Gail and I are spending some days in Hawaii. Thanks for asking. Yes, it is beautiful as usual, and no, we have not completely escaped the real world. The internet connections are too good and mass media are ubiquitous even if we try to avoid them.

Yesterday we drove down the Kohala Coast to visit Earl Bakken, an icon of medical device innovation and the founder of Medtronic. It is a long, dusty drive across an ancient lava field to his oasis on a secluded bay. The radio was tuned to PBS, as is my habit, and the program was about the stubborn unemployment rate, an issue of significant interest in the presidential election. In order to get the rate to a historic "okay" rate of 5 percent, the experts being interviewed used various computer models to predict the rate of unemployment and to make other projections. After various rosy scenarios were put into the computer program, including a very optimistic economy and a fully-recovered Europe, as well as booming economies in China, India, and Brazil, they still could not get the projected US unemployment rate down to 5 percent. The conclusion they reached was that it will take a long time to create all the jobs needed to reach 5%.

We were still driving, and I began to wonder, are there going to be more people than are needed for jobs? We seem to assume that growth is infinite and jobs will always be there. Here we are going to visit a man synonymous with medical innovations, so I will ask him if innovation will solve the unemployment problem. It is always a pleasure to visit Earl, who has combined traditional Hawaiian healing methods and eastern techniques in Waimea, where he is the major patron.

At the same time as he embraces "integrative medicine," Earl, at 89, is on top of the latest medical technology and is very excited to talk about renal neuronal innovation and control of hypertension. We speculated that renal denervation may be an extension of self-imposed neurohormonal control of blood pressure. I remembered Peter Sleight’s international lecture at the ACC Annual Meeting on the use of chanting and mantras and their beneficial effect on hypertension. Will renal denervation replace yoga?

The conversation returned to the wonders of innovation and technology. I asked him if technology and innovation could solve the chronic unemployment rate we face. "Certainly commitments to improving infrastructure could produce some jobs," he said, referring to the geothermal generators drawing steam from the volcano below our feet to supply 20 percent of the Big Island’s electrical needs at the present time. But he hastens to add that technologic advancement in general creates less employment. As we become more efficient through technologic advances, fewer people are needed. Having my suspicion that there are too many people for the jobs we can create confirmed by a captain of industry was not comforting. It is hard to imagine too many people while looking for miles in all directions from his beach enclave, I can see none.

Earl began to reflect on the accomplishments achieved since he built the first pacemaker and started the largest medical device company in the world. "Nine million people have our devices implanted and many lives have been saved." I said, "And many have been saved and sent back to work by all we do in cardiology be it revascularization, control of heart failure, hypertension, and hyperlipidemia, all the way to AICDs and much more." We jokingly concluded that we are contributing to the unemployment rate and that, in fact, is a good thing. I don’t think we will hear a proposal to let patients die to improve the unemployment rate, and it is unlikely that governments less centralized than China's will impose a limit on births. Still it remains an inescapable conclusion that jobs will not magically increase to match the population growth.

Earl, a committed "Hawaiiphile," said the population in ancient Hawaii was controlled by how much food could be produced. I have seen similar studies about the stability of the population of Japan based on limited rice production over many centuries. With technology, we have thrown out many of the old rules of ecology but our planet and its resources are finite, and now, perhaps, jobs are finite as well.

Having exceeded my three score and 10 years that used to be considered a full life, and realizing that our patients continue to thrive far beyond that, I am not willing to enlist the Grim Reaper to help solve unemployment. We should realize, however, that systems in nature are controlled by various feedback mechanisms, while current economics seemed to be based on growth without limits. As medicine becomes more of an industry with growth expectations, we should be proud of our major contribution to employment but also recognize the runaway costs that it has produced and search for a balance that is more akin to biologic systems than economic ones. Enabling longer and more productive lives is our legacy. Perhaps we should stick with that. Aloha!

Spencer B. King, III, MD, is president of the Saint Joseph’s Heart and Vascular Institute and Professor of Medicine Emeritus at Emory University School of Medicine in Atlanta. He is also editor-in-chief of JACC Cardiovascular Interventions. He has been a pioneer in interventional cardiology, directing the first trial of angioplasty versus surgery.

 

Keywords: Denervation, Hyperlipidemias, Population Growth, Heart Failure, Mass Media, Unemployment, Integrative Medicine, Blood Pressure, Angioplasty, Internet, Hypertension

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