What If There Were No Such Thing As Illness?

Disease undoubtedly influences human behavior. Someone who saw his or her chain-smoking grandfather struggle to breathe might not take up smoking. Let's reverse that: If people couldn't get sick, would more people smoke cigarettes, take illegal drugs and engage in unprotected sex? Would we take more risks in general?

Maybe not. We'd have other deterrents from unprotected sex, like unwanted pregnancies. Actually, sexually transmitted diseases barely influence our decisions about condoms, says Marc Boulay, who studies how people decide about sex and family planning, both in the developing and developed world.

When contemplating sex, we think more about social pressures than disease risk, Boulay explains. If you're unmarried in a culture that prohibits premarital sex, you're not likely to have sex before marriage, he adds. Your friends pose another big influence. You'll probably have many partners and not use condoms if your friends do or if you think your friends want you to, Boulay says. Does that sound like teenage behavior? It's also true for adults, he says.

Let's go briefly to Uganda, where professor Hye-Jin Paek from the University of Georgia and her colleagues surveyed people about their contraceptive use. Men and women were more likely to reach for contraception if they talked to their spouses, friends or siblings about using it, but not if they listened to a radio program about family planning [source: Paek]. So, with social forces still in place, we don't predict a sexual revolution brought on by the absence of disease.

What about drugs? Would everyone use heroin? Addiction is a disease, so people wouldn't become addicted, a possible push toward drugs. They would build a tolerance, however, and that carries the risk of overdose and death. But if we apply social models like those found for sexual behavior, neither outcome would matter. People wouldn't take drugs because workplaces and governments would enforce rules against drug use. These institutions would have incentive to make rules, since driving while on cocaine would cause road chaos, and nobody would work if they were high on heroin.

Sex and drugs are interesting, but they're small issues compared to what would happen to the health care system if disease didn't exist. Would doctors, nurses, pharmacists and mental health workers lose their jobs? Again, no. We'd still need these workers, plus hospitals, for accident victims and elective surgeries, as well as births and abortions. The pharmaceutical industry probably would also get by, at the very least, by selling anesthetic for painless childbirth and cosmetic surgeries and repairing wrecked bodies after accidents. It might even market drugs for enhancing life beyond healthy.

As predictions go, ours are about as certain as a weather forecast. There's room to disagree with us and certainly more forecasts to make. Why not use the links on the next page to read up on some relevant topics, like aging, then make your own educated guesses about a world without illness and give us your take?