Credit where it's due

I have tossed my share of snark in the direction of National Public Radio, but this time, they get their full complement of "l"s. I thought this story by Alix Spiegel was exemplary journalism. This is what the profession ought to be about, and is so seldom.

It's also a great follow-up on yesterday's post and gives me a chance to make an additional important point. You'll notice the URL for this site - health vs medicine. That represents a basic premise that I probably don't bring to the foreground often enough. Obviously medicine is supposed to be making us healthier, but it's just as much the enemy of good health as it is the champion. This happens in multiple ways. Taxonomies are always a little bit arbitrary -- you can lump or split as you like, and organize groups of phenomena in various ways. I'll just make a crude first effort here.

First, as Spiegel's story makes clear, doctors may simply do things that hurt more than they help. They have enormous power over our bodies, including the power to cut out essential parts. We don't generally know any better than to trust their judgment, but it isn't necessarily very good. This is partly due to the general culture and the specific medical culture that's both embedded in it and highly influential. We have a bias toward action, toward doing something; we're all about being bold and decisive and heroic. And we have a lot of faith in technology and anything that wears the guise of science. But the shocking truth is, much of medical intervention is not based in science at all, is not driven by evidence, but by physician's intuitions and customary ways of doing things. And, let's bite the bullet and make this painful admission: doctors are paid to do stuff, and the more radical their actions, the more they are paid.

Second, by holding out the false promise of perfect health and great longevity, medicine distorts the culture and our individual response to pain and disability. Ivan Illich, who was a Catholic priest and had that Catholic fatalism, was an aggressive proponent of this view. It showed up in Keith Olbermann's special comment, where he seemed to champion the defeat of death and worship at the altar of medical miracles. Life sometimes throws adversity our way. Not that it isn't worth trying to cure disease and relieve pain and give people a good lifespan, but we also just have to suck it up and deal with it sometimes.

Third, our excessive faith in medicine diverts our attention from the very important social determinants of health, to which Bix eloquently alludes in a comment on yesterday's post. Social justice begins long before we even think about universal health care. Sure, if we had it our society would be more just than it is now but we would still have huge inequalities in health and life expectancy because of all the other inequalities that would remain, for which medicine does not have the answer.

And fourth, every dollar we spend on medicine is a dollar we don't spend on something else, whether it's a modicum of justice, or a measure to promote the general welfare such as generating cleaner energy or providing parks or mass transit or clean water.

That's why health care reform is only the beginning. And the wrong kind of reform, that just extends the present medical pathology to everyone, and sucks more money and more social and cultural capital out of us all, will be worse than nothing.