We are spending the week beating the heat in the Appalachian Mountains. We own some property high up in the mountains where we maintain our own little preserve. We also venture out to the national forest, looking for modest circle hikes offering inviting vistas and cool breezes. We have access to old growth forests, although the term old is relative. Along the steep mountainsides where logging is difficult grow the majestic Canada Hemlocks and Tulip Poplars. While not quite to the scale of the Coastal Redwoods, these are huge old trees.
However, the Hemlocks are in trouble, being attacked by a ravenous beetle imported inadvertently from Asia. The US Forest Service is trying to treat some of these beautiful trees, marking the ones treated with small tags. I am not too optimistic given previous experience. I grew up in a once stately city which had beautiful boulevards lined with majestic elms forming graceful canopies. However, the elms were decimated by Dutch Elm disease, decimating these stately trees at about the same time changes in economic fundamentals created blighted communities. Later in my life, I became an avid outdoors man hiking much of the Appalachian Trail in Virginia and North Carolina. My guides often pointed out the rotting hulks of the American Chestnut. While there were estimated to be approximately three billion American Chestnut trees in the US, they now number in the hundreds.
The story was remarkable. A beautiful tree, appearing to be almost perfectly suited for a particular environment, competes for a particular niche, thrives, and becomes a dominant force in a time frame which we humans view as an eternity. As it turns out the equilibrium is really fleeting when viewed through the prism of time. Even what appears to be the strongest of entities has weaknesses which can be exploited by the most modest of creatures..a beetle or a fungus.
Charles Mann's new book "1493" was reviewed today in the WSJ. While I started this blog piece before I read this review, the concepts he describes in his book fit in well with my most recent forest contemplation. It is inherently human to want to hold on to what we have and resist change. Our perspective on time limits our abilities to see the nature of the world in its dynamism. We tend to overestimate some of our impact as drivers of change while completely missing others. According to Mann, just by the nature of our ability to travel we have impact. When Europeans brought the earthworm to North America, the impact was viewed as positive. When the elm bark beetle was transported, it was viewed as a disaster. In both cases, the new entry reshaped the North American ecosystem in fundamental and unpredictable ways.
Lessons of nature seem always to have implications for human institutions. What brings down dominant players in any complex system is generally not foreseeable. What is enduring and what is transient is for the most part beyond human comprehension. What we see as the giant Canada Hemlock like institutions of American Medicine are really not any older than the old growth trees I view on my walks. Like the Hemlocks, the Elms, and the American Chestnuts, they grew to enormous size in an environment which was remarkably conducive to such growth. In such forests, there was no reason to believe these spectacular creatures could not dominate forever.
That is for one thing... nothing dominates forever. The rules change, the environments change, sometimes dramatically and sometimes subtly, and the world changes. Those entities which appear to be the biggest and most dominant always go away and are replaced by something else. In the same sense, the dominant institutions of American Medicine in the last century are not likely to survive the current century. What institutions will become dominant and which roles will compete with the historically dominant physician role is an open question. It will be decided by the combined influence of economics, politics, and animal spirits.