In the ongoing political debate over who will have control over the one-seventh of the American economy devoted largely to crisis medicine (government bureaucrats being the most likely), an important question is being overlooked. Although it is understandable that the people of an affluent nation would choose to allot this large proportion of their earnings to good health, why are they getting so little in return? Is the current level of human technology capable of providing only crisis medicine for the great majority of people - who suffer and die long before experiencing 80 or 90 years of healthful life? Is preventive medicine really constrained to a gaggle of correlational studies, health food gurus, and general life style advice that few people follow and even fewer find beneficial? The answer to these questions is definitely, no! Yet, for 30 years I have watched in sorrow as their practical answer was given in the affirmative. The reason for this seems to be that many of the research and development people who apply technology to health are unable or untrained to think quantitatively, and those who do not have this failing are constrained by government agencies. These constraints take the form of bureaucratic domination of research through tax-financed institutions, regulations that make advances uneconomical unless huge sums of money are paid for
In addition, as a result of the personal seriousness of the matter, we are inundated by general advice about life style, nutrition, vitamin supplements, exercise, drugs, and other factors that may change the odds (calculated relative to the whole population and not considering our own individual characteristics) of our being chosen for the knife. Although much of this advice is sensible, it is difficult for us to know which advice is best for us personally, and, in the absence of information about our cardiac health, the advice is only sporadically followed.
Would it not be better to monitor our hearts regularly in all sorts of conditions - exercise, sleep, and other activities - all day, every day (or at least one day per week)? This would build a longitudinal baseline of data for us, individually. Suppose the calculated parameters of the electrocardiogram were simply normalized to our individual life-long baseline (giving them enhanced predictive value), crunched into a single parameter, and combined with predictive research information to display a single number - the probability of death from heart malfunction. Although it would not be perfect because of the fundamental limitations of this technique, this probability would rise for many people long before crisis medicine decided they were candidates for surgery.
Electrocardiograms should be tools for measuring - and allowing us to fight - the probability of disease rather than disease itself. Also, by giving us something quantitatively measurable with which to judge our progress, they could help us to adhere to those healthful habits that lower our own individual probabilities of death - and help us to avoid those fads that are not helpful or even may be harmful to us.
Mass production of portable cardiac monitors (then sold at retail stores for hand-calculator prices) and a little computer software that would be trivial to produce could bring this remarkable tool for preventive medicine within reach of all Americans. Mass marketing would pay development costs even with the regulatory burdens.
Three groups of people stand in the way. First, government regulators who might not allow such dangerous toys in the hands of mere American citizens. Second, some medical people who prefer medicine as a monopolistic system (only some, since the vast majority of physicians place human health above self-interest). Third, some lawyers (only some, we are not complaining here about all lawyers) who would bring lawsuits against the manufacturers and suppliers each time the monitors failed to prevent a heart problem - on the basis that reliance upon the device diverted their clients from other alternatives. Since no predictive device will ever be perfect (especially not the initial technology), there will always be grounds to sue. The more good the device does, the greater the profits of its producers, which can be targeted by the lawyers.
Notice that none of these impediments are technological and none of them enhance human health. They are all distortions of free enterprise which derive from misuse of government power.
As a second example, consider blood and urine analysis which can now provide more health information than electrocardiograms, and, with technology that has already been demonstrated, could provide hundreds of times more. See
Access to Energy 23-4, December 1995.Today, when we "go in for some tests'' and provide blood and urine, the samples are sent to a clinical laboratory that analyzes a few substances - mostly the same few that have been popular for more than 40 years. Each value is then reported to our doctor along with the mean and range for the "normal population.'' No attempt at quantitative interpretation of the entire observed pattern is made and, of course, no baseline pattern is considered for our biochemical individuality. A ten-year-old could look over the data sheet and report sagely that "everything looks fine'' - as our physician does on our next visit.
America's clinical labs charge tens of billions of dollars annually for this service, which our doctor orders whether he wants it or not to avoid legal claims against him for medical malpractice.
These measurements, like the occasional electrocardiogram, do have some merit. If a value is too far out of the normal range, crisis medicine kicks in along with the usual price tag. Also, a little preventive medicine takes place as our blood lipid values are also compared to those of millions of other people, and we are advised to eat less fat -which may be good or bad advice for us individually.
If instead of this charade, a larger number of substances (or even the same number) were measured at low cost, reduced to computerized quantitative patterns, and reported as probabilities of impending disease, then blood and urine analysis - especially used in comparison with life-long individualized profiles - could become a major technological tool permitting us to fight the probability of disease rather than disease itself.
The stakes are high. Avoidance of premature death could add at least a decade to the average lifespan and could avoid the unnecessary suffering that is often a part of early death - suffering that afflicts not only the dying person but also those around him.
The goal of medicine should be to ensure that each person has an optimum chance to live in good health to an age near the intrinsic human life span (now approximately 90 years) and then to die at the greatest individual age possible with a minimum of suffering.
The technological tools to accomplish this already exist. For the most part, however, they are not being applied to the daily, quantitative measurement of individual health that is necessary for preventive medicine. The tools of crisis medicine are remarkable. It is good that they exist and are available when preventive medicine fails. High-tech preventive medicine could accomplish, however, far more of the goals of medical science.
There is no magic here. Nor are geniuses required. It is only necessary for government to get out of the way - to stop taxing away the needed capital, to stop regulating away the needed freedom, to stop fostering a legal system that penalizes those who take risks, and to stop enforcing monopolies for those who cling to obsolete methods.
Until these things are done, we shall each continue to be observers who watch unnecessary suffering and death overtake those around us, one by one, until finally the antitechnologist reaper comes for us.
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Vol. 23, No. 9
Newsletter: Access to Energy Newsletter Archive Volume: Issues Issue/No.: Vol. 23, No. 9 Date: May 01, 1996 03:17 PM Title: Correlation and Causality
Copyright © 2004 - Access to Energy Newsletter Archive
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