Breakout: Pioneers of the Future, Prison Guards of the Past, and the Epic Battle That Will Decide America's Fate
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BREAKOUT
BREAKOUT
PIONEERS OF THE FUTURE,
PRISON GUARDS OF THE PAST,
AND THE EPIC BATTLE
THAT WILL DECIDE AMERICA’S FATE
NEWT GINGRICH
WITH ROSS WORTHINGTON
An Eagle Publishing Company • Washington, DC
Copyright © 2013 by Newt Gingrich
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means electronic or mechanical, including photocopy, recording, or any information storage and retrieval system now known or to be invented, without permission in writing from the publisher, except by a reviewer who wishes to quote brief passages in connection with a review written for inclusion in a magazine, newspaper, website, or broadcast.
First ebook edition © 2013
eISBN 978-1-62157-022-6
The Library of Congress has cataloged the hardcover edition as follows:
Published in the United States by
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To the pioneers of the future, who create so many better opportunities for all Americans.
CONTENTS
INTRODUCTION
CHAPTER ONE: Breakout: The Great Opportunity
CHAPTER TWO: Breakout in Learning
CHAPTER THREE: Breakout in Health
CHAPTER FOUR: Breakout in American Energy
CHAPTER FIVE: The Green Prison Guards
CHAPTER SIX: Breakout in Transportation
CHAPTER SEVEN: Breakout in Space
CHAPTER EIGHT: Breakdown in Government
CHAPTER NINE: Breakout in Government
CHAPTER TEN: Breakout from Poverty
CHAPTER ELEVEN: Breakout in Achieving Cures
CHAPTER TWELVE: Breakout from Disabilities to Capabilities
CHAPTER THIRTEEN: Breakout Champions
CONCLUSION
ACKNOWLEDGMENTS
NOTES
INDEX
INTRODUCTION
Even before the painful sore appeared in her mouth just before Christmas in 1999, Abigail Burroughs was an exceptional young woman. She had earned awards for her community service in her hometown of Falls Church, Virginia, and had volunteered in homeless shelters. She had graduated second in her high school class, and now she was excelling in an honors program at the University of Virginia.
Of all the reasons we might have read about Abigail in the Washington Post, a desperate battle with bureaucracy over access to a lifesaving drug would have seemed the least likely. It was a cruel battle she shouldn’t have had to fight.
“It was annoying,” Abigail told the Cavalier Daily, her college newspaper, referring to the sore in her mouth. “I just wanted it to go away.” She finally convinced her doctor to remove it. Before classes resumed after winter break, Abigail heard from the doctor. The lab results were shocking: the sore was cancerous. She was nineteen years old.1
Still, Abigail’s prognosis was good once the surrounding tissues were removed. Her doctor told her there was a 90-percent chance the cancer wouldn’t come back. The short procedure should have been the end of the matter.
But it wasn’t. The cancer returned a few months later, this time as a larger lump in her neck. She had it removed surgically and quickly began radiation and chemotherapy, which left “severe burns on the inside of her mouth.”2 But Abigail was optimistic she would recover and return to school, where she had a boyfriend and lived in an apartment with other girls her age.
Not long after the first round of treatment, though, her doctors found another lump in her neck. They discovered the cancer had spread to her lungs and stomach too. The doctors in Charlottesville had nothing else to try. But doctors at Johns Hopkins, one of the leading cancer centers in the country, knew about two breakthrough drugs that showed promise for cases like Abigail’s. They were her best chance, the doctors said.
Unfortunately, neither drug was approved by the Food and Drug Administration, the federal agency that must clear virtually every medical product for safety and effectiveness. Both drugs had passed the early stages of trials, indicating that they were safe for use in patients. But it would take many years—and hundreds of millions of dollars—for the companies behind them to prove to the FDA’s highest standards of scientific evidence what some of the best doctors in the field had already observed: these drugs could help cancer patients who had failed to respond to the traditional treatments. Abigail Burroughs didn’t have years to wait for definitive evidence while the FDA haggled with the drugmakers. She was dying. She needed the breakthrough treatments immediately.
Abigail’s doctors tried to enroll her in the clinical trials the companies were conducting to obtain FDA approval. Either of these would have given her a chance of getting the real treatment—or of getting a placebo (which of course meant certain death). But Abigail’s condition didn’t meet the exacting standards for even this undesirable choice.
The FDA offers just one recourse for patients who urgently need access to breakthrough drugs if they don’t make the clinical trials. Patients can ask the drugmakers for “compassionate use,” which, if granted, must be approved by FDA bureaucrats on a case-by-case basis.
At this point Abigail’s story began to get national attention. It started at the University of Virginia, where the administration, fraternities, and student groups organized a campaign to petition the companies to give Abigail the drugs. Then the campaign spread. Thousands of people she had never met began writing to the drug companies on her behalf.
At the same time, her father founded the Abigail Alliance for Better Access to Developmental Drugs to push for wider access to new drugs for terminally ill patients who had no other options. He argued that it is unjustifiable to keep the drugs from dying patients, even if they carry risks.
A reporter from the Washington Post visited Abigail in her apartment and published a heartbreaking story on her struggle. He reported that the college junior “rates her life by what she can do—a daily visit to her favorite Starbucks—or how far she can walk—she slept 24 hours to gather strength to make it to a Dave Matthews concert last month.”3
Despite months of public pressure on Abigail’s behalf, the companies refused to give her the drugs. It seemed that in the middle of their billion-dollar effort to win FDA approval, they were unwilling to risk a bright twenty-one-year-old girl’s dying while receiving the treatment that was under scrutiny. For Abigail, it would be the FDA-sanctioned treatments, or nothing at all.
“I try not to think about [the companies], because when I start to, it makes me really, really angry,” she told the Post. “I can’t understand how these people can be so nonchalantly by-the-book and just say no.”
Abigail passed away about a month later. Her father carried his quest for more open access all the way to the Supreme Court, which declined to hear his challenge to the existing system. His suit attempted to make available one of the
drugs to which Abigail had sought access, C225, known today as Erbitux.
Researchers invented Erbitux in 1983, when Abigail was three years old.4 Only a small fraction of drugs passes successfully through the regulatory gauntlet, and it took a decade before they found a company willing to bear the tremendously expensive risk.5
By the time Abigail asked for Erbitux in 2001, eighteen years after its invention, it had already shown promising results. Yet it did not receive FDA approval for three more years, and then only for colorectal cancer. It took until 2006 to win approval for localized head and neck cancer. The drug was not approved for late-stage head and neck cancer like Abigail’s until 2011, ten years after her death, eighteen years after a drug company acquired the rights, and twenty-eight years after it was invented.
Abigail’s story is tragic, but it is the norm. Somebody was willing to lock her in the past, denying her the breakthrough drug of tomorrow that might have saved her life. And as you will read here, the forces fighting “to keep the Past upon its throne” are not limited to medicine. They are at work in many important fields.
This is what we must change.
CHAPTER ONE
BREAKOUT
THE GREAT OPPORTUNITY
America is on the edge of a breakout.
Astonishing progress in medicine, transportation, learning, energy production, and other areas has set the stage for one of the most spectacular leaps in human wellbeing in history. But like Abigail Burroughs, we might never reach the breakout these breakthroughs make possible.
Even as pioneering scientists, engineers, and entrepreneurs apply their genius and industry to overcoming some of our most serious problems, there are institutions, interests, and individuals hard at work to thwart this breakout. Their power and comfort are often bound up with the status quo. They are willing to forgo the breakout, to keep us prisoners of the past, in order to cling to the privileges that the old order has bestowed on them. And they will succeed if we let them.
This book is about that contest. You will read about the almost unbelievable advances that are on the threshold of reality—triumphs of human ingenuity that will save millions of lives and vanquish afflictions that have vexed us for centuries. And you will meet those who are trying to kill that breakout before it begins.
The defining battle of our time is not between the Left and the Right. It is between the past and the future. And every American is a contestant, whether he or she knows it or not. As you read in the following chapters about breakthroughs in one field after another, you will see that the choice before us could hardly be more urgent.
Breakouts Past
Breakouts are bigger and more powerful than breakthroughs. In a dynamic, entrepreneurial society like America, breakthroughs are happening all the time in various fields. They are quickly absorbed into our economic and social routine.
There are times, though, when a combination of science, technology, innovation, and entrepreneurship creates waves of new possibilities that reinforce each other. Then, in a matter of thirty or forty years, the world is dramatically different.
Breakouts change how we live and how we think about living, how we organize activities and how we organize government.
To understand the magnitude of change in a breakout, consider the world that emerged in the decades just prior to 1870. In only a generation, the steam engine had revolutionized the economy, drawing millions of Americans from lives of subsistence farming to work at factories in major cities. Sewing machines had radically changed the way people made clothes, cotton gins had sped the production of cloth, and motorized farm equipment had transformed agriculture.
Steamboats traveled up and down American rivers routinely and had shortened the journey across the Atlantic from more than ten weeks by sail to just twelve days by steam. The transcontinental railroad, also powered by steam, had enabled fast long-distance travel and made shipping goods across the United States practicable.
The camera had produced the first photographs, and the telegraph had enabled simple communication nearly at the speed of light. Networks had emerged to carry news throughout the United States and Europe in minutes rather than weeks.
If life in 1870 wasn’t what we would call comfortable, it was materially much better and technologically much more advanced than it had been in 1840. To a person in middle age, the world was a marvel of technological achievement.
He might read Jules Verne’s Around the World in Eighty Days (the speed was intended to be impressive), published in 1873, and imagine an incredible future.
He would also worry about the uncertain new world. Cities were bursting with people. In 1820 there were only five U.S. cities with a population over twenty-five thousand; by 1850 there were twenty-six.1 They were crowded and unpleasant. Disease was rampant. Immigrants, drawn by the new opportunities, flooded in from all over the world, to the dismay of many Americans.
No one could have imagined the world that was just around the corner. The impressive technological progress that Americans surveyed in 1870 only set the stage for what was to come. Candles still lit homes at night, ice had to be cut from lakes and stored in iceboxes, and most travel was by foot or horse.
In the lifetime of someone born in 1870, Edison invented the electric light bulb, which quickly replaced candles as the dominant source of light. Refrigerators replaced iceboxes, washing machines replaced wash-boards, and vacuum cleaners replaced many brooms. Electric fans let people cool themselves with artificial wind.
The telephone enabled distance communication by voice, and radio enabled a new kind of mass communication completely different from newspapers. For the first time, any citizen could hear the words of prominent Americans, and everyone could listen to the same music and live sporting events. Gramophones and motion pictures became available, replacing vaudeville as forms of popular entertainment. That common culture helped assimilate the millions of new Americans who had arrived on the steamships.
The internal combustion engine was developed, and the automobile replaced the horse and buggy. Americans now enjoyed flexibility in where they lived and worked, and Detroit became a boomtown. In cities, underground transit systems—subways—connected far-flung neighborhoods. The Wright brothers made their first flight in 1903, and in 1927, just fifty-four years after Verne’s Around the World in Eighty Days, Charles Lindbergh flew from New York to Paris in thirty-three hours.
Physicians began using X-rays and the newly invented electrocardiogram. In the early 1920s, scientists identified vitamins, and in 1928 they discovered penicillin.
By 1930, pioneering Americans had created some early version of virtually everything we think of as modern.
The generation that lived through that change found itself rethinking work, leisure, retirement, and government. The reform movement that created much of modern government was the political parallel of the explosion of new science, technology, and entrepreneurship.
Until the Great Depression began in 1929 (and, for most Americans, even after it began as well), life was simply much better than it had been in 1870. Life was better not because politicians had the right plans or because government built a bridge to the future, but because millions of Americans embraced the opportunities to improve their lives. They solved many of the problems of daily life and transformed it in the process. They had produced a real American breakout.
Breakouts Future
Americans in the second decade of the twenty-first century have witnessed a breakout in the field of information. Soon after Motorola made the first handheld mobile telephone in 1973, Apple and Microsoft opened the first act of the information revolution with the personal computer. The next act began in the early 1980s as the internet began to emerge. By the mid-1990s, it was widely available, and we got AOL, Amazon, Yahoo!, and, in 1998, Google.
By the mid to late 2000s, we were into the third act, when the internet became a major part of our lives. A high-spirited Harvard undergraduate, Mark Zuckerberg, launched a campus phot
o site called “Facemash” in 2003, whose instant popularity crashed the university’s network. In 2004 he launched Facebook, which nine years later had more than a billion users. This deep integration of information into our lives continued with ubiquitous iPhones and Android devices constantly connecting us to the virtual world. In 2013, Google reported that 1.5 million new Android devices are activated every single day.2
If you have lived through these changes, you know how different the world is today from your childhood. Imagine having no personal computer, no cell phone, no Google, no Wikipedia, no Facebook. Imagine a world with no online shopping, no online hotel and airline reservations, no Google Maps. Without their iPhones, many people today are lost, literally.
Our desperation when our batteries die—we race to find a plug like scuba divers whose tanks have run out of air—is a reminder of how much we have woven our lives around a two-hundred-dollar device that no amount money could have purchased ten years ago.
It is all quite amazing. But like people in the 1870s marveling at steam engines and railroads, we have not quite digested the change that has taken place or begun to understand the change that is to come as breakthroughs continue in other fields.
We have seen an information revolution, but there have been no comparable advances in healthcare, education, transportation, manufacturing, or government.
What’s the holdup? After thirty years of exponential improvement in computers, why does education still look the same—or worse, and more expensive? Why is healthcare still fundamentally the same—or worse, and more expensive? Why is government disastrously worse and much more expensive? Why, outside the confines of our pockets and our computer screens, is everything so old?
The fact is, we got lucky with computers, and especially with the internet. No one succeeded in blocking their future, largely because both were open systems. The big research labs of the 1970s at places like IBM and AT&T didn’t have a veto over the emerging personal computer industry, because before long, anyone with a little know-how could assemble the components in his garage and start tinkering around with code. If he was innovative enough, his ideas could catch on. And they did: two of those garage tinkerers founded Apple and Microsoft.