Life without Disease: The Pursuit of Medical Utopia [Hardcover]

William B. Schwartz (Author)

Book Description

ISBN-10: 0520214676 | ISBN-13: 978-0520214675 | Publication Date: May 19, 1998 | Edition: 1

The chaotic state of today's health care is the result of an explosion of effective medical technologies. Rising costs will continue to trouble U.S. health care in the coming decades, but new molecular strategies may eventually contain costs. As life expectancy is dramatically extended by molecular medicine, a growing population of the aged will bring new problems. In the next fifty years genetic intervention will shift the focus of medicine in the United States from repairing the ravages of disease to preventing the onset of disease. Understanding the role of genes in human health, says Dr. William B. Schwartz, is the driving force that will change the direction of medical care, and the age-old dream of life without disease may come close to realization by the middle of the next century. Medical care in 2050 will be vastly more effective, Schwartz maintains, and it may also be less expensive than the resource-intensive procedures such as coronary bypass surgery that medicine relies on today.
Schwartz's alluring prospect of a medical utopia raises urgent questions, however. What are the scientific and public policy obstacles that must be overcome if such a goal is to become a reality? Restrictions on access imposed by managed care plans, the corporatization of charitable health care institutions, the increasing numbers of citizens without health insurance, the problems with malpractice insurance, and the threatened Medicare bankruptcy--all are the legacy of medicine's great progress in mastering the human body and society's inability to assimilate that mastery into existing economic, ethical, and legal structures. And if the average American life span is 130 years, a genuine possibility by 2050, what social and economic problems will result?
Schwartz examines the forces that have brought us to the current health care state and shows how those same forces will exert themselves in the decades ahead. Focusing on the inextricable link between scientific progress and health policy, he encourages a careful examination of these two forces in order to determine the kind of medical utopia that awaits us. The decisions we make will affect not only our own care, but also the system of care we bequeath to our children.

Editorial Reviews

From Kirkus Reviews

A physician grounded in economics, ethics, and public policy sheds light on medical care issues by examining how the recent past has shaped the present and what the future is likely to offer. Schwartz, a professor of medicine at the University of Southern California and a former advisor to the Rand Corporation on health policy, divides his analysis into three parts: a look back over the last 50 years to the beginnings of the modern health- care industry; a short-range forecast for the years 2000 to 2020, and a longer-range one to the year 2050. He chronicles the trends of the past half century: the enormous advances in medical technology that followed the federal government's funding of biomedical research, the revolution in health insurance, the public's perception of health care as a right, and the current concerns over spiraling costs and the threat of health-care rationing. In the near future, he sees a continuation of current trendsfewer and larger providers, a growing corporate role in health-care delivery, and great advances in bioengineering and molecular medicine. While their initial value has been limited primarily to diagnosis and genetic screening, Schwartz spells out how in the coming decades these will lead to powerful tools for treating disease and repairing its consequences. He examines what these new and expensive high-tech therapies will offer and how they will clash with health-care cost-containment efforts, and he proposes comparing the per dollar cost of expected benefits as a method of resource allocation. By the year 2050, Schwartz predicts, molecular medicine and improvements in diet and the environment may have brought us to the threshold of a virtually disease-free world in which health-care costs would likely plateau or even fall. However, he cautions, the resulting dramatic increase in life expectancy will create new ethical and social problems requiring careful thought. A provocative analysis of the challenges facing makers of health-care policy. -- Copyright ©1998, Kirkus Associates, LP. All rights reserved.

Review

"An easy and interesting guide to the background and evolution of medical therapy and health care delivery, with an extrapolation to the future. I recommend it to anyone concerned with health policy and also to practicing doctors who, immersed in patient care, had better take the time to learn where they fit in the scheme of things." -- Fredrick Abrams, Journal of the American Medical Association

"Read this book -- you will learn a lot and enjoy the experience!" (Henry Aaron, Health Affairs

"Read this book--you will learn a lot and enjoy the experience!" -- Henry Aaron, Health Affairs

See all Editorial Reviews

Product Details

• Hardcover: 190 pages
• Publisher: University of California Press; 1 edition (May 19, 1998)
• Language: English
• ISBN-10: 0520214676
• ISBN-13: 978-0520214675
• Product Dimensions: 9 x 5.5 x 0.8 inches
• Shipping Weight: 11.2 ounces
• Average Customer Review: 4.0 out of 5 stars  See all reviews (1 customer review)
• Amazon Best Sellers Rank: #3,884,041 in Books (See Top 100 in Books)

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1 of 1 people found the following review helpful:

4.0 out of 5 stars The Manhattan project and the seeds of modern medicine, August 9, 2003

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AIR33.ORG (Toronto, Ontario) - See all my reviews

This review is from: Life without Disease: The Pursuit of Medical Utopia (Paperback)

When I first happened upon this book a little over three years ago, I thought I was just going to have a short, interesting read. Little did I know that this book would change how I looked at medicine and bring me back to something I had detached myself from since I started University. I had always been interested in medicine since I was quite young, however for quite a number of reasons I just did not see myself in this role. I also assumed that medicine was not as interdisciplinary as I had hoped, but this book quickly changed my inaccurate assumptions.
Dr. Schwartz boldly introduces his work by making the claim that in the next fifty years, genetic intervention will shift the present focus of medicine (in the United States) from repairing and maintenance therapies to preventing the onset of disease. Dr. Schwartz is hopeful that medical care in 50 years will be more effective, less expensive and will rely less on resource-intensive procedures. While I remain skeptical about such a utopian prospect, I can quickly see why he has such enthusiasm regarding the massive changes which is currently uprooting traditional medicine. Dr. Schwartz is not only a physician; he also is a professor, a former chair of the department of medicine at Tufts University, President of the American Society of Nephrology and Principal advisor to the health Sciences Program at the Rand Corporation. He is both is a practitioner of medicine as well as an administrator and policy maker, who views the onset of this utopia from two unique perspectives; as a Doctor where the practice of medicine will change from merely treating symptoms, as well as maintaining clients' levels of health, to that of an administrator who views the this new paradigm as one which will eliminate the sky rocking cost of care in patients which is only increasing. While I find Dr. Schwartz a little over-enthused about this new revolution in medicine, other parts of his work are really interesting, even if only from a historical as well as political viewpoint.
Dr. Schwartz starts his examination with the birth as well growth of big medicine. Following World War II, scientists and government leaders became increasingly supportive of medical research which could yield dramatic results, such as the Manhattan Project had years earlier. It was out of this examination that they believed that the "American people were ready to harness some of the nation's growing economic muscle in the fight against disease". One of the main supporters of this program was actually a wealthy and successful woman named Mary Lasker, who along with her husband helped establish a coalition of public and private leaders who placed medical research funding on the national political agenda. Mary Lasker was also the individual who was responsible for the transformation of the American Cancer Society from a relatively insignificant support organization into a bulging source of money for medical research.
I emphasize this aspect of the work because the steady streams of medical discoveries which spring from research centers such as NIH as well as the nations medical schools and research laboratories is dependant upon this foundation which was established by a few private interests. The world of medicine as we know it today did not change until federal government began to bankroll the nation's biomedical research effort. In 1950, Congress had provided the NIH with the resources which helped build the new facility in Bethesda, MD.
Medical care quickly shifted from the dark ages into dramatic advances which saw the development of technologies such as the artificial kidney, new imaging technologies, hip and other joint replacement, and cardiac pacemakers which unfortunately were only available for those who can afford them. It was not until 1972 that a new provision was added to the social security act entitling every patient, rich or poor to free dialysis. It also was not until the advent of Medicare and Medicaid in 1965 that many of the poor, under serviced as well as elderly gained `equal' access to care. While Healthcare has `reformed' somewhat since the mid-sixties, much of what is currently practiced in current medicine evolved from this period after the mid- seventies Revolutions in other areas of science, such as the discovery of DNA contributed greatly to medicine as well as the development of noninvasive technologies such as CT, MRI, as well as ultrasound, which have opened doors that allowed the practice of medicine to evolve from its origins. Transplantations are now possible, as well in vitro fertilization, and the `gamma' knife which have greatly improved care. Most importantly Dr. Schwartz outlines all the major discoveries in modern medicine from the 1950's onward, and touches upon the motivations of governments as well as managed care plans, and how this constantly maintains the growth of this area, even to the point of bankruptcy.
Although policies are discussed in much more detail in Dr. Schwartz's book which I have been unable to even touch upon here, "Life without Disease" presents the history and evolution of medicine from its humble origins with three unique viewpoints, that of the policy makers, the physicians, and ultimately the patients who have come utilize their developments. One interesting question still remains for me however - if life without disease were truly possible, where would this current system of medicine find itself, and where would this leave physicians, researchers and insurance companies?