Map of life expectancy at birth from Global Education Project.

Tuesday, February 08, 2011

A new mode of existence

Well, not entirely new, perhaps, but different from the old version and much more common. What I am about to say, you already know, actually, but may not really have noticed. Like other radical developments that are overtaking us, we prefer not to pay much attention.

We traditionally think of medicine as being about curing disease, but obviously, once a disease is cured, it stops using up medical resources. The most important category of cure in medicine is chemicals that kill pathogens -- antibiotics, antifungals, antiparastics. Those have been around for a while now, and most diseases in those categories are now generally curable. People today have no idea what the world was like before World War II. Death was ever at hand, for everyone.

But there are a lot of diseases that medicine can't cure, but instead converts from quickly fatal (or perhaps completely unnoticed most of the time and occasionally fatal or crippling) to chronic. Type 1 diabetes was the original example, but now we also have many other autoimmune diseases, HIV, chronic kidney disease, Type 2 diabetes, hypertension, many cases of cancer that are never cured but only controlled for a long time, and many others. Sooner or later, just about everybody has a chronic disease diagnosis, unless you die young.

This has created a very large class of people whose social status includes one or more permanent diagnostic labels, and who have a once unheard of task of taking medications continually, for the rest of their lives. At the lowest impact end of the spectrum, where I currently happen to reside, there's uncomplicated hypertension. I take cheap generic drugs, with no side effects, and it's not a big deal. But people with chronic kidney disease may be taking 20 drugs, going regularly for dialysis in the end stage, and find their lives entirely ruled by their medical regimen.

This is one reason -- a very important reason, as a matter of fact -- why health care costs keep rising. Instead of dying, we are being converted into permanent patients. Sure, that's better than the alternative, but one thing about dying that you can't deny is that it saves a lot of money. And as we learn to manage more diseases we learn how to manage, without curing them, the trend will continue. (By the way, drug companies are much more interested in developing drugs that control diseases, than in developing drugs that cure them, for obvious reasons.)

It also creates a whole new set of economic, psychological, and instrumental problems for a large portion of the population. We acquire disease labels as part of our identities. We have to think about the logistics of taking pills in connection with travel or anything we want to do that changes our daily routine. We have more medical visits, more to worry about, a major set of conversational topics with which to bore our friends and family.

This is the world we live in, where everybody is diseased. We're living longer, for sure, and our diseases don't necessarily make us feel sick, or at least not very sick. It's a continuum. But most of us are on it somewhere, and moving along it. Abnormal is the new normal.

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