Tuesday, November 22, 2005

The great "medicine keeps people sick" myth

Callahan calls for rationing of medical care again....(he has a whole book about who should die if they don't meet his criteria for "quality of life)...

As baby boomers age, you will hear this more and more, and I suspect "post Christian" Europe, who have contracepted/aborted themselves into negative population growth, will increase their euthanization of the old and sick, at least until Sharia law takes over...

But the argument is based on a false premise that we hear over and over again:

The momentous gain in life expectancy—which began long before modern clinical medicine became efficacious but accelerated thereafter—was accompanied by changed patterns and trajectories of death. Death from most infectious diseases (such as dysentery, typhoid, plague, and smallpox) was often miserable but relatively fast, lasting from a few days to a few weeks; and, if one survived, there was rarely any lingering damage. Contemporary death, increasingly in old age, is for the most part slow and drawn out, lasting many weeks, months, and often years.

Reality check please...

Two major problems.

The first is the "bell curve"...
In Africa, people were "old" at fifty...
Read history...Washington died of "old age" at age 70 or so...my grandmother was bedridden for years from high blood pressure and varicose vein ulcers, and died of "old age" at 66...
My mother drove a car until she was 87.

Old age isn't what it used to be...people age slower.
The REAL problem is that the "bell curve" moved right...so the "old age" is now 85, not 65.

Percentagewize, there are probably just as many 85 year olds now as 65 year olds a hundred years ago...what has changed is that there are not as many 5 year olds, or 25 year olds to care for them....

Second problem:
Death from infectious disease was not necessarily "fast"...
Typhoid? You were high fevers for 4-6 weeks and might spend 6 months recovering until you were strong...
Ditto for other diseases (typhus...strep throat aka Scarlet fever, Rheumatic fever...)
How about Tuberculosis? HOw many languished with that for years, unable to work, but not dying either?
And what about TB of the bone? Talk about pain and disability?
And Remember Polio?
How about Neurosyphillis? Untreated schizophrenia?
Rheumatic heart disease and "dropsy"?

But you don't even need infectious disease to cause chronic disability.

How about clubfoot...or a poorly healed fracture...or chronic osteomyelitis from a cut...all those wounded soldiers? Farmers? women with fistulas from prolonged labor? Scoliosis? Severe osteoporotic fractures due to excess childbearing? Ricketts?

The woman "with a hemorrhage" in the Bible...and many other women suffering from obstetrical or gynecological illnesses....

Chronic diarrhea (The Black prince and General Braddock suffered for months before dying of this)....

And furthur back in history: Leprosy....BeriBeri dementia...Scurvy...

Trachoma causing blindness....

Calahan forgets that the complaint about the chronically ill being a burden is not new...

Plato's Republic laments doctors who prolong the lives of the "sick" but who don't cure them...

And of course, that was the argument that inspired the Nazi T4 project....