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In volume, technical detail, and avuncular reassurance, the net’s medical advice had no archival peer. A serious life-extension upgrade was a personal crisis to rank with puberty, building a mansion, or joining an army.
The medical-industrial complex dominated the planet’s economy. Biomedicine had the highest investment rates and the highest rates of technical innovation of any industry in the world. Biomedicine was in a deliberate state of controlled frenzy, giving off enough heat to power the entire culture. In terms of government expenditure it outranked transportation, police, and what passed for defense. In what had once been called the private sector, biomedicine was bigger than chemisynthesis, almost as big as computation. Various aspects of the medical-industrial complex employed 15 percent of the planet’s working populace. The scope of gerontological research alone was bigger than agriculture.
The prize was survival. Failure deterred no one. The spectrum of research was vast and multiplex. For every life-extension treatment that was accepted for human use, there were hundreds of schemes that had never moved beyond the enormous tormented ranks of the animal models. New upgrade methods were licensed by medical ethicists. Older and less successful techniques were allowed to lapse out of practice, taking their unlucky investors with them.
There were a hundred clever ways to judge a life-extension upgrade. Stay with the blue chips and you were practically guaranteed a steady rate of survival. Volunteer early for some brilliant new start-up, however, and you’d probably outlive the rest of your generation. Keep in mind, though, that novelty and technical sweetness were no guarantees of genuine long-term success. Many lines of medical advancement folded in a spindling crash of medical vaporware, leaving their survivors internally scarred and psychically wrecked.
Medical upgrades were always improving, never steadily, but with convulsive organic jumps. Any blue-chip upgrade licensed in the 2090s would be (very roughly speaking) about twice as effective as the best available in the 2080s. There had been limit-shattering paradigmatic breakthroughs in life extension during the 2060s and 2070s. As for the 2050s, the stunts they’d been calling “medicine” back then (which had seemed tremendously impressive at the time) scarcely qualified as life extension at all, by modern standards. The medical techniques of the 2050s barely qualified as common hygienic procedures. They were even cheap.
As for the traditional medical procedures that predated the 2050s, almost every one of them had been abandoned. They were dangerous, counterproductive, based on views of biological reality that were fundamentally mistaken.
Given these circumstances, it was wise to postpone your upgrade for as long as possible. The longer you waited, the better your choices would become. Unfortunately, the natural aging process never stopped in the meantime, so waiting too long made you subject to serious cumulative damage from natural metabolic decline. Sooner or later you had to hold your nose and make your choice. Since the outcome of leading-edge research was unknown by definition, the authorities could make no guarantees. Therefore, the pursuit of longevity was declared a fundamental freedom left to the choice of the individual. The polity offered its best advice, consensually derived in endless open meetings through vast thriving packs of experts, but advice was nothing better than advice.
If you were smart or lucky, you chose an upgrade path with excellent long-term potential. Your odds were good. You would be around for quite a while. Your choice would become and remain popular. The installed base of users would expand, and that would help you quite a lot. If anything went wrong with your upgrade, there’d be plenty of expertise in dealing with it.
If you were unlucky or foolish, your short-term gains would reveal serious long-term flaws. As the years ground on, you’d become isolated, freakish, obsolescent.
The truly bad techniques were the ones that complicated your transitions to another and better upgrade. Once your quality of life was irreparably degraded, you’d have no choice but to turn your attention to the quality of your death.
There were various methods of hedging your bets. You could, for instance, be conspicuously and repeatedly good. You always voted, you committed no crimes, you worked for charities, you looked after your fellow citizens with a smile on your face and a song in your heart. You joined civil support and served on net committees. You took a tangible wholehearted interest in the basic well-being of civilization. The community officially wanted you kept alive. You were probably old, probably well behaved, and probably a woman. You were awarded certain special considerations by a polity that appreciated your valuable public spirit. You were the exact sort of person who had basically seized power in modern society.
If you were responsible in your own daily health-care practices, the polity appreciated the way in which you eased the general strain on medical resources. You had objectively demonstrated your firm will to live. Your serious-minded, meticulous approach to longevity was easily verified by anyone, through your public medical records. You had discipline and forethought. You could be kept alive fairly cheaply, because you had been well maintained. You deserved to live.
Some people destroyed their health, yet they rarely did this through deliberate intention. They did it because they lacked foresight, because they were careless, impatient, and irresponsible. There were enormous numbers of medically careless people in the world. There had once been titanic, earth-shattering numbers of such people, but hygienically careless people had died in their billions during the plagues of the 2030s and 2040s. The survivors were a permanently cautious and foresightful lot. Careless people had become a declining interest group with a shrinking demographic share.
Once upon a time, having money had almost guaranteed good health, or at least good health care. Nowadays mere wealth guaranteed very little. People who publicly destroyed their own health had a rather hard time staying wealthy—not because it took good health to become wealthy, but because it took other people’s confidence to make and keep money. If you were on a conspicuously public metabolic bender, then you weren’t the kind of person that people trusted nowadays. You were a credit risk and a bad business partner. You had points demerits and got cheap medical care.
Even the cheap treatments were improving radically, so you were almost sure to do very well by historical standards. But those who destroyed their health still died young, by comparison with the elite. If you wanted to destroy your health, that was your individual prerogative. Once you were thoroughly wrecked, the polity would encourage you to die.
It was a ruthless system, but it had been invented by people who had survived two decades of devastating general plagues. After the plagues everything had become different, in much the way that everything was different after a world war. The experience of massive dieback, of septic terror and emptied cities, had permanently removed the culture’s squeamishness. Some people died and some didn’t. Those who took steps to fight death would be methodically rewarded, and those who acted like fools would be buried with the rest.
There were, of course, some people who morally disagreed with the entire idea of technologized life extension. Their moral decision was respected and they were perfectly free to drop dead.
Mia’s choice of upgrade was known as Neo-Telomeric Dissipative Cellular Detoxification, or NTDCD. It was a very radical treatment that was very little tried and very expensive. Mia knew a great deal about NTDCD, because she was a professional medical economist. She qualified for it because she had been very careful. She chose to take it because it promised her the world, and she was in a mood to gamble.