Saturday, September 25, 2010

Lewis Thomas talks about Health Care circa 1976

The Health-Care System

The health-care system of this country is a staggering enterprise, in any sense of the adjective. Whatever the failures of distribution and lack of coordination, it is the gigantic scale and scope of the total collective effort that first catches the breath, and its cost. The dollar figures are almost beyond grasping. They vary from year to year, always upward, ranging from something like $10 billion in 1950 to an estimated $140 billion in 1978, with much more to come in the years just ahead, whenever a national health-insurance program is installed. The official guess is that we are now investing a round 8 percent of the GNP in health; it could soon rise to 10 or 12 percent.
Those are the official numbers, and only for the dollars that flow in an authorized way--for hospital charges, physician's fees, prescribed drugs, insurance premiums, the construction of facilities, research, and the like.
But these dollars are only part of it. Why limit the estimates to the strictly professional costs? There is another huge marketplace, in which vast sums are exchanged for items designed for the improvement of Health.
The television and radio industry, no small part of the national economy, feeds on Health, or, more precisely, on disease, for a large part of its sustenance. Not just the primarily medical dramas and the illness or surgical episodes threaded through many of the nonmedical stories, in which the central human dilemma is illness; almost all the commercial announcements, in an average evening, are pitches for items to restore failed health: things for stomach gas, constipation, headaches, nervousness, sleeplessness or sleepiness, arthritis, anemia, disquiet, and the despair of malodorousness, sweat, yellowed teeth, dandruff, furuncles, piles. The food industry plays the role of surrogate physician, advertising breakfast cereals as though they were tonics, vitamins, resoratives; they are now out-hawked by the specialized Health-food industry itself, with its nonpolluted, organic, "naturally" vitalizing products. Chewing gum is sold as a tooth cleanser. Vitamins have taken the place of prayer.
The publishing industry, hardcover, paperbacks, magazines, and all, seems to be kept alive by Health, new techniques for achieving mental health, cures for arthritis, and diets mostly for the improvement of everything.
The transformation of our environment has itself become an immense industry, costing rather more than the moon, in aid of Health. Pollution is supposed to be primarily a medical problem; when the television weatherman tells whether New York's air is "acceptable" or not that day, he is talking about human lungs, he believes. Pollutants which may be impairing photosynthesis by algae in the world's oceans, or destroying all the life in topsoil, or killing all the birds are being worried about lest they cause cancer in us, for heaven's sake.
Tennis has become more than the national sport; it is a rigorous discipline, a form of collective physiotherapy. Jogging is done by swarms of people, out onto the streets each day in underpants, moving in a stolid sort of rapid trudge, hoping by this to stay alive. Bicycles are cures. Meditation may be good for the soul but is even better for the blood pressure.
As a people, we have become obsessed with Health.
There is something fundamentally, radically unhealthy about all this. We do not seem to be seeking more exuberance in living as much as staving off failure, putting off dying. We have lost all confidence in the human body.
The new consensus is that we are badly designed, intrinsically fallible, vulnerable to a host of hostile influences inside and around us, and only precariously alive. We live in danger of falling apart any moment, and are therefore always in need of surveillance and propping up. Without the professional attention of a health-care system, we would fall in our tracks.
This is a new way of looking at things, and perhaps it can only be accounted for as a manifestation of spontaneous, undirected, societal propaganda. We keep telling each other this sort of thing, and back it comes on television or in the weekly newsmagazines, confirming all the fears, instructing us, as in the usual final paragraph of the personal-advice columns in the daily paper, to "seek professional help." Get a checkup. Go on a diet. Meditate. Jog. Have some surgery. Take two tablets, with water. Spring water. If pain persists, if anomie persists, if boredom persists, see your doctor.
It is extraordinary that we have just now become convinced of our bad health, our constant jeopardy of disease and death, at the very time when the facts should be telling us the opposite. In a more rational world, you'd think we would be staging bicentennial ceremonies for the celebration of our general good shape. In the year 1976, out of a population of around 220 million, only 1.9 million died, or just under 1 percent, not at all a discouraging record once you accept the fact of mortality itself. The life expectancy for the whole population rose to seventy-two years, the longest stretch ever achieved in this country. Despite the persisting roster of still-unsolved major diseases--cancer, heart disease, stroke, arthritis, and the rest--most of us have a clear, unimpeded run at a longer and healthier lifetime than could have been foreseen by any earlier generation. The illnesses that plague us the most, when you count up the numbers in the U.S. Vital Statistics reports, are respiratory and gastrointestinal infections, which are, by and large, transient, reversible affairs needing not much more than Grandmother's advice for getting through safely. Thanks in great part to the improved sanitary engineering, nutrition, and housing of the past century, and in real but less part to contemporary immunization and antibiotics, we are free of the great infectious diseases, especially tuberculosis and lobar pneumonia, which used to cut us down long before our time. We are even beginning to make progress in our understanding of the mechanisms underlying the chronic illnesses still with us, and sooner or later, depending on the quality and energy of biomedical research, we will learn to cope effectively with most of these, maybe all. We will still age away and die, but the aging, and even the dying, can become a healthy process. On balance, we ought to be more pleased with ourselves than we are, and more optimistic for the future.
The trouble is, we are being taken by the propaganda, and it is bad not only for the spirit of society; it will make any health-care system, no matter how large and efficient, unworkable. If people are educated to believe that they are fundamentally fragile, always on the verge of mortal disease, perpetually in need of support by lealth-professionals at every side, always dependent on an imagined discipline of "preventive" medicine, there can be no limit to the numbers of doctors' offices, clinics, and hospitals required to meet the demand. In the end, we would all become doctors, spending our days screening each other for disease.
We are, in real life, a reasonably healthy people. Far from being ineptly put together, we are amazingly tough, durable organisms, full of health, ready for most contingencies. The new danger to our well-being, if we continue to listen to all the talk, is in becoming a nation of healthy hypochondriacs, living gingerly, worrying ourselves half to death.
And we do not have time for this sort of thing anymore, nor can we afford such a distraction from our other, considerably more urgent problems. Indeed, we should be worrying that our preoccupation with personal health may be a symptom of copping out, an excuse for running upstairs to recline on a couch, sniffing the air for contaminants, spraying the room with deodorants, while just outside, the whole of society is coming undone.

Lewis Thomas, A Long Line of Cells, 1990

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