Going into Shock

by reader Noni Mausa

Title: Going into Shock

Subhead: Some economic metaphors seem more appropriate than “tighten your belt.”

Explaining economic realities and their likely solutions can be made a lot easier with the judicial use of well-understood metaphors. Unfortunately, these tools can be also Used for Evil, or at least Confusion.

In times of economic catastrophe like these, one of the common metaphors is that, when times are bad and money is scarce, people, nations, and businesses need to “tighten their belts.” The idea is that since the ordinary household cuts back and saves money and puts off Johnny’s new bicycle to next summer, therefore it makes just as much sense for America to stop spending and put off her bicycle to next summer.

In this case, a different metaphor seems more appropriate. Compare the economic body to a human body going into shock.

A detailed description of shock [link http://en.wikipedia.org/wiki/Shock_(circulatory) ] makes it clear that it’s no minor ailment. Shock is a killer — not a psychological event but a string of chemical processes which lead to organ failure and death if not interrupted.

Like all biochemistry, it’s pretty complicated. The commonest form of shock is called hypovolemic shock — that is, shock due to loss of blood volume, often from serious accidental injury, stabbing, gunshot, or hemorrhage.

In sequence, the inadequate blood volume leads to loss of oxygen and nutrients to the cells. This leaves the cells trying to keep themselves going by using other energy sources which have toxic byproducts. Soon, breakdown of the cell membrane and failure of the sodium pump follows, leading to a bodily release of digestive enzymes, which releases more toxic substances into circulation. Eventually capillary damage and generalized cell death follows — that is, the patient dies of pervasive metabolic poisoning and organ failure.

It seems to me that the sudden loss of circulatory volume to the economic body is having much the same effect on the interconnected and mutually dependent nations of the world.

So, how is shock treated? By telling the patient to “snap out of it” and tighten his belt? Hell no. The article goes on:

In the early stages, shock requires immediate intervention to preserve life… The management of shock requires immediate intervention, even before a diagnosis is made. Re-establishing perfusion to the organs is the primary goal through restoring and maintaining the blood circulating volume ensuring oxygenation and blood pressure are adequate, achieving and maintaining effective cardiac function, and preventing complications….

(Sounds a bit like a stimulus package, doesn’t it?)

In hypovolemic shock, caused by bleeding, it is necessary to immediately control the bleeding and restore the casualty’s blood volume by giving infusions … Regardless of the cause, the restoration of the circulating volume is priority. As soon as the airway is maintained and oxygen administered the next step is to commence replacement of fluids via the intravenous route.

…Vasoconstrictor agents have no role in the initial treatment of hemorrhagic shock, due to their relative inefficacy in the setting of acidosis, and because the body, in the setting of hemorrhagic shock, is in an endogenously catecholaminergic state. . Definitive care and control of the hemorrhage is absolutely necessary, and should not be delayed.

Roughly this last paragraph says : “…trying to raise blood pressure by administering drugs that constrict blood vessels doesn’t help prevent the ongoing release of metabolic poisons…” (I confess I don’t have a clue as to what the “endogenously catecholaminergic state” has to do with it — or even what it is.) Anyway, to carry on:

Regardless of the cause, the restoration of the circulating volume is priority. As soon as the airway is maintained and oxygen administered the next step is to commence replacement of fluids via the intravenous route.

As I see it, capillaries are local communities, smaller businesses and civic governments, the large organs skirting failure are states, nations and large financial and business organizations, and the cells are the struggling people themselves.

Telling them to tighten their belts is to accelerate, not ameliorate the situation. Urgent action is indeed necessary, lest the toxic byproducts of social malfunction build up further, to destroy the very people and institutions that make up a healthy body politic. A transfusion and an IV drip, not a balanced budget, is the approach of choice right now.