Unsustainable medicine

June 14, 2011

It's routine, as you get out your credit card in the supermarket
checkout line, to be asked to donate a few dollars to medical research. It's an
easy way to contribute--and who wouldn't want to help conquer breast cancer or
prostate cancer?

But Daniel Callahan and Sherwin Nuland, writing in the New
Republic
, contend that
enlisting Americans in the war against disease conveys a dangerously
unrealistic picture of contemporary medicine. Over the past generation, they
say, very little progress has been made toward finding a cure for the major
lethal diseases, such as cancer, heart disease and stroke. "Our main
achievements today consist of devising ways to marginally extend the lives of
the very sick." (The Hastings Center offers a summary of the article.)

This extension of life can be a blessing, of course--but overall
it is a huge burden, financial and human. "The struggle against disease has
begun to look like the trench warfare of World War I: little real progress in
taking enemy territory but enormous economic and human cost in trying to do
so." The war against disease, they write, has created a medical system "that is
barely affordable now and forbiddingly unaffordable in the long run." (See the Century editorial on health-care costs and
the federal budget.)

What to do? Callahan and Nuland recommend nothing short of a
revolution in thinking about and practicing medicine.

Their revolution would entail: improving public health and primary care medicine while
reducing the use of high-tech care at the end of life, training physicians to
tell patients about how aggressive medicine enhances the likelihood of a poor
death, and shifting the emphasis in treatment of chronic disease to care
rather than cure.

Rather than waging a war on death, Callahan
and Nuland say, medicine should aim to bring everyone's life expectancy up to
age 80. Perhaps most radical of all: they say the health system should give
first priority to children, second priority to those in their adult ears, and
lowest priority to those over 80. (Callahan and Nuland, it should be noted, are
both 80.)

Contemplating this kind of medical
system is mind-boggling--not to mention trying to fashion such a system out of
the current one. But is there any doubt that such a system would be more humane
and sustainable than what we have now?