You know what? Medicine really has come a long way.

I was just hanging out with a couple of physicians around my own age, and they go to reminiscing about the old days when they were interns and such. Their earliest memories of doctoring were of young men showing up with wasting and generalized lymphadenopathy and disseminated cytomegalovirus and dying -- one after another after another, and there was absolutely nothing they could do about it. That was AIDS.

One of them is now a cardiologist. The age adjusted death rate from heart disease in this country has fallen by about 50% since then. (I don't feel like looking up the exact number, but it's in that ballpark.) It's not because we're eating better, or exercising more -- on the contrary. It's because of pills, mostly, and clot busting for people who have just had heart attacks. Childhood leukemia and other cancers of childhood are now largely curable. The death rate from many adult cancers has also fallen sharply. We're living longer and longer.

When I was in graduate school, the general picture was that the huge gains in life expectancy during the 20th Century didn't have a whole lot to do with medicine. They had a lot more to do with public health (e.g. clean water) and higher standards of living, mostly better nutrition. It was even possible for Ivan Illich to write a highly respected book, that everyone had to take seriously, that made the claim that medicine, on balance, did more harm than good. (It's called Medical Nemesis, if you're interested.)

Well, you just can't say that any more. Yes, we'd much prefer for people to exercise and eat right and not smoke and drink only in moderation and practice safe sex and all that good stuff. But the incontrovertible truth is, when we do get sick, we've got a much better chance, and that's now the biggest part of the story of increasing life expectancy.

It's important to remember that this is why universal access to health care, and medical costs and affordability, have become such a crisis. 60 years ago, medical intervention just wasn't as important. Doctors couldn't do nearly as much, there was much less on which to spend money even if you had it, it really was possible to take care of the basic needs of poor people through charity and for country docs to accept chickens from struggling farmers. If you had cancer or heart disease, you were just going to die anyway so que será será.

It isn't like that today. It's important to keep all that in perspective.