The Braintrust

by Marc Stiegler

  Byron pondered that for a moment, becoming almost calm. “That can’t be true. The California government has used its exclusive buying power to clamp down on the pharmaceutical companies and the doctors and the hospitals, forcing them to deliver the lowest possible prices.”

  Colin shook his head. “Governments are all about punishment. They have no grasp of rewards, except for favored lobbying groups. Here on the BrainTrust we’ve used simple incentive engineering strategies to reward people who make larger contributions. The consequence is radical innovation in efficiency which ultimately beats the cost savings of governmental clampdown. Focusing on rewards rather than punishments gets better results.”

  Byron barked a laugh. “So you pay your doctors more to get lower prices.”

  “Exactly.”

  Dash added, “Surely you can see how it’s done? Consider how we do surgery. A single surgeon typically oversees four simultaneous operations being performed by robots. If the doctor makes half as much money per patient, he is still making twice as much money.”

  Byron frowned. “That’s still only a factor of two savings. Colin is talking about a factor of ten.”

  Colin picked up the thread. “Excess cost is built into every aspect of American healthcare. In America, an OBGYN pays a hundred thousand a year for liability insurance. On the BrainTrust, mediation practices have reduced that to about five thousand dollars per year, a factor of twenty reduction.”

  “Still, malpractice insurance is a small part of the total costs.”

  Colin nodded. “Yes, in America it only costs as much as if you were running a full-blown war in Iraq. But the hidden costs of litigation are a factor of ten greater than that.”

  Byron shook his head. “Hidden costs?”

  “Hidden costs are the ones hardest to control or manage, for obvious reasons. For example, doctors do relentless testing, all too often not to protect the patient from the illness or side effects but to protect the doctor from the litigation.” Colin peered into a distant memory. “Once, long ago, I had pleurisy, an irritation in the lining of the lungs. When it flared in the middle of the night, I went to the emergency room to make sure it hadn’t turned into pneumonia, as my doctor had warned me to do. Twenty seconds with a stethoscope showed it wasn’t a problem, but the doctor ran an MRI to make sure I wasn’t having a heart attack. He knew I wasn’t, but he had to protect himself and his hospital. That compulsion turned what should have been a twenty-five-dollar doctor visit into a three-thousand-dollar nightmare.”

  Dash did the calculation. “So in this example the liability issues inflated the costs by more than a factor of one hundred.”

  Colin nodded and continued, “And of course, doctors from all over the world compete for the opportunity to work here, some on board the ships, some remotely. We have some Canadian doctors, whose salaries were fixed by the government as you noted, who moved to Bermuda, work from the beach, and make more money than ever before by offering a lower price per patient than the doctors in competition with them.”

  Byron snorted. “They can’t possibly provide the best quality care.”

  Colin shrugged. “If they don’t give excellent care, they don’t get any more patients. I said earlier we focus on rewards for excellence, but we do have a stick, too. In America, the medical industry never allows more doctors to be certified than there are patients to serve the doctors’ need for full schedules. On the BrainTrust, the competition among doctors worldwide to serve the patients’ needs is nothing short of ferocious. Any medical practitioner who puts people in waiting lines or delivers poor service is swept from the field.”

  Dash added, “Like the MRI machine we just purchased for the lab. Remember, Byron? The MRI that passed the American FDA certification process was quoted at a hundred thousand dollars, so we bought the one from India that cost ten thousand dollars. Another factor of ten, now that I think about it.”

  “Bah!” Byron changed the topic, though not as much as Dash might have preferred. “I was wondering, Dash, if you had thought any more about what I said about the moral issues with your therapy.”

  “You mean treating tyrants and dictators?” Dash shook her head. “I will say again, it would be most unwise of them to want to be part of our current research.”

  Byron pressed. “But if they did?” He turned to Colin. “Has anyone in the President’s office contacted you?”

  When Colin failed to respond promptly, Dash looked at him in surprise. “Pak Colin, does the President-for-Life want to be an experimental patient?”

  Colin frowned. “It was discussed. In the end his people rejected the idea.”

  “See!?” Byron demanded. “They’re already hounding you, and it’ll just get worse.”

  Dash closed her eyes for a moment. “So you want me to create rules about who will be allowed to receive telomere therapy? I should pick who lives and who dies?” She shook her head. “I just do not see it, Byron. People will have to find a more sensible way of replacing national leaders than waiting for them to die.”

  Byron slid forward in his chair and challenged her. “Like what?”

  Dash lowered her head. “I do not know.” She raised her eyes to meet his. “But as Pak Colin said earlier, we are not trying to solve all of the world’s problems. You and I have set out to solve one very important problem. I think we may solve it pretty well, but many other problems will remain. And this problem—the immortal dictator problem—is outside my areas of expertise.” Though as she thought about it, she wondered if maybe she should expand her horizons. Perhaps she should make it an area of expertise.

  Byron rose abruptly from the table and stalked away, practically shaking with anger.

  Colin watched him sadly. “If he’s not careful, he’ll wind up a bitter old man.”

  Dash defended her assistant, at least a little. “His question is still interesting. Furthermore, it is about to become much more important. How might we make the process for replacing a bad dictator more reliable?”

  Colin stared at her thoughtfully. “To get a better answer, you need to ask a better question.” He too rose from the table and left.

  And Dash sat nibbling on her kahala, pondering the question of what question she should ask.

  ***

  Mediator Joshua Pickett was astonished. Two cases of violent assault on security personnel in such a short period of time. Extraordinary! And both assaults had taken place here on his ship, the Chiron. Coincidence, or were they somehow connected?

  Scanning the brief documents on the assailants, it struck him that these two, like the first one, were from Pakistan. Indeed, looking more closely at his data, he saw that the previous accused, one of these two, and the peacekeeper at the center of this latest incident all had the same last name. The probability of a coincidence seemed small indeed.

  Well, on to the facts.

  He faced a larger group of people this time, but some of the faces were the same. “Amanda?”

  Amanda nodded graciously. “As it happens, I know the peacekeeper and the resident involved. Dr. Dash is a research lead here on Chiron. Although she is project owner for an independent venture-sponsored startup, I am part of the technical team reviewing her work on behalf of the investors.”

  Joshua pursed his lips. “Colin.”

  Amanda just shrugged.

  He looked beyond her. “Ms. Ping?”

  “Just Ping, sir. Dash and Jam are friends of mine. I’m here for moral support.”

  Joshua wondered if she was really here in hopes that another fight would break out so she’d be able to participate. Well, considering how violence-wracked the ship had suddenly become, perhaps her presence was not a bad thing.

  He next turned to one of the assaulted parties. “Dr. Dash?”

  “Yes, sir. If you need an assessment of the medical condition of the participants here, I would be happy to assist.”

  “I suspect Amanda, that is, Dr. Copeland, can fill that capacity for today. You’ve had a rather
rough couple of hours. But thank you.” He turned to the peacekeeper standing next to her. “Mrs. Yousafzai?”

  Jam stood stiffly at attention. “I am no longer Mrs. Yousafzai, sir. After the altercation, I persuaded my husband to divorce me. It is done. Please call me Jam.”

  “Jam.” Joshua made a notation for the record. “I presume your, erm, ex-husband is Mr. Jamal Yousafzai?” He looked over at the man whose jaw was locked in position by external wiring.

  A BrainTrust guest advocate was standing next to him. “Excuse me, sir, but as you can see, Mr. Yousafzai is not able to speak on his own behalf. I shall be acting as his voice as well as his counsel.”

  “Very good. He turned to the last man. “Can you speak for yourself, Mr., uh, Tarkani?”

  Marjan answered through his phone translator. “Yes, sir.” His voice sounded a bit muffled; Joshua realized his nose was broken and packed with cotton. The nose had been a victim of the battle, Joshua guessed. Interesting that Jamal’s nose appeared to have been broken in the same way some time in the past—unless that was a common nose shape among Pakistani men. Rather unlikely, he supposed.

  “Everyone, please be seated.” They all sat, except the four peacekeepers standing behind Jamal and Marjan. They seemed disturbingly alert for any transgression on the part of the guests that might give them an opportunity to dispense more justice. Joshua shook his head. “Let’s see what happened, shall we?”

  There were so many vidcams in the vicinity of this assault that they could construct a 3D composite. He observed the moment when Marjan’s nose suffered its fate. He paused toward the end, when Jamal was lying on the ground turning purple after Jam kicked him in a most sensitive area. “Ms. Jam. I fear I have to ask. Is this the point at which you renegotiated your marital arrangement with your ex-husband?”

  Jam stared forward. “It is, sir.”

  Joshua spoke forcefully. “You understand that it is inappropriate for a representative of the BrainTrust, an autonomous society which strives to represent the highest standards of civilization, to negotiate with a tourist in this fashion?”

  Jam’s eyes glistened. “I am sorry, sir. I was not thinking clearly at the time. I had lost sight of the fact that he was a guest.”

  Joshua buried his head in his hands. He muttered his mantra to himself once again, “This is not funny. This is a serious matter,” and placed his hands calmly on the desk. “Please strive to do better in the future, Ms. Jam.”

  “Yes, sir.”

  The video ended.

  Joshua looked at Jamal. “It would seem you were attempting to murder our peacekeeper.”

  Jamal turned to the advocate and whispered something slowly. The advocate spoke for him. “He says he was simply attempting to restore his family’s honor, sir. He begs forgiveness and prays for understanding.”

  Joshua turned to Jam. “Does that mean he was not trying to kill you?”

  “It means that a year ago I broke his nose to escape a beating, sir. He will remain disgraced as long as I live.” She reached up involuntarily and touched the scar below her eye.

  The scar looked remarkably similar to the scar that had been forming on Amu’s face when Joshua had last seen him. He looked at Ping, who grinned back. He was suddenly certain that justice was being served in ways he would be better off not investigating. “Ms. Jam, Dr. Dash, do you have any serious injuries to report? I see your arm is taped up, Ms. Jam, presumably from that knife slash we witnessed on the video?”

  Jam shook her head, “I am fine, sir.”

  Dash raised her hand to speak. “I am fine, but I feel obligated to note another injury Jam has suffered. In contact with her attacking ex-husband, she experienced severe abrasions to the joints of her hand.”

  Joshua took a few seconds to parse this sentence. He rolled the video to the place where he suspected the injury had taken place. “Was this the point at which Ms. Jam suffered these abrasions?”

  Dash looked at him very seriously. “Yes.”

  Joshua rolled his lips. “You’re telling me that Ms. Jam hurt her knuckles when she broke Mr. Yousafzai’s jaw?”

  Dash seemed set on arguing, then reconsidered. “It was a very serious abrasion.”

  Joshua put his head in his hands again and silently ran his mantra through his mind. Three times. “Of course.” He looked at Jamal and Marjan.

  “What about the injuries to our two other participants?”

  Amanda answered. “The broken jaw looks bad, but it will heal nicely. We recommend holding them on board till we can remove the bracing.”

  “And Mr. Tarkani?”

  Dash answered this time. “The damage to his eardrum is minor.”

  Marjan turned stiffly. “What?” he asked.

  “Though the hearing loss is considerable,” Dash continued smoothly.

  The advocate felt obligated to object. “Mediator Pickett, allow me to point out that my client cannot see very well because the pain of his broken nose causes tears to well in his eyes, and he cannot hear very well because of the damage to his eardrum. I hardly think the damage is minor.”

  Dash could not let that stand. “I assure you the damage is minor. I was very careful to penetrate the ear with the pen in such a manner as to fully distract Mr. Tarkani while inflicting as little damage as possible.”

  Joshua was incredulous. “So, in the middle of a desperate fight with assailants intent on murdering your friend, you were careful while jamming a pen into the assailant’s ear?”

  “Of course,” Dash responded primly.

  Joshua was about to ream her out for claims perilously close to perjury when Amanda coughed politely. He turned to her.

  “Josh—I mean, Mediator Pickett—speaking as a friend of the mediation, I’m quite certain she’s telling the truth. ‘First do no harm,’ you know.”

  Dash interjected, “Very much so. I take my oath seriously.”

  Amanda continued. “That’s just the way she is. Really.” Her expression turned rueful.

  Joshua looked between the two of them. “Well, then.”

  Dash looked a little guilty. “A surgeon of even mediocre skill could repair his eardrum. I can fix it if you want me to.” She paused. The next words seemed forced from her. “The nose, too.”

  Amanda glared at her, though Dash seemed oblivious. Joshua addressed Amanda. “Dr. Copeland? You have something you wish to add?”

  Amanda spoke with barely controlled fury. “We are already fulfilling our contractual obligation to these attempted murderers. We do not need to go to any such extremes.”

  Joshua was inclined to agree. “Very well.”

  A wicked smile lit Jam’s face.

  Joshua knew it would be better if he did not pursue this, but chose the course of unwisdom. “Ms. Jam, do you have something to add?”

  Jam stared at her brother. “The doctor in our village is a butcher. Many women have died during childbirth because of his incompetence. Handing Marjan over to him for surgery would be…” she groped for the right words, “an act of justice.”

  Ah, yes. Justice. A goal ever to strive for, never to achieve. Joshua wondered how well he was doing here today. Were he striving to serve irony rather than justice, he thought he would be doing rather well. “We’ll hold Mr. Tarkani and Mr. Yousafzai until the broken jaw is healed enough for transport. Then they’ll be shipped back to Pakistan.”

  Amanda objected. “Joshua, these people are murderers! An honor killing? You know what’ll happen to them if we just send them back. They’ll just be sent home with no jail time and no punishment.” She calmed down. “Sir.”

  Joshua waved his hands helplessly. “What else can I do?” He looked at the battered pair of men. He thought of the three wise monkeys: See no evil, hear no evil, speak no evil. Between the two of them, they had all the injuries needed to be wise. “Perhaps they have already received a minimally educational set of punishments from their intended victims.” He was about to end the meeting when Jamal spoke urgently to the advo
cate. The advocate delivered Jamal’s request. “Uh, sir, Mr. Yousafzai would like to have his knife returned to him when he departs.”

  “The knife?” he asked in puzzlement.

  “Yes.” The advocate gestured to one of the security guards, who brought forth the item in question.

  “Ah.” Suddenly Joshua had a thought. “Is this knife valuable?”

  Jamal nodded his head vigorously. He spoke to the advocate. The advocate spoke back. Jamal spoke angrily. The advocate countered in frustration. Still more words. Finally the advocate relented. Joshua realized the advocate’d had the same thought as himself, but Jamal wasn’t listening.

  The advocate spoke with resignation. “The knife is very valuable, and it’s a family heirloom.” He looked down at his feet sadly. “It’s very important to him.”

  Joshua smiled in satisfaction. “How wonderful.” He addressed Jamal and Marjan. “You know, normally in mediation, the conflict comes down to money. The injured party receives compensatory remuneration for damages. We didn’t discuss such remuneration during this mediation because you two don’t have a dime between the pair of you.” Here he smiled, “but compensation need not be financial. I hereby transfer ownership of the knife.” He looked at it closely. “An ivory-hilted knife with a curved blade—”

  Jam interrupted. “A chura.”

  “Excellent. I hereby transfer ownership of this chura to Dr. Dash and Ms. Jam.” He looked at them. “You’ll have to figure out a way to share it.”

  Jam shook her head. “I don’t want it. Dash, it’s yours.”

  Dash looked bemused. “What would I do with it?”