There were two articles in today’s The Wall Street Journal that drew my eye.  In the first article, Joseph Rago interviewed John Lechleiter, CEO and Chairman of Eli Lilly & Co.

Mr Lechleiter offered these comments, among others:

In 1960 the average life expectancy in East Asia was 39…. In 1990, 30 years later, it was 67. Think about that. Does that explain the Asian economic boom? I think it might go a long way….  Wealth follows health, and it ain’t the other way around.

Lechleiter expanded on the point: longer, healthier, more productive lives, and more of them; more workers; an expanding middle class; more opportunities for the formation of capital—this virtuous medical-economic cycle is helping to generate the equally staggering growth in China and elsewhere in the region.

This could very well be a biomedical century, in the same way that the last was a physical and engineering century, with similarly explosive improvements in capability for taking care of our bodies and minds, and lives.  After a period of labor-saving device advances, now perhaps, a period of advances in  life- and quality of life-saving devices and techniques.

But maybe not in the United States.  Genentech’s Avastin is a drug that had been approved for use as a treatment option for women with metastatic breast cancer; that approval has been withdrawn by the FDA.  The rationale for the withdrawal is instructive:

The National Comprehensive Cancer Network, a highly respected consortium of U.S. oncology programs, has four times reaffirmed its recommendation that Avastin is “an appropriate therapeutic option.”

Perhaps the most telling passage in Dr. Hamburg’s apologia arrives when she rejects such practical expertise because the Cancer Network tries “to provide clinicians with ready access to synthesized information they can use in making patient decisions.” She says the FDA’s judgment is superior because its experts “have extensive qualifications in clinical trial design and evaluation.” Rarely are assertions of regulatory purism over the evidence and practice of the real world so chillingly blunt.

Further, Dr Margaret Hamburg, FDA Commissioner, while acknowledging that many women experience dramatic improvements with Avastin, insists that “it is not possible to determine if there is some subset of patients within the population as a whole that may have had a meaningful benefit.”

I suppose, though, there is a bright side to this.  It isn’t every nation in the world that has such august personages in their governments who personally know better than empirical evidence what the correct course must be.

Can the EU be saved?  Spiegel Online International asks this question and outlines some possible paths to a rescue.  Related to this is a question the Europeans dare not ask: should it be saved?

I think the paths outlined are doomed to failure, and I think the attempt should not be made.

The Spiegel authors allude to a similarity with the original American colonies and our Articles of Confederation, and this is an apt comparison, as far as it goes.  Under the Articles, the united States [sic] were as utterly helpless to solve their problems as the EU is today.  In order to achieve anything substantive, the Articles demanded a unanimous vote from 13 independent States, States who had come together under the Articles in a diplomatic conclave, not as a single nation.  Even for less important matters, the Articles required a super majority for enactment.  Thus, 235 years ago, as the ex-European Commission President José Manuel Barroso put it in describing the current condition of the EU, “Any idiot [could] veto anything.”

However, the authors do not explore the comparison enough, and so they do not see a critical difference between the Treaties of Lisbon, Maastricht, and Rome that created the EU, and the Articles of Confederation that created the initial American nation.  There are 27 nations in the European Union, and there are 17 nations in the subset that is the euro zone.  This compares to 13 colonies/States in the Confederation.  The critical difference, though, that allowed the Confederation to transform itself into the United States of America and that stands in the way of a similar EU transformation is this: a very large degree of homogeneity existed among the 13 States that agreed, finally, to toss the Articles and the glorified alliance that they documented and to supplant the mess with a Constitution, a Federal government, and a true nation.  The States also had to give up real measures of their sovereignty to achieve this transformation.

This was only possible due to the American States’ fundamental similarity of thought, particularly the philosophical view of the relationship of men with government and with each other, of the purposes of society, of government, of an economy, of money—in short, of social and political philosophy.

This homogeneity does not obtain in Europe, and so a similar removal of the Treaties and transformation of the nations of the EU into a true European nation is impossible.  Whatever we might think of the various underlying philosophies, the differences among the European nations are as fundamental as were the similarities among the American States.  The views of the Mediterranean nations are not those of western Europe, and northern Europe differs from both, and eastern Europe differs still.  And within each region, particularly western Europe, there are fundamental differences in political and economic philosophy.  Without confluence on philosophy, the unity essential to nationhood is impossible to achieve.  Additionally, so long as these philosophical differences exist, the nations will not yield the sovereignty necessary to allow a central über government with teeth, even a federal one, to exist.

There is, also, a practical difference between the situation of the Confederation of 235 years ago and the EU of today.  This is the age and maturity of the constituent States.  The American colonies still were young, largely unformed in their polities (although they had all the trappings of fully formed governments), and for all their economic competition, were used to working with each other against a hostile outside world.  The nations of today’s European Union are fully formed, mature nations, settled in their political, social, and economic ways, and in many very serious respects, not at all used to wholesale cooperation against a hostile outside world, but they are rather used to conflict in their mutual hostility.

Integration is even harder with money.  Without a common understanding of the purpose and use of money, there can be no hope of a common currency.  Who should pay for a man’s retirement, for instance?  If government should (not a universal belief), then from where will that government get the money with which to pay?  This can only come from taxpayer/citizens.  But if one nation of the Union (or one State of the desired new Federation) believes it appropriate for a man to retire at 55, on what basis will a citizen of another State of the Federation, a State that believes, across its society, that a man should work until 67, agree to pay for that earlier retirement?  If the purpose of money, according to one polity, is current consumption—because government will provide the future—how can another polity, believing that money has also (if not instead) a purpose of storing value against an uncertain future use the same currency?

Indeed, some Europeans understand this today.  Hermann Lübbe, writing in the Frankfurter Algemeine Zeitung (I’m paraphrasing from the Spiegel translation; my German is virtually non-existent), acknowledges that a federation of European states is an impossibility, as the current euro zone debt failures demonstrate.  Lübbe writes that there is “no prospect” of achieving consensus among “Finland and Greece, Slovenia and Portugal, Austria and France.”

Even were a pan-European federation workable, though, the solutions offered are incomplete and doomed to failure from that incompleteness.  Joschka Fischer, erstwhile German foreign minister, for instance, suggests a stronger European economic government for the euro zone, an government that would assume fiscal control over the member nations.  But this cannot work without including defense in the government, because defense must be paid for by something, especially in a world where Americans are tired of spending our own treasure and blood for the sake of other nations that choose not to contribute to their own defensive needs.  In fact, none of the solutions suggested consider a common defense requirement.

Any inclusion of a unified defense governance, though, will be as difficult as trying for a common currency, or a common underlying philosophy of government, generally.  The several European nations each have their own defense imperatives, such as they are.  In an anti-terror war in Afghanistan, for instance, can a Spain be required to produce troops after it has decided its own interests lie with bringing the troops it had assigned back home?  Can a Germany be required to provide the bulk of the defense for a pan-Europe, with German soldiers necessarily stationed in the nations of pan-Europe (and how would a France react to that with the border area between the two so recently, and for so long, a common battleground; to say nothing of the wholly different views in these two nations of the role a defense establishment must play, and the differing views of nuclear weapons)?  How, indeed, should the nations that view a war against an amorphous enemy like terror organizations respond to that war?  Yet these questions can only be answered by considering the economics of defense, and the politics of defense, as well as the military nature of defense.

What’s the alternative, then?  Must Europe revert to the 27 separate nationalities of the last century?  Certainly, they could.  The threats of that century—Germany, France, and Great Britain economically prostrate and so looking for national advantage in the early part of the century; the Soviet threat in the latter half of the century—no longer exist.  The nations—even Greece—are relatively prosperous today, and the nations no longer view each other as overt threats.  However, there is profit (in every sense of the word) to be had in reducing the level of economic and political fragmentation that 27 separate nations, each going its own way, demonstrates.

There are natural groupings among the several states, and such groupings could form the core of common currency zones and even federations comprising members of those groups.  But it’s critical even here, that commonality of world view must be the guiding force in creating these Unions.

Some Unions that come to mind are Italy, Spain, and Portugal; Germany, Austria, and (yes) Poland; the Baltic States; Scandinavia to suggest a few.  This leaves Great Britain outside, but this is to the detriment of no one.  For centuries the British have made a prosperous living remaining outside continental Europe, brokering arrangements among the continental powers, when the British were not dealing with the world at large; this is a fine course for Great Britain today through the intermediate future.  This leaves France, also, on the outside—looking in, but also looking outward, and this does no harm to France or to Europe, even though some of the less imaginative think Europe without France to be inconceivable.

These larger Unions, while not pan-European, will have the economic strength to operate prosperously on the global stage, and they can add to their economic strength in the same way that North America has, with its nations of differing world views: with a pan-European free trade zone.

This sort of arrangement necessarily represents a fragmentation of the European Union, but the present whole is unworkable and needs to go another way, anyway.  The several Unions, the several common currencies, with a collective free trade agreement, will be far stronger, and the constituent parts, for being more homogeneous internally, will be far more stable, both internally and vis-à-vis each other.

Update: Corrected typo that changed the meaning of a sentence: opening the 4th paragraph, “However, the authors explore the comparison enough….” has been corrected to “However, the authors do not explore the comparison enough….”