tremendous.

A single pharmaceutical, the North American Moderna, reported profits of 13,000 million dollars in 2021 selling between 18 and 24 dollars each dose whose cost was estimated at 2.85.

Medicine dispensary in a pharmacy in Miami, United States.

Jeffrey Greenberg (Getty)

That plague had, among so many unforeseen effects, that of increasing AIDS infections: in the poorest countries, many boys and girls who could no longer go to school or their jobs transmitted it to them.

In 2020, some 450,000 people died of AIDS in Africa;

in the United States and Europe, with a slightly smaller population, some 13,000 died in that same year.

AIDS is a very brutal example: a disease that medicine learned to control —because it first appeared in rich countries— with more or less expensive remedies that many couldn't afford and died from it.

In 2022 almost no one was dying of AIDS anymore: hundreds of thousands were dying of poverty.

In those days, moreover, the great scandal of oxycontin had just become known, the opiate that an American company, Purdue Pharma, sold for decades, assuring that it was not addictive thanks to an authorization from the federal government: a circuit of complicity and corruption had allowed a company will be filled with money poisoning millions.

In 2020 it was estimated that oxycodine had already caused the death of some 500,000 addicts and all the social violence that used to surround these situations.

The company had been ordered to pay compensation of more than 8,000 million euros to all its victims —individuals, administrations— and the reputation of pharmaceutical companies was in tatters: they used to appear in all surveys as the sector most hated by the public. along with governments and oil companies.

Plague -

- helped them to recover part of that prestige and earn loads of money.

7. Death and its variantsPeople still died, isolated and mechanized.

What did those societies do with death.

The arrival of a great plague that changed many things.

the world then

A history of the present

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