Customer Reviews

Life without Disease: The Pursuit of Medical Utopia

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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?