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Premise

This is meant to be a dark corollary of the cliche "demographics are destiny." The premise is a hegemonic-like state with persistent drawdowns in fiscal income. Meanwhile unfunded liabilities, to a large extent includes social security, are growing too fast for this state. They've already invoked all the financial voodoo they could in terms of tenor of debt issuance and letting inflation run higher (to pay back less to bondholders in real terms). But it was not to be enough. Faced with a run on their currency (which the state needs to acquire goods and commodities it needs but can't produce), the decision was made to start pulling levers on human lifespans -- indirectly and quietly via suppressing things like cures to cancer.

In today's world of interconnected and peer-reviewed medical research, the above scenario seems a bit unrealistic. This is the crux of my dilemma. I'd imagine that facilities with the manpower and equipment to develop major life-saving technologies would be from prominent biotech companies. Much of these would have public floats and be subject to shareholder interests, board of directors and transparent financial reporting. Granted there are still information asymmetries and insider trading opportunities, but let's assume the market has grown savvy to blatant market abuse.

But simply put, these are companies with very public profiles and a very interconnected web of medical professionals. I see the interconnectedness of all these scientists (nodes) as well as a more transparent form of corporate governance as major obstacles for the government to prevent something like 'the cure for cancer' from making it to market.

A comically stylized script might read:

Deep state man: Here's the deal. That trial was not a success, it was a failure. And I was never here.

Research director: Whatever you say. But I have 300 researchers under me that will need convincing. Some might be willing to play ball, but others have a moral conscience.

CEO: This miracle drug is virtually a mandate for us. We have decades long correspondence with our shareholders and bondholders and now is the big moment. If the trial is a failure again, we can stall for time but in a few years we're going to be in big trouble.

Question

How can a malign government to suppress a life-saving technology altogether or at least reduce as many points of failure in this plan as possible?
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    $\begingroup$ I don't understand why a government would want to suppress medical advances. Why exactly don't they want people living longer? $\endgroup$
    – Monty Wild
    Jan 6, 2022 at 6:57
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    $\begingroup$ Old people have pensions, and expensive medical bills. $\endgroup$
    – Nepene Nep
    Jan 6, 2022 at 9:32
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    $\begingroup$ A "hegemonic-like state" need not be especially deceptive or subtle in their methods. The existing hegemonic controls over society, politics, economy, and information flow prevent the transparency, open discussion, or open peer-review that seems an obstacle. $\endgroup$
    – user535733
    Jan 6, 2022 at 13:26
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    $\begingroup$ @MontyWild it also depends on who they don't want living longer. Propose that there are classes in that society and those with money don't want the lower classes to get educated, use medical resources, or compete economically. This lower class needs to die faster. That would allow the existing upper class to continue to exploit them. It keeps the social order intact. $\endgroup$
    – David R
    Jan 6, 2022 at 15:21
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    $\begingroup$ Have some actors pose on YouTube as doctors and warn about the alleged dangers of the life-saving technology. $\endgroup$
    – AndreKR
    Jan 7, 2022 at 0:44

7 Answers 7

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Just look at the USA. Make it too expensive for most to access.

The rich and powerful don't want to die. They also have massive influence, and can punish you if you prevent them from accessing healthcare. They can also just fly to another country if you stop them.

As such, just make medical care unsubsidised. Encourage insurance companies to charge people a lot for their bills. Encourage hospitals to overcharge people It doesn't matter if you have a cure to cancer if it costs 300k a year.

In addition, as an extra fuck you, if they get in debt, make it so medical debts can't be discharged in bankrupcy, and have the courts lock people up in jail for failure to pay bills, and then give them no healthcare in prison.

Make red tape make cheap drugs expensive and limited.

Insulin is pretty easy and cheap to make. But, in the USA, there's a shortage. The FDA blocks generics from being sold, and only lets a small number of companies make it.

This means there's a massive shortage of insulin. People have to ration their insulin now, and often can't afford it. Another win for the state.

You can also block people buying drugs from abroad because of vague safety concerns, so they die while 'safe' from affordable drugs.

So, there's a strong precedent for this happening with a normal government.

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    $\begingroup$ The obvious counterpoint is that, well, the US does all that and our population grows quite well. OP's country wants to get smaller. $\endgroup$
    – Cadence
    Jan 6, 2022 at 18:06
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    $\begingroup$ Lack of healthcare access generally correlates with more population growth. Western Europe has excellent healthcare and most countries' population is shrinking. If you remove access to healthcare, people generally respond by having more babies to make sure their bloodline survives. $\endgroup$
    – Erik
    Jan 6, 2022 at 19:33
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    $\begingroup$ @Cadence except that the US's population doesn't grow: census.gov/library/stories/2021/12/… ... so, case in support of this answer. $\endgroup$
    – FuzzyChef
    Jan 6, 2022 at 22:47
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    $\begingroup$ The government op made doesn't care about population growth, they care about unfunded obligations to older people like pensions. They don't care if people have lots of babies who can work for the state so long as the old people are dead and they don't have to pay for them. $\endgroup$
    – Nepene Nep
    Jan 6, 2022 at 23:26
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    $\begingroup$ @Cadence most of that growth comes from immigration. $\endgroup$
    – vsz
    Jan 7, 2022 at 14:06
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How about having social media attack the credibility of anyone recommending following valid medical science? Then social media could promote quack cures, claim the real items are toxic, used to control minds, make you magnetic, etc. Go on FaceBook and post about a possible vaccine against a certain form of cancer and see how fast you get attacked if you want a real world example.

I would suggest that having a high ranking politician holding a news conference where he brings up the possibility of using bleach internally to treat a disease during a news conference, but that would be as unbelievable as politicians directly attacking the credibility of the goverment's top scientists. Even alternate reality stories shouldn't contain things that weird.

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    $\begingroup$ Maybe throw in media outlets that give equal airtime to scientists who’ve spent their life studying the medicine in question and random minority quacks with no real qualifications? They can justify it ‘in the name of balance’ and use it to make it seem like there’s discord over the safety and efficacy of the medicine even when there really isn’t. Or would that be too unbelievable? $\endgroup$
    – Joe Bloggs
    Jan 7, 2022 at 11:32
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    $\begingroup$ @JoeBloggs - Well, we do want to be fail and balanced, right? Just don't have the quacks do any unbelievably crazy stuff like talking about demon sperm or recommending therapies already proven ineffective by large and well-designed double-blind clinical trials. That sort of quackery wouldn't be believable even from doctors who had lost their medical licenses. $\endgroup$ Jan 7, 2022 at 12:37
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    $\begingroup$ After all, all discredited doctors have left is their integrity… $\endgroup$
    – Joe Bloggs
    Jan 7, 2022 at 14:17
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    $\begingroup$ @JoeBloggs and by "equal airtime", you mean the doctors are interrupted and talked over by both the hosts and the quacks, while the hosts ensure that the quacks get their time uninterrupted, and supported by the hosts uncritically repeating everything the quacks say as though it were undisputed facts. $\endgroup$ Jan 7, 2022 at 20:19
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    $\begingroup$ @TheoBrinkman Nooo, that would be too much. Right? $\endgroup$
    – Joe Bloggs
    Jan 8, 2022 at 15:38
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The government doesn't directly suppress the technology, it just need to make accessing it very, very, very difficult and cumbersome.

When a bureaucracy wants to make a process as winding as possible, the possibilities are endless and you can easily slip in some kafkian situation.

For example:

  • the candidate patient needs to be evaluated by their GP and given a recommendation to access the treatment
  • the recommendation is validated by an ethical committee composed by 5 members. If unanimously approved, the recommendation is sent to the scientific committee for success analysis
  • if the scientific committee evaluates positively the chances of success versus the cost of the therapy, they send the recommendation to the funding department for approval
  • when the funding department receives the request, it budgets and prioritizes for it and send it to acquisition department

make it all the above happen in a single, centralized and understaffed agency, where if you are lucky each step takes months for happening.

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    $\begingroup$ Don't have a single centralized agency. Have each agency on alternate opposite sides of the country & the paper file with the persons application must be physically sent across country each time between agencies. Also, have each agency meet on specific small number of days every month, & only on those days. A cooling off period could also be introduced into each step of the process, where the application must be held & no progress made in case each agency needs to review a second time. $\endgroup$
    – user81881
    Jan 7, 2022 at 4:54
  • $\begingroup$ Just have the government convince insurance companies to not cover the medicine, procedure, etc. The majority of people wouldn't be able to afford it on their own. $\endgroup$ Jan 7, 2022 at 16:33
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Here's another idea which might be neater for a sinister story: they don't fight it at the science level, but at the factory level.

Once the drug is completed and tested, the medical companies (with the CEOs in on the scheme) switch from research to production. And on the production floor the final product that comes off the assembly line is quite watered down. The whole production process is a complicated one, with only a few select people having a full knowledge of all the moving parts, so nobody catches on.

Meanwhile scientists are sent elsewhere and no further studies are done on these drugs by the companies themselves. In the academy additional research on "proven" drugs is deprioritized on state level and potential researchers rarely (if ever) get the financing to study the finished product closer.

This also gives your protagonist a plausible way of detecting the fraud - they somehow put the pieces together of what is happening in the factory. Maybe they happen to talk to a few of the right people, or maybe they get their hands on several unrelated documents that put together reveal the secret.

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Make the trial fail.

This will require quite a bit of subterfuge, but a government with sufficient resources could secretly interfere with ongoing late-stage clinical trials. Maybe the trial data gets hacked or destroyed, or perhaps government agents poison trial participants so that the treatment arm shows no benefit or intolerable side effects. If you can manipulate the data, that will convince the scientists regardless of their moral compass. No matter how much the scientists believe the treatment should have worked, it's tough to argue with Phase 3 trial data that shows it didn't. This is a bit of an overbearing solution since you'll have to interfere with trials that would have failed anyway, but it could be a very effective way to have the scientists themselves conclude that the treatment is not worthwhile.

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Use Latinamerica as inspiration

Probably the latinamerican strategy could help you in some perspectives: you cannot (nor want to) end the healthcare demand, which would eventually draw in suppliers, but you can make it look like the available supply is not right and keep that demand idle or block the supply for the country's sake.

Make sure most of the public opinion is servile, so that they will repeat anything that comes from an official source; and keep the population as uneducated as possible so that they are eager for any message that makes them feel powerful and special (in this case, like statements on traditional medicine from ancient civilizations). Anything against this can be labeled as conspiration, as fake news, as anti-patriotic or any label that uses rage against a power group.

Then destroy the public image of any laboratory, biotech or health professional that is not in your payroll or under your control. You manage media, so you can send as many messages as necessary and a big, ignorant audience eager to be told what they should believe. With this, the health player's audience gets smaller and more expensive to reach, so they could have the answer but not the attention to share it and trust to sell it. Of course, those answering to the government move and talk in the opposite direction of the research, giving the image destruction a "professional support".

Make it operationaly impossible for these players to scale the production and distribution. You could make sure they cannot import any component they will be needing, block their access to qualified professionals or set rules for distribution that increase the cost and effort exponencially. They might have the solution, but if they cannot produce it or producing it makes it unaffordable for enough people so that it is not sustainable to produce and distribute it, they would not have any incentive to do it. And since they are evil, "it's for the best".

So, it is not the government not allowing access to the cure, it is the government protecting you from these evil companies that sell expensive solutions that help no one... (or look at Cancer related treatments status in Mexico).

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Modified Malthus

Thomas Robert Malthus lived in the 18th and 19th centuries. He predicted (in cartoon form) that human population would grow way past the availability of resources, and then would crash, killing everyone. (Specifically, he claimed that population growth is exponential and resource growth is linear, and had a specific prediction on when that intersect would occur).

You can see this same argument echoed in discussions on everything from global warming to peak oil to conservationism. While Malthus' specific predictions were wrong, the basic form of his argument has resonated for many people ever since.

So, your dystopia implementation is just having enough people lean in to that explanation. The zeitgeist says that overpopulation is the cause of all problems and is a moral issue. You discuss it with a mix of the "hoarder" rhetoric from collapsing economies and the covid rhetoric from the past two years. The reason that things are bad is that boomers are hoarding all the stuff and endangering everyone else. Clearly everyone should treat their supposed "right" to get cancer meds like it was Karen asserting her "right" to cough in everyone's face.

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