BOOK REVIEW : The Myths of Modern Medicine
What Kind of Life: The Limits of Medical Progress by Daniel Callahan (Simon and Schuster: $19.95; 303 pages)
Everyone knows he’s going to die, but most people don’t believe it. Both points are sad but true.
On top of that, the marvelous successes of medical science in this century have fostered the notion that immortality is achievable if not quite within our grasp. We believe there is no limit to progress. Antibiotics and organ transplants are just the beginning. Heart disease, cancer, stroke, Alzheimer’s--all can be overcome if only we will spend enough and think hard enough about doing it.
This belief is basically wrong, says Daniel Callahan, one of the country’s foremost experts on medical ethics and the director of the Hastings Center, just north of New York, the think tank that inquires into such issues.
In “What Kind of Life,” a sober, bracing and important look at the realities of medicine and its costs, Callahan argues that the ideal of unending medical treatment and limitless medical progress is both unaffordable and unattainable. The quest for immortality is misdirected, unachievable and doomed to expensive failure. What’s more, he says, it diverts our energy and resources from more appropriate social goals.
“No matter how far we push the frontiers of medical progress we are always left with a ragged edge,” Callahan writes, “with poor outcomes, with cases as bad as those we have succeeded in curing, with the inexorable decline of the body however much we seem to have arrested the process.”
Asking medicine to save us from death, he says, is “a recipe for endlessly increased expenditures and perpetually needy, dissatisfied people.” Callahan rightly attributes the out-of-control cost of medical care to our insistence on all things for all patients. No procedure is to be spared, no high-tech treatment avoided, no stone left unturned in the battle against disease and deterioration.
The result, he says, is that “people are saved from one disease only to be put in a position to incur the costs of another disease and in general to be led by the power of high technology to ever higher levels of desire and aspiration, to want cures for each succeeding illness.”
We should be more concerned with care, not cure, Callahan argues. There is a limit to what medicine can do, and beyond that point we are simply using more and more technology to preserve less and less of the quality of life.
The law of diminishing returns has set in with a vengeance, he says. In an era of limited resources, the blank check we have written to medicine has distorted our spending priorities.
We “spend too much on health in comparison with other social needs, too much on the old in comparison with the young, too much on the acutely ill in comparison with the chronically ill, too much on curing in comparison with caring, too much on expensive individual health needs in comparison with less expensive social health needs, and too much on extending the length of life rather than enhancing the quality of life,” Callahan concludes.
This is all well and good as social analysis, but try telling it to an acutely ill person in a hospital, or to his family.
Most people would probably agree that we are spending too much on medicine but only if you’re talking about medical care for other people, not for me.
On average, fully half of a person’s lifetime medical expenses occur during the last six months of life, but you can never be sure beforehand when those last six months begin. We all know of people who made remarkable recoveries from life-threatening illnesses and went on to enjoy many more years of high-quality life.
Callahan’s solution is to alter somehow our basic thinking about life and death and to impose limits on medical treatment--by political force, if necessary.
Fat chance. This is the weak part of the book. Hasn’t he noticed that it is politically impossible to get anybody to give up anything? That’s why the federal deficit cannot be controlled. That’s why the only stumble that Ronald Reagan made in the first term of his presidency was the suggestion that Social Security benefits might be reduced. And that was talk about reducing money. Callahan wants to put limits on something much more fundamental.
The argument he makes is undeniably true, and perhaps people will one day come face to face with the fact that we simply cannot afford all the medicine that we demand. But it is unlikely that we will be satisfied with less or that we will have the political will to impose it.
Like many people in many fields, Callahan is an expert on the problem, not on the solution.
