Wednesday, December 24, 2014

The Long Tail of Life-Prolongation

Marcia Angell's review of Atul Gawande's latest book, Being Mortal: Medicine and What Matters in the End, in the latest (January 8) issue of The New York Review of Books makes for fascinating reading, even if it is more than a little macabre for what is supposed to be an optimistic holiday season. What may be most interesting is Gawande's approach to the traditional view that the role of medicine is to prolong life at all costs, even (often?) when the condition is at its most dire. From an objective point of view, this amounts to denying that life expectancy, like so many other phenomena that cannot be explained precisely, follows the normal (bell curve) statistical distribution. Gawande's language about trying to "beat" the statistics is at its most vivid:
We've built our medical system and culture around the long tail. We've created a multi trillion-dollar edifice for dispensing the medical equivalent of lottery tickets.
The reality of the social world, however, is that doctors are just as susceptible to playing the lottery as patients are. This has two disastrous side effects. One is a refusal to embrace a realistic view of death. The other is yet another revenue stream for the medical industry, once again promoting its industrial qualities over any attempt to view medical care as a service. This may sound more than a little ghoulish, but the very idea of quality care for the terminally ill has been all but eliminated because industrial thinking has discovered that there are big bucks to be found at death's door.

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