21st Century Miracle Medicine: RoboSurgery, Wonder Cures and the Quest
for Immortality by Alexandra Wyke, Plenum, $26.95,
ISBN 0 306 45565 X
FOR all the hype that surrounds it, modern medicine has actually done little
to overcome the great killer diseases. Rather, it is improved sanitation and
living standards, not least the humble fridge, that have made the greatest
contributions to better health. Antibiotics were wonderful, but foolish
overprescribing has proved counterproductive. Most new drugs since penicillin
have been disappointments. And cancer and degenerative conditions such as
diabetes and Alzheimer鈥檚 continue to spread.
Alexandra Wyke, a managing editor at The Economist, brings this
point鈥攑reviously made by Ivan Illich, among others鈥攈ome in 21st
Century Miracle Medicine. The portrait of 20th-century medicine that she
paints is largely unflattering: ill-kept medical records, misdiagnoses, surgical
bungles, lack of rigorous clinical testing of treatments, exorbitant costs and
poor value for money.
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But for Wyke, the fault lies not in high-tech capitalist medicine, but rather
in its absence. The trouble with today鈥檚 medicine, she says, is that it has
failed to become properly rational, scientific and businesslike. Physicians have
enjoyed and abused professional privileges, and our expectation that the
taxpayer will pick up the tab has encouraged profligacy and
unaccountability.
Things are changing, however, and Wyke contends that it is for the better.
Most of 21st Century Miracle Medicineis devoted to extolling the more
powerful and cost-effective medicine of tomorrow that will ensure 鈥渨e can look
forward to a universally hale and hearty future鈥�. But how will our healthcare be
delivered?
In the fiercely competitive American healthcare market, the interplay between
huge health maintenance organisations (HMOs) and similar managed-care
enterprises, 鈥渃utting-edge鈥� medical suppliers and consumer groups, will spur
innovation and reduce waste. In Britain, comparable benefits will be produced by
the internal market within the NHS. The multiplication of superfluous and costly
procedures will cease, and unnecessary drugs will be eliminated. Thanks to the
information revolution brought about by the digitalisation of data, diagnosis
will at last become scientific鈥攊ndeed, increasingly
computer-assisted. Mistakes and malpractice will decline. Healthcare suppliers
and customers will both benefit.
Ruthless cost cutting in healthcare will stimulate innovation in biomedicine,
Wyke claims. The Human Genome Project, once completed, will resolve the
remaining puzzles of disease aetiology, revealing how 鈥渕ost of the diseases we
suffer from are jolted forth by `bad鈥� genes鈥�. Once our genetic flaws鈥攁nd
she includes propensities to criminality here鈥攈ave thus been documented,
defective fetuses can be aborted, while biotechnology and genetic engineering
will enable the correction of any glitches after birth. Gene therapy will make
for a healthier population by energising the long-neglected area of preventive
medicine.
Turning to cures, Wyke envisages a growing uptake of new high-tech
procedures鈥攆or example, keyhole and other precision surgery. Robotic
surgery will flourish.
Above all, monitoring devices will soon be as ubiquitous as watches. Hooked
up to central medical facilities and to personal computers, these devices will
permit individual regulation of health on a day-to-day basis and at a glance.
The sick can then order their own medications along with their supermarket
groceries, thus taking control of their own wellbeing.
In addition to bringing empowerment and choice to the consumer, developments
such as these will slash the numbers of expensive and often blundering
physicians, while imposing more rational work procedures on the rest.
In short, the future will see 鈥渄octors and government melt away鈥�, as one of
the chapter headings proclaims. Tomorrow鈥檚 medicine will sideline the
old-fashioned paternalistic professionals, replacing them with a market
dominated by medical corporations and consumer choice. Sharing Margaret
Thatcher鈥檚 veneration of business and antipathy towards professionals, Wyke sees
medicine鈥檚 future as the extension of the free-market dream to health.
All that, Wyke tells us, will be pure gain. By 2050 the population will be
living longer, few will die of disease, and improved health will come 鈥渕ore
cheaply鈥�. What鈥檚 more, the benefits will not be confined to an elite. For, she
explains, 鈥渁dded to the clinical assets telecommunications technologies can
download on a deprived community, they are capable of markedly dropping overall
medical costs, channelling them into the price range of even the
耻苍辫辞蝉蝉别蝉蝉别诲鈥�.
I found it necessary to read that sentence many times before I got its gist.
This kind of prose pervades the book. Grotesque mixed metaphors abound (for
instance, she has medicine continuing 鈥渢o swallow income hand over fist鈥�), until
the pressure of clich茅s and odd phrases numbs the brain.
Writing of this kind is not merely an affront to the language; it also
mystifies. To return to one of the above quotations, what can it mean to say
that computerised medicine will be within the 鈥減rice range of the unpossessed鈥�?
What sort of 鈥渦npossessed鈥� can afford to purchase sophisticated computerised
healthcare? Promo-speak and marketing jargon are used to obscure realities
here.
And there is no doubt where such verbal smokescreens originate. As Wyke tells
us, the research for her book involved numerous interviews conducted with the
executives of major medical corporations and 鈥渟tart-up鈥� medical laboratories
ranging in location anywhere from the US to Japan. It is their language and
messages that are being relayed, and their version of the future which is being
publicised. As a result, the account Wyke offers of medicine fifty years hence
is partial and partisan.
Many of her predictions are surely sound: there is little doubt that genetic
therapies will increase, and robots will become as normal in the operating
theatre as they are in car-assembly plants. But 21st Century Miracle
Medicine fails to analyse the wider implications of these developments. Let
us return to the idea that the triumph of high-tech medicine within the
capitalist market will reduce costs and improve access for all, including the
鈥湷懿员璐遣醪醣鸩醪醣鸹邂��. What grounds do we have for trusting that assertion? The US
currently leads the world in high-tech medicine and relies more heavily than any
other nation on market mechanisms to adjust healthcare supply. The result is
that nearly 40 million Americans live without medical insurance. There are
dramatic health inequalities, even though the US spends a larger proportion of
its GNP on health than any other industrialised nation.
In short, the notion that market medicine is cost-efficient, and will benefit
all, including the 鈥渦npossessed鈥�, seems positively contradicted by available
experience. While the laws of supply and demand may work quite well for some
commodities, medicine is a separate case: those whose needs are greatest are
rarely in a position to afford it.
There is something appealing about Wyke鈥檚 technological optimism. But when
she writes that 鈥渢omorrow鈥檚 healthcare setting will see the quality of medical
services shift into the position of becoming a supreme requirement for the
accolade of good doctoring鈥�, the impenetrability of the prose is symptomatic of
the woolliness of the thinking.