Reflections
BUELL, JOHN
REFLECTIONS John Buell The Perils of Medical Miracles Few dared criticize the U.S. space program when Neil Armstrong took his giant leap to the moon in 1969. Only a handful of skeptics questioned...
...a baboon heart was placed inside a newborn girl...
...False positives bring follow-up procedures and, in some instances, life-threatening surgery...
...It used to be about 2-to-l...
...This is not to suggest that sick persons should be refused the benefits of scientific wizardry...
...Repairs of fractures, much emergency-room care, some immunization programs, public-health sanitation measures, and simple forms of surgery can be performed with great prospect of success, minimal reliance on technology, and respect for the patient...
...Seen in a broader light, this problem becomes one of allocating scarce treatments...
...an even smaller group of disbelievers suggested that NASA might eventually be enlisted into military service...
...And although more than 200,000 heart bypass operations are performed each year, studies show that surgery does not increase the probability of survival for the victims of many kinds of arterial blockage...
...Furthermore, twenty states allow "living wills," by which patients can specify, in advance of an emergency, when efforts to sustain their bodily functions should cease...
...The individual's autonomy seems to be an afterthought...
...The life expectancy of physicians themselves, significantly shorter than the life expectancy of the rest of the population, symbolizes the double-edged nature of our search for miracle cures...
...Healing is a process of helping people lead a full existence by giving them a measure of control over their bodies...
...Rubber hearts have been installed in two men...
...It's progress," chimed enthusiasts...
...However, political intervention in life and death issues is not just a problem for the future...
...Cost-containment strategies of the sort that have received much attention lately are not the answer...
...they may influence the specific allocation of hi-tech medicine, but they will in no way reverse the basic direction our health establishment has chosen to take...
...Now the news magazines and television specials trumpet another frontier—not in the heavens but in the human body...
...Unfortunately, the intensity of modern medicine has taken us far beyond this point...
...The importance of the community hospital is therefore diminished, while the general practitioner—known today by a specialty name, "family practice physician"—is displaced...
...But as Dr...
...Even where the efficacy of a particular drug or surgical procedure has been established, modern medicine pays all too little attention to the illness engendered by the health-care system itself...
...asks Leonard H. Blantz of Boston University's School of Public Health and Medicine...
...CAT scans, heart-lung machines, and cardiac and surgical intensive-care units can push the ratio of support personnel to doctors as high as 15-to-l...
...Rather, we must begin to acknowledge the ethical and political implications of a health care system characterized by increasing reliance on high technology...
...The colorful spectacle of lunar modules and splash landings overwhelmed such concerns...
...Their challenge to death may, paradoxically, lessen the value of life...
...This, in turn, leads more of us to spend more of our time as patients...
...Not everyone who can use a new heart will get one...
...At best, hi-tech medicine provides us with a reduced incidence of disease, and it does so at enormous cost...
...Patients are routinely removed from their neighborhoods and transported to urban medical centers that deal with them as possessors of specific organs or diseases...
...A routine heart transJohn Buell is an associate editor of The Progressive...
...Because of the shortage of organs available for transfer, some physicians are already urging state governments to issue more precise definitions of death, so that organs of brain-dead persons can be transplanted...
...The natural order is denied, as if death itself were a failure of medical practice...
...Once the large institutions and their employees have made an economic and personal investment in equipment and skill, they seek every opportunity to use their tools...
...There is, of course, no danger of weapons being implanted in the next William Schroeder or Baby Fae...
...It alienates the patient from the health-care providers and severs communal and family supports that have traditionally encouraged well-being...
...The wider distribution of medical miracles holds less promise of a healthy nation than does an effort to control the economic, environmental, and cultural factors that bring on sickness in the first place...
...Health care must begin with the recognition that there is a human condition, and that attempts to deny its reality can only diminish our dignity and autonomy...
...For example, tests to screen for cervical, breast, and colo-rectal cancer can detect the disease at early, treatable stages...
...plant, for example, costs more than $100,000, and fewer than 650 Americans have had the operation...
...As care becomes increasingly specialized, physicians and their assistants are inclined to view patients not as whole persons but as machines with components that stand in need of repair or replacement...
...A humane and efficient medical system must, of couse, be based on democratic principles of local control and popular input...
...The medical "miracles" entail a much more subtle risk: By fostering the notion that humans can overcome the limits of nature—by applying this central assumption of industrial society to ourselves—they threaten to dehumanize us...
...medical advances, looking for the proper party—government, insurance company, or patient—to bill...
...But modern medicine has come to define its mission more narrowly: prolonging life and keeping various tissues disease-free...
...It is "progress" we can ill afford, m...
...The result is a health-care system that grows largely by its own momentum...
...The current course of modern medicine may buy a longer biological existence for a few—but at an intolerable price for all...
...Some doctors believe that as many as nine out of ten biopsies performed because of a positive mammogram turn out to be unnecessary...
...Medical miracles necessarily involve scores of technicians...
...Today, peace-loving Americans are trying to brake the momentum of an arms race in space...
...The noblest intentions cannot relieve a healthcare provider from the pressure of keeping up with the competition...
...We must place our first reliance on the body's own capacity for recovery, encouraging individuals and society to fashion an economic and social environment conducive to good health...
...We need not embrace medical nihilism to acknowledge that technology has its limits and that nature has its calling...
...Eugene Robin points out in Matters of Life and Death, these procedures also generate significant numbers of "false positives"— cases in which the test showed the presence of a cancer that was not there...
...Such developments reflect a greater complication: Hi-tech solutions remove health care from our hands...
...But it becomes more difficult to meet these conditions as health institutions and their technologies increase the distance separating health providers from their communities...
...Though transplants are currently restricted to patients suffering terminal heart disease, procedural advances can be expected to increase the number of potential candidates to include individuals with milder forms of heart damage...
...And the growth of complex urban hospitals managed by intricate bureaucratic structures contributes to an environment that fosters such chronic degenerative conditions as hypertension...
...Once again, the awe-inspired news coverage leaves little room for doubters...
...So far, those who take a long view have concerned themselves with the costs of...
...Only a handful of skeptics questioned the diversion of national resources from earthly problems...
...Only cities can support the huge capital investment of sophisticated machinery...
...Did you ever notice when you give a two-year-old a hammer, suddenly everything within reach needs hammering...
...The expansion of the system has brought improved health in some ways, but it has produced hazards as well...
...Modern medicine is continually learning how to discover and treat an ever-increasing number of disorders...
...Now we've given our doctors all this marvelous medical technology and suddenly every machine has to be used in every case...
...Such an environment may actually delay recovery, since it tends to defeat the patient's senses of self and self-reliance...
Vol. 49 • March 1985 • No. 3
