Peter Curson: Time to rethink what we want from modern medicine

COMMENT


These are curious times. We are all living longer, we are probably healthier than ever before, but remain more fearful about our health. Probably we have never had it so good.

An average New Zealander can now look forward to living to about 80. That is 10 years more than 50 years ago and probably double that which prevailed in the mid-19th century. Infant mortality is at an all-time low, with only six deaths per 1000 live births, compared to 126 in the mid-1870s.

Infectious disease as a cause of death has dwindled away, with a few exceptions (for example, pneumonia and bronchitis in the very old and Aids in the much younger). There are now probably double as many hip replacements as five to 10 years ago, and deaths in childbirth are largely a thing of the past. Yet people do not feel confident about their health, or about the medical profession, or about medical science's ability to protect them.

In addition, the price we have paid for living longer has probably been more ill-health and disability, as well as having to direct more resources into health care and aged support services.

We are all fortunate to live in an age of high-tech medical science but it has not removed deep, underlying fears about health, about contagion, about the fear of "outsiders" and communicable disease (witness Sars).

It is also a great irony that the healthier a society becomes, the more medicine it craves, almost as a right. One might add that it also seeks more recourse to alternative therapies, and in times of "crisis" may even fall back on traditional folk cures.

Moreover, the high priests of medicine and societal confidence have been shaken many times over the past century. In 1918-19, the influenza pandemic killed more than 30 million people, with re-runs in 1957-8 and 1968-9. Between 1948 and 1956, polio paralysed many developed societies. Aids did much the same in the 1980s and 1990s, as did Sars more recently.

There would seem little doubt that the next decade will see the emergence or re-emergence of many new "hot viruses".

Much of this relates to our carefree attitude to our environment, our increasing mobility, our greed and our general carelessness. But some of it also relates to our political and economic structure, which has not only allowed (or pursued) wilful environmental modification or destruction and ignored greenhouse protocols but, in pursuit of economic returns, sought to locate production in developing countries so as to take advantage of lower overheads and avoid stringent health and environmental controls.

But what do we want out of modern medicine? What role should the medical profession assume in modern society?

Is it to provide relief from suffering? Is it to keep us alive longer, regardless of the quality of life we may be forced to endure? Is it to make us lead healthier lives?

Or, in this high-tech environment, is it simply to act as a service provider catering for the whims and wishes of people wanting cosmetic enhancements?

One sees this also in Big Pharma, where most of the world's pharmaceutical companies see their salvation in producing cholesterol, hypertension and obesity drugs, rather than addressing the problems of infectious disease in the developing world and the rapidly rising problem of antibiotic resistance in our own.

In the final analysis, a number of questions cry out for answers. Why is it, in a society committed to social equality and welfare, that certain groups of people - the young, the old and the disadvantaged - continue to bear a disproportionate burden of injury and disease?

Why is it that our high-technology and high-quality hospitals belie their true purpose and cause ill-health? Probably one in every 10 people entering hospital for a surgical procedure these days will acquire a hospital-based infection. Why is it that so many people die as a result of injuries or diseases sustained in the course of their employment?

In New Zealand there are now more deaths from this source than there are on the roads. In addition, about one in every seven New Zealanders suffer a non-fatal injury or illness (for example, broken bones, hearing loss, asthma, headaches, stress, or RSI) in the workplace.

Why is it that indoor and outdoor pollution continue to play a role in our health?

It is vital that future research and action recognise and seek to redress these inequalities.

* Professor Peter Curson is director of the health studies programme at Macquarie University, New South Wales.