Am I alone in feeling that faint thrill in the air, the thrill that comes in the interregnum between the expectation of pain and its arrival? There’ s probably a word for it, something Germanic and angular, compounded from the lexica of psychopathology. A bit like schadenfreude although the pain will be all your own. I’ m talking about the cuts of course, the budget deficit, all those billions that need to be sliced from the soft underbelly of our public services. Am I alone in hearing a little Spartan relish in the sound of the knives scraping the whetstones? After the fat comes the lean.
Scratching around recently on an entirely unrelated matter I came across the book False Hopes by the philosopher Daniel Callahan in which he asks the wonderful question: does medicine do any good? Being a philosopher he naturally gives several answers to this question, but as at least one of them is ‘no’ , I thought this might be a helpful place for anyone considering balancing the national books to start. Let us get rid of the NHS entirely. Think of the savings. Over a hundred billion pounds at the stroke of the a pen.
So wherefore comes Callahan’ s no? I’ ll let him speak for himself:
‘The second half of the answer to the question of whether medicine makes a difference is no, not all that much, if the health of the population as a whole is considered…Medical technology does bring about comparatively small incremental gains for most people, and some dramatic gains for others…But for everyone the gains are usually now achieved at a relatively high and increasing cost, with little effect on general population health, and they are usually not equally or even fairly distributed.’
Callahan’ s point is that the cost of technological innovation in medicine is wildly outstripping its shrinking incremental benefits. Powerful interests: patients seeking cures, commercial companies hunting profits, scientists after breakthroughs, doctors looking for control over disease, all drive innovation relentlessly forward, irrespective of the cost-effectiveness of the outcomes.
And yet, for all the technological frenzy, it is probably reasonable to assume that life, at least for the foreseeable future, will continue to end in death, and our bodies and minds will continue to suffer and decay, despite the resources we pour into medicine. The costs of failing to accept this reality are not just economic, they are also psychological. For as long as technology holds out the promise that ill health is eradicable and death can always be deferred, medicine will always end in failure and the profound psychological resources that are associated with acceptance are denied to us. Not acquiescence in the face of illness and suffering, but a wise understanding that the fight cannot go on forever. ‘My good man’ , as Montaigne puts it, ‘it is all over. No one can put you on your feet again; at most they will plaster and prop you up a bit and prolong your misery an hour or so.’
Perhaps it is time to un-harness our hopes from the behemoth of medical technology and, as Callahan suggests, focus our energies instead on public health interventions and on promoting personal responsibility for health. It won’ t be as sexy. It won’ t grab the headlines, but it might just be the single silver lining to the fiscal storm ahead.
Julian Sheather is ethics manager, BMA. The views he expresses in his blog posts are entirely his own.