David Quinn
The Irish health budget comes to some €17 billion per annum. That is an astounding sum of money. We believe we have an underfunded health system, but actually, compared with the size of our population, we spend more on health than most industrialised countries. This is despite the fact that our population is younger on average as well.
Very few people seem to know this and so the demand is for ever more spending. The reality is that we often seem to receive poor value for money. Look at the huge cost-overrun for the planned new National Children’s Hospital, for example.
But another part of the problem, and this is not limited to Ireland by any means, is the huge expectation we place upon the health system. We expect it to cure us of all our ills, and today, not tomorrow.
The World Health Organisation (WHO) contributes to this sort of hyper-expectation. Its definition of health is incredibly all-encompassing. It describes health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Frankly, this is both utopian and quasi-religious. In fact, few religions have ever promised such a state of mind in the here and now. What is being described is actually the perfect peace found only in Heaven or in brief, fleeting moments in this life.
Attention
In his new book, Can Medicine Be Cured?, Seamus O’Mahony, a Cork-based doctor devotes a lot of attention to the inflated expectations we place on medicine.
Towards the end of his book, he drily observes: “Neither religion nor philosophy claims that life should be happy, but the WHO does.”
He points out that more than 40 years ago, in 1975, Dr Halfdan Mahler, then director-general of the WHO, promised health for all by 2000. That is to say, 19 years ago we should have already reached “a state of complete physical, mental and social well-being”.
Let’s be clear: this is never going to happen so long as we are actually human beings. In Brave New World, Aldous Huxley imagines a future in which we are all genetically bred and socially conditioned in order to be happy and content with whatever role in life our betters have assigned to us. Whenever we are feeling low, we can take a drug called Soma which will pick us up again.
Huxley’s imagined world is completely totalitarian and entails becoming less than fully human. This is the only way suffering can be finally eradicated.
Short of going down this road of transhuman humans (and who can rule anything out these days?), there is no possibility of the WHO’s vision being achieved, but along the way its mentality can actually add to the sum total of human misery as all utopian schemes do.
Utopian schemes always promise perfection, but humans are imperfectible. Communism is the classic example of a utopian vision that went very badly wrong.
The WHO and its vision cannot go off the rails like that, but in promising happiness at the level it has in mind, it can only end up tormenting us because the very attempt to achieve total happiness always means it is out of reach. You will always fall short and will berate yourself or someone else for the failure.
Dr O’Mahony says that medicine did, in fact, have a golden age, from roughly the 1930s until the 1980s. In this 50-year timespan, scientists developed numerous vaccines and anti-biotics that cured or kept at bay many of the dread diseases that have haunted us for aeons, such as cholera, TB, smallpox, typhoid and so on.
But he also points out that some of the biggest advances in health didn’t come from doctors at all, but from engineers and others who gave us good housing, clean water and improved nutrition. Countless numbers of people have died down the centuries from infected water, poor nutrition that depletes the immune system, and living close to each other in cold, damp and unhygienic conditions.
O’Mahony now believes we have reached the point of diminishing returns with medicine. Gigantic amounts are being invested in treatments that have little effect compared with the hopes and the money invested in them.
He says that a great deal of this money could instead be put into (say) palliative care which accepts the inevitability of death but is dedicated to ensuring we die in as much comfort and with as much dignity as possible.
Basically, we now have a view of public health that will place endless demands on it, and which can never actually be met, so causing more anger and resentment and yet more public money being spent that could be better used elsewhere. It is a vicious circle.
Instead, we need to adjust our expectations of medicine, and of life as well. Yes, the job of medicine is to try and heal us, and where that can’t be done, manage our ailments as best it can, and then offer us comfort-care at the end of life.
But it cannot ever relieve us of all suffering and misery. This is built-into the human condition which is why all of the great religions and philosophies tell us to temper our expectations and limit what we can expect of life. We should never expect perfection.
Religion is often accused of offering ‘pie-in-the-sky’, but arguably the wrong view of medicine does the exact same thing. The pie will always be out of reach, but the promise that one day we will have our pie (and eat it) guarantees we will never have the perfect peace and health it promises.
The message of Dr O’Mahony’s book is, essentially, that we need to place realistic expectations on doctors and the health system, and doctors in turn need to be realistic about what they can do for us.