I’M NOT HIP

Does Health Depend on Medical Care?

 

           

 

                        When New Jersey’s HIP HMO announced its closing, a reporter asked a plan member’s reaction. The member said, “It’s terrible.  I have to change pediatricians and my pediatrician is like my right arm.”

           

                        Life presents some difficult choices. Choosing between my right arm or my child’s pediatrician is not among them.              

 

                        Medical care has become the central political issue.  Politicians are earnestly focus-grouping and polling to see what the public wants.  The apparent consensus is that people should go to whatever doctor they want, as often as they want, for whatever condition they want.  And they shouldn’t have to pay a lot for these options.               

                        There are several perspectives from which to consider American medical care.  One could discuss the unequal access to the system.   One could compare the American medical care system to that in Canada, Sweden or the United Kingdom.  Or one could lash out against HMOs as the clearest manifestation of evil since Stalin. No, make that Satan.  But that’s all been done before.   Repeatedly.

           

                        Instead, I wish to evaluate, using basic data and my own observations, whether medical care is as important in preserving and enriching the quality of life as many believe.    In so doing, I recently re-read a book I read years ago, Medical Nemesis by the deservedly world-renowned sociologist, Ivan Illich (1976).  Its central themes still seem valid.   (After writing this article, I sent it to Ivan, who amiably endorsed it for the new millennium).

           

                        Illich first contended that, although it is heretical to say so, modern medicine does not heal people nearly as well as most believe.  For example, decreases in mortality from such diseases as tuberculosis and diphtheria occurred long before the development of either diagnostic tests or drugs.  Rather, these, and other, diseases became less of a threat as people ate more and lived and worked in better conditions.    

           

                        The statistical increase in life spans since the turn of the century has been driven far more by diminution in infant mortality rates than by medical interventions later in life.  In a tragically common scenario, my great-grandmother came to this country around the turn of the century, had little money and bore something like ten kids.   Half died at birth or in infancy.  After people had more food and better living conditions, they became stronger and their kids made it through those first few rough years.   Life expectancy at birth skyrocketed.

           

                        Corroborating Illich, I have read in several places, including Jimmy Carter’s recent book on aging, that, although Americans have access to far more medical care, life spans over sixty have changed very little in this century. Bill Horgan,  author of The End of Science, contends that even the modest increases in life spans that are frequently reported are inaccurate.  He says that life spans have not increased since 1971 and that we can’t be too sure of life spans before then because records were sketchy.  Any marginal gains in overall life expectancy have occurred in a social context where jobs have become less hazardous (compare carpal tunnel to black lung) and fewer people drink excessively or smoke.  Some extremists even eat tofu and sprouts.  

             

                        In this vein, Illich considered cancer survival rates.  He speculated that spokesmen for the “War on Cancer” may be doing what American officials did during much of the Vietnam War, distorting data to encourage the lucrative continuation of a futile effort.  Because it is impossible to conduct my own large scale study, I draw on what I have seen.  I know about a dozen  people diagnosed with cancer in the past few years.  Despite extensive treatment, nearly all have died without improving.  Most opined that the treatments made them worse.     

           

                        It seems that, even without medical care, if you have 2,500 calories and 40 grams of protein per day, clean water, a warm place to sleep, protection from violence and a reason to live, you may spend your seventies doing the fox trot in a magazine ad.  If you lack these or abuse your body, you should listen carefully the next time Ed McMahon hawks that life insurance policy, even if your doctor is Marcus Welby.     

 

                        And even if you believe that life spans are increasing and medicine deserves the credit, is medicine enhancing the quality of life?  My eyes tell me that for every eighty five year old you see skydiving on TV, many more shared semi-conscious stays in nursing homes with my grandmothers.  Perhaps many of these folks owe their extended survival, as did my grandmothers, to antibiotics that thwarted pneumonia.

                        Illich contends that, by buying into the notion that doctors keep them healthy, Americans have developed  a dysfunctional reliance on doctors that causes people to disregard measures they could take themselves to promote their own health or the health of those around them.  Instead of quitting smoking and drinking, we use surgery and chemotherapy.  Instead of changing the way we eat,  how fast and far we drive or finding a purpose in life, we use diet pills, traction, tranquilizers and anti-depressants.  Instead of breast-feeding and otherwise nourishing our children to strengthen their immune systems, we demand antibiotics when they get colds.   Instead of having kids in our twenties or early thirties, we wait and consult fertility specialists.  We demand AIDS cocktails and abortions as “cures” for promiscuity and drug abuse.

              

                        Illich also observed that many medical treatments are iatrogenic, i.e., they actually worsen people’s health.  Certainly, many prescription drugs, from antibiotics to digestive aids to blood pressure pills to hormone replacements to sexual function boosters, have deleterious side effects.  And, as Illich noted, people’s health often worsens from hospital visits or surgery.   I could share many accounts of people I know who obtained bad results from medical treatments. But you probably have your own stories.  Or you hear them on elevators.

             

                        The body is wise.  It knows how to heal itself most of the time.  Eventually it wears out. So babies can be born.

             

                        I’m not saying there are not a few things  that doctors might help us with.  I don’t even seek to convince people that they are over-relying on doctors or drugs.  Only their own,  personally and socially costly experience can tell them whether or not that is so. 

                       

                        I only wish to suggest a different, and, still heretical, perspective on the relative importance of medical care. By temporarily questioning the conventional wisdom that we can’t live without doctors, others can determine if their own observations and perspectives prompt them to conclude, as I have, that medical care is not the same as health care.