March 31, 2004
BREAKING THE CIRCLE OF LIFE:
The Limits of Medicine (Philip Longman, Washington Post, 31/03/04)
Faith in medicine runs deep in America. We spend more per person on health care than any other nation. Most of us are confident that we will live longer, more active lives than our parents. Whether we eat too much or exercise too little, whether we're turning gray or feeling blue, we increasingly look to some pill or procedure to make us better. No one likes to hear official projections such as those that came out last week about Medicare, which show that the program will be running multitrillion-dollar annual deficits just when baby boomers need it. But a common response is: What's a more important priority for society's resources?Good question, assuming that devoting ever more dollars to medicine will bring us longer, healthier lives. But there is mounting evidence that each new dollar we devote to the current health care system brings small and diminishing returns to public health. Today the United States spends more than $4,500 per person per year on health care. Costa Rica spends less than $300, and has half as many doctors per capita. Yet life expectancy at birth is nearly identical in both countries.
Despite the ballyhooed "longevity revolution," life expectancy among the elderly in the United States is hardly improving. Since 1990 Medicare expenditures per senior have more than doubled. Yet life expectancy among American women at age 65 was lower in 2003 than it was in 1991, according to estimates released by the Social Security Administration last week. Yes, we are an aging society, but primarily because of falling birthrates.
Younger Americans, meanwhile, are far more likely to be disabled than they were 20 years ago. Most affected are people in their thirties, whose disability rates increased by nearly 130 percent, due primarily to obesity. Americans of all ages are also increasingly likely to die from a host of infectious diseases and chronic conditions. Between 1980 and 2000, the age-adjusted death rate from diabetes increased by 39 percent, chronic lung disease by 49 percent, and kidney disease by 21 percent.
Why has our huge investment in health care left us so unhealthy? Partly it is because so many promised "miracle cures," from Interferon to gene therapies, have proven to be ineffective or even dangerous. Partly it's because health care dollars are so concentrated on the terminally ill and the very old that even when medical interventions "work," the gains to average life expectancy are small. And partly it is because of medical errors and adverse reaction to prescription drugs, which cause more deaths than motor vehicle accidents, breast cancer or AIDS. Each year roughly 200,000 seniors suffer fatal or life-threatening "adverse drug events" due to improper drug use or drug interaction. Will Medicare's new prescription drug benefit save more lives than it ends? The answer is not obvious.
There are some simple ways to improve the effectiveness of medicine. Each year 90,000 patients in the United States die from infections they contract in hospitals, and doctors and nurses who fail to wash their hands are the biggest vector. To cut down on medical errors, many hospitals are adopting sophisticated quality control measures similar to those used by manufacturers to reduce "defect rates." Today only 1 cent out of every dollar spent on the National Institutes of Health goes to establishing "best practices" in medicine. Redirecting more funds from basic research to studying the effectiveness of different treatments would go a long way toward preventing such lethal medical fads as high-dose chemotherapy and bone marrow transplants.
It is all well and good to encourage people to have more children to support the aged, but given the modern frantic determination to live as long as possible at whatever cost, what kind of slavery will they be born into?
The great truth is death in inevitable to every one of us. We can tinker with the causes but ultimately cannot change the outcome. So much of this discussion has become political to those agencies who depend on tax revenue. In point of fact, as we work to eliminate the causes, we make the remaining factors even larger in magnitude as the residual always equals 100%. Eliminate obesity and cure diabetes, then what?
Old age is a terminal disease. Good health is just the slowest way of dying.
Posted by: john at March 31, 2004 8:51 AMYounger Americans, meanwhile, are far more likely to be disabled than they were 20 years ago.
Might that be because people with disabilities or severe injuries were more likely to die younger 20 years ago than they are today?
Posted by: Mike Morley at March 31, 2004 9:16 AMSafire quoted E.B. White today: the most beautiful sound is "the tinkling of ice at twilight." Relax gentlemen it's a one time, one way trip.
As when sailing, riding or skiing: it's not the destination that matters; it's the experience.
Posted by: genecis at March 31, 2004 9:46 AMI once had a coworker, a lawyer/biochemist/classically trained concert pianist, who was convinced that death could be cured, and that until it was all of our lives were futile and meaningless. He was great fun at parties.
Posted by: David Cohen at March 31, 2004 10:08 AMDavid: Ever notice that a disproportionate number of people like that go to law school? I never thought anyone would describe me as "cheery" until I met other lawyers.
Posted by: Chris at March 31, 2004 12:29 PMChris -- I know exactly what you're talking about. There is a certain type of overly earnest personality that ends up in law school and spends the next three years failing to communicate, at tedious length, with the careerists. That's why I always found the Left's Hilary love so amusing. I recognized her immediately.
However, I wasn't being sarcastic up above. This guy was great fun at parties. He was a Beethoven aficionado and could sit down cold at a piano and knock out almost any random movement. He was not a great interpreter, which is why he hadn't pursued a concert career, but he was technically fabulous.
I'll never forget sitting around in a mutual friends apartment drinking beer and listening to the Ninth Symphony. My coworker would be able to explain small little details that I had never noticed and was moved to tears at the end. He would then explain, perfectly sincerely, that Beethoven's life had been wasted because he had died.
Posted by: David Cohen at March 31, 2004 1:30 PMMaybe all those extra health care dollars just work to offset the effect of our (overall) poor eating and exercise habits.
Posted by: Rick T. at March 31, 2004 1:56 PMthe author hit the nail on the head with his implication that our society merely relies on some miracle pill or treatment to help us live longer. i hate seeing fat parents bringing in their fat kids with complaints of dyspnea and HTN, simply because i know these 'patients' will only get worse as they continue to rely on drug treatments as opposed to eating less and working out more.
america is world's laziest country, by far. and guess what, it's usually medicaid and non-insurance patients that are the worse off, constantly complaining about the health care they 'deserve'. if we could go back to payment-for-service (which every other fukking field in this country gets), people might learn to take better care of themselves.
our huge investment in health care has left us so unhealthy because of a feeling of entitlement, whereby anyone can indulge themselves in whatever they want (drugs, drinking, cigs, food, lack of activity, etc) and still ask for a doctor to write a script without a hint of modifying behavior. i weep for those in the future who won't have the money to pay for their own healthcare because it's quite obvious that our current healthcare system is going to crash and doctors aren't going to work for peanuts.
Posted by: a at March 31, 2004 3:36 PMthe author hit the nail on the head with his implication that our society merely relies on some miracle pill or treatment to help us live longer. i hate seeing fat parents bringing in their fat kids with complaints of dyspnea and HTN, simply because i know these 'patients' will only get worse as they continue to rely on drug treatments as opposed to eating less and working out more.
america is world's laziest country, by far. and guess what, it's usually medicaid and non-insurance patients that are the worse off, constantly complaining about the health care they 'deserve'. if we could go back to payment-for-service (which every other fukking field in this country gets), people might learn to take better care of themselves.
our huge investment in health care has left us so unhealthy because of a feeling of entitlement, whereby anyone can indulge themselves in whatever they want (drugs, drinking, cigs, food, lack of activity, etc) and still ask for a doctor to write a script without a hint of modifying behavior. i weep for those in the future who won't have the money to pay for their own healthcare because it's quite obvious that our current healthcare system is going to crash and doctors aren't going to work for peanuts.
Posted by: a at March 31, 2004 3:37 PMBeware bogus statistics.
Compare the highway death rate of twenty years ago with todays.
If that rate goes down, which it did, than other rates will go up, not because they became more frequent, but because another cause of death became less frequent.
Posted by: Jeff Guinn at March 31, 2004 5:29 PM