I have recently spoken with two smart people who have optimistic views about future advances in medical technology that might enable cures for cancer, viral infections, paralysis, organ regeneration, etc.
Invoking stem cell therapy, nanotechnology, spectrophotometry, genetic manipulation, immunomodulation and other biotechnologies, they argue for dramatic progress, if not Ray Kurzweil’s coming singularity (when “humans transcend biology”).
In effect, they are saying that dramatically extended life expectancy, perhaps perpetual life, is possible.
They continue to believe that because some early detection prevents some illnesses, then even more, and even earlier detection will prevent all illnesses. And they trust – hope springing ever eternal in the human breast – that this will lead to the singularity to which Western civilization aspires.
Civilian observers of medical advances do not see the whole picture
But these aspirational observers of medical research pay only lip service to the cost, the complications, the problems, the time course, the ethics and the unintended consequences of these potential interventions. Furthermore, most civilian observers of medical research have not seen research subjects die as a result of some hopeful project or a patient suffer a fatal side effect of a lifestyle (aka, “seen on TV”) medication.
I am not a pessimist. I am not a Luddite. I am all for responsible research and I do expect progress to be made, but I would argue that researchers should spend less time promoting what their work “might” do and more time resetting expectations about what it actually can do, in what time frame and at what cost.
Every step forward has unintended consequences
As I have referenced before, H. Gilbert Welch, M.D., has written a brilliant book, Overdiagnosed, which dispels the myth that more detection and earlier detection saves lives without cost or complication. He compares diagnostic medical technology to the computerization of cars. Do we really want all those warning lights in our cars to come on so regularly? Do we really care if the tire pressure is a pound or two low? Do we want to take the car in every time the “service light” comes on? What about the false alarms? Wasn’t life simpler and more manageable when we kept a record of the last oil change and scheduled the next; when we eyeballed our tires and topped them up when they looked low?
I will take his analogy another step. For every step forward there is the potential for unintended consequences, sometimes tragic. Consider the automobile’s electric windows. When first introduced in the 1940’s, the electric window seemed to be a marvelous advance. Now drivers could adjust the windows and ventilation without leaving their seats. Who enjoyed the hand cranks, slow at best and frequently awkward to use? But what unintended consequence did electric windows visit on our advanced society? The answer is death to hundreds and injury to thousands of children.
More than 50 children have died since 1990 and more than a thousand emergency room visits occur annually because of injuries caused by power windows (according to http://kidsandcars.org).
Much touted robotic surgery has not delivered on its promise
One of the great triumphs of the last few decades has been the advent of minimally invasive surgery. But another small-scale example of technology that has failed to deliver on its promise is robotic surgery. It adds cost and risk to laparoscopic surgery without adding clinical benefit. Beware the celebrity surgeon who touts robotic surgery. They are probably a paid spokesperson for the manufacturer.
Looking at the bigger picture and the promise of nanotechnology, stem cell research and genetic therapy, I would liken the future of these entities to the history of space travel. Yes, there is a role for each of them but widespread benefit is far in the future, if ever.
You won’t be meeting Luke Skywalker for a beer; space travel for everyone is too expensive in our lifetime
When the U.S. space program began in the 1950’s it achieved extraordinary results. Men on the moon, space stations, Mars probes and shuttles are spectacular to behold but still represent the most rare and most costly of events. The rich can pay for a short, purposeless trip into space. But functional space travel for the average consumer remains a dangerous and overly expensive pipedream. The image of Luke Skywalker commandeering a rocket ship and spontaneously travelling intergalactically, which is what most people conjure up when the promise of space travel is broached, will never come to pass.
Yes, there will be the occasional stem cell-induced improvement in spinal cord function and there will be nanotech delivery of chemotherapy but the Pollyannas who believe this will lead to perpetual life at acceptable cost also believe that Han Solo is dashing across space to meet Luke Skywalker for a beer.
We need more realism, not more optimism
We do not need more optimism in medicine, we need more realism. We need representatives of medical research and progress to promote real science and the ethical values that present the cost and complications of a therapy as well as the aspirational promises of such treatment. We need less PR and less hype. We need more transparency on the part of researchers and skepticism on the part of consumers. Anyone “selling” you on a therapy is just a shill in a white coat. Frequently they are a paid performer, and that reduces them to the level of a snake-oil salesman in my eyes.
Do you sense my anger?
Let us focus on the benefits of healthy behaviors. Let us focus on primary care. When we need specialized care, let us ignore the hype and reset expectations.
With the advent of the internet and the ease of access to medical information and the experience of others, it is possible for people to become partners with their doctors in deciding what risks to take for the promise of a longer life of good quality. I have found that for mechanical, i.e. musculoskeletal failures of the body, modern medicine has made possible very effective cures that extend an active lifestyle, which ultimately leads to a longer high quality life. But, one must become very informed about the risks and rewards when making a decision about serious surgery and then must trust that their chosen doctor is an excellent technician in the OR.
Thank you, Andy. Some of your catch phrases prompt me to write several more pieces on this topic. Mechanical fixes are important but when needed early in life suggest to me that the patient’s lifestyle was a bit too active and when done too late in life promise the false hope of renewed youth of one joint when the others are failing around it.
In my opinion, the advent of the internet and dissemination of medical information has elevated medical training so that now all good doctors have the same knowledge and nearly the same skill sets. There are no meccas where a few doctors have secret successful treatments. Therefore it is more important to avoid a bad doctor than to worry about finding the “best” doctor (“best” is a moniker applied to the doctors with good PR and not necessarily because of better results).
Your point about trust is very important. Within the world of good doctors your choice should
be based on finding a doctor whose mission is medicine, not commercialism, and then trusting them to give you the highest quality advice and treatment focused solely on your needs.