Of Death and Politics
KRISTOL, IRVING
THINKING ALOUD Of Death and Politics By Irving Kristof THIRTY-TWO REGIONAL medical centers-in effect research and training institutes affiliated with medical schools-that would familiarize...
...These institutions would aim to achieve a general decrease in the death rate from cancer, heart disease, and stroke...
...The most brilliant and extraordinary efforts now result in the most grudging gains...
...and stroke, and would also be testing-grounds for new drugs and surgical procedures: This is what President Johnson has just recommended to Congress...
...But, oh, what a mountain of nauseating demagogy gave birth to this comely, little mouse...
...Perhaps he thought this would detract from the credibility of his performance...
...To reform this state of affairs, the President said at that time that he would request an initial appropriation of $150 million for the establishment of regional medical centers and community medical stations...
...What President Johnson and his Commission also avoided mentioning is the relevant fact that despite the great advances of medicine in recent years, the average adult life-span has increased scarcely at all: If fewer people die of pneumonia, they die of cancer, or some-thing else...
...An excellent, detailed report on such a typical "medical miracle" can be found in the December 22 Wall Street Journal...
...THE FALSEHOOD derived from a calculated ambiguity...
...However, the thrust of his remarks, upon accepting the report, not unexpectedly put the accent on t~e positive...
...or perhaps he is merely keeping it in reserve for 1968...
...What is left is 32 regional research institutes, which will presumably treat a few thousand cases, chosen from among the very rich and the very poor, as before...
...Isn't it a good idea to have these 32 institutes...
...The life-span of the average American is already stretched quite taut, and seems to be pressing against some kind of biological limit...
...THINKING ALOUD Of Death and Politics By Irving Kristof THIRTY-TWO REGIONAL medical centers-in effect research and training institutes affiliated with medical schools-that would familiarize doctors with the latest developments in the study of cancer, heart disease...
...And any researcher in these fields would be quick to say candidly that no one knows whether or not we can foresee a "historic breakthrough" in the prevention or cure of all of these illnesses...
...and it would seem that this technique leads to a more accurate diagnosis of heart conditions...
...No mention is made of them in the President's message to Congress...
...This principle of selection is arbitrary and irrational...
...But to contemplate any such thing is not only unwise...
...The privileged few, in such an event, are the very rich who can pay for it and the very poor who are chosen by the clinics as suitable "experimental" cases...
...Indeed, the linkage of cancer, heart disease, and stroke is utterly arbitrary, and arises only from the fact that they are among the top four on death's hit parade...
...It was last April 17 that the President appointed a Commission on Heart Disease, Cancer, and Stroke, to the accompaniment of some preelection pyrotechnics...
...And, it might be added, a decent respect for the integrity of science...
...From having said correctly that two-thirds of the American people died from these maladies, he now came perilously close to declaring what he had previously only hinted at ("unless we do better"): that two-thirds of the American people died unnecessarily from them...
...It might actually hinder medical research by allocating existing resources and shaping medical education prematurely...
...This promise was an unscrupulous and heartless deception...
...Yes, it is a very good idea...
...We stand at the threshold of a historic breakthrough," he declared dramatically, and promised that heart disease, cancer, and stroke "can be conquered not in a millennium, not in a century, but in the next few on rushing decades...
...It presumably had meetings, somewhere and sometime...
...The American press instantly, massively, and approvingly communicated this piece of "hard news" to its dying public...
...Those of us who have experience of such tragic situations know how impossible it is to answer the question for oneself...
...More typical, and more important, is the "medical miracle" that may increase diagnostic certitude, or temporarily prolong life, or effect a partial cure-but at such great expense and bother that it cannot, in its existing form, be made available to any but the privileged few...
...That would be a Great Society indeed...
...To apply this single technique to the more than three million Americans with heart disease (and ignoring the two million or so with "suspicious symptoms") would cost half a billion dollars-and this does not count the cost of equipment, which would run to tens of millions of dollars more...
...And if people cease to die of cancer, one can expect them to die of arteriosclerosis, or whatever...
...but it is not possible, given the circumstances, to imagine one that would not be...
...The Journal, it might surprise some to learn, has the best reports on medical technology of any paper in the country-possibly because so many of its readers own drug stocks...
...A technique called "selective sine coronary arteriography" has been perfected at the Cleveland Clinic...
...Not so very long ago, for a public figure to go around promising "medical miracles" would have been thought to be not quite proper...
...But is it not also a good idea that there should be a decent respect on the part of the U.S...
...it is positively absurd...
...Research into their respective causes and possible cures is at wildly varying levels, and the results of this research are still either pitifully meager or baffling in their multiplicity...
...In the case of cancer, perhaps...
...3 in the causes of American death: accidents...
...But a "medical miracle" is not a medical cure...
...government and the American press for the intelligence of the American people...
...But even this facile and bland exaggeration of the promise of modern medicine was not the worst of it...
...For the Commission had reported that "medical miracles are in many instances available only to the few who can get to the unique medical institution or specialist who can perform that miracle," and that "these benefits should and must be made available to all the people when and where they need them...
...Unless we do better," the President said gravely and truly at that time, "two-thirds of all Americans now living will suffer or die from cancer, heart disease, or stroke...
...The $150 million had become $125 million-over a two-year period...
...The absence of critical and dissenting voices, on this occasion, cannot be regarded as a very healthy symptom...
...Many such "medical miracles" are discovered (or invented) every year...
...They would also aim to achieve a more perfect, democratic distribution of death...
...There isn't a fraction of the doctors, nurses, technicians, laboratory equipment, and hospital space available that would be required...
...But they are certainly capable of being misled into believing what the Commission's report states as a fact: that there exist "medical miracles" now available only to the rich, that will henceforth be available to all...
...Yes, scarcely a month-scarcely even a week-passes without a "medical miracle" being achieved in our laboratories and hospitals...
...At one of its extremes, a "medical miracle" might simply mean keeping people from dying a relatively quick death in order to die a slower, more agonizing and more expensive death...
...Most of them are impermanent contributions-that is to say, one "medical miracle" replaces an earlier one...
...And in due course someone wrote a report for it, which was duly presented to the President in front of TV cameras and the working press...
...it involves taking X-ray movies of the coronary arteries...
...For the government to con-template immediately establishing each of them on a nation-wide basis would be unwise...
...The American people, after all, are neither so credulous nor so superstitious as to believe that immortality can be acquired for them by Presidential fiat...
...A perfectly sensible, even modest proposal, which will surely be enacted into law with little or no fuss...
...Here, there is a gain in scientific knowledge-but whether there is a gain in human betterment is a question that no government can presume to answer for us...
...A close observer might have noticed that the President, by this time, was proceeding with some caution...
...It is interesting to note that the President did not suggest a Federal program against No...
...in the case of stroke, there are very few signs of progress...
...For one thing, he kept the surgeons, the public-spirited citizens, the cameras, and the reporters cooling their heels for an hour-and-a-half beyond the appointed moment, during which time he was in conference with Senator Eastland over the body politic rather than the body physic...
...We can, if we wish, make "medical miracles" available to all the people-but only by transforming ourselves into something suspiciously resembling a nation of hypochondriacs...
...It is a complicated procedure, calling for the insertion of catheters, filled with a photographic fluid, into the coronary arteries, and some doctors (and patients, too) are not sure it is worth the trouble...
...Once the smoke had cleared, those community medical stations, with their assortment of "medical miracles," simply vanished...
...So a commission of 18 physicians and 10 "public spirited citizens" was duly appointed, under the chairmanship of a famous surgeon-from Houston, naturally...
...For another, he clearly indicated that he had no intention of carrying on his campaign single-handedly: "We are going to ask Congress and the country to lend a hand in the fight against these ancient enemies of mankind," the New York Times quoted him as saying...
...This arithmetic, in any case, is an exercise with imaginary numbers-there aren't nearly enough surgeons and clinicians to use this technique extensively...
...Now, President Johnson was not then, nor is he now, privy to any confidential or restricted information about the state of research into cancer, heart disease, or stroke...
...Even in the case of cancer itself, the greater incidence of cures for certain kinds of cancer has been accompanied by an increase in the death rate from other kinds, so that the overall death rate from cancer has not diminished...
...It is also fabulously expensive, since it demands what is in effect a not-so-minor operation using brand-new equipment...
Vol. 48 • January 1965 • No. 2
