Facing life as we know it

"Only the Good Die Young"-Billy Joel

So if you are reading this, we somehow survived the financial "Armageddon" and life (as exemplified by my musings in this publication) goes on. And if you are not reading this, then the world did end and I wasted an afternoon writing this when I could have gone surfing instead.

Daniel Callahan and Sherwin Nuland (retired clinical professor of surgery at Yale) describe the utopian vision of a "compression of morbidity," in which medicine provides a long life with little illness followed by a brief period of disability and then a quick death. This sounds pretty good to me!

But this is not happening, the authors point out. Instead, we humans typically become afflicted with chronic illnesses, progressively lose function and quality of life, and become disabled before succumbing to death:

"Ours is now a medicine that may doom most of us to an old age that will end badly; with our declining bodies falling apart as they always have but devilishly-and expensively-stretching out the suffering and decay."

This is sobering stuff to read while also wrestling with the $14 trillion federal budget deficit.

What to do?

What do the authors recommend we do about this gloomy prospect of our bodies inexorably failing (much like our cars the week after the warranty expires)? They propose we:

Say Callahan and Nuland: "Doctors will have to call repeated attention to the economic and social realities of the endless war on disease. They will have to remind the public that this war cannot be won."

It used to be that my country and its leaders were characterized by inspirational and ambitious goals (e.g., President Johnson's war on poverty, President Kennedy's Apollo Mission to land a man on the moon, and President Nixon's war on cancer). Nowadays, do we face a time when our country is over its head in debt and we are told that the government should control our health-care system and let the old people die? Is this our "new normal"?

Peter J. McDonnell, MD director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

He can be reached at 727 Maumenee Building 600 N. Wolfe St. Baltimore, MD 21287-9278, Phone: 443/287-1511, Fax: 443/287-1514. E-mail: pmcdonn1@jhmi.edu