To: LindyBill who wrote (49299 ) 6/8/2004 9:11:50 AM From: LindyBill Respond to of 793652 Irony of medical advances - Paul Campos is a professor of law at the University of Colorado. Rocky Mountain News Ronald Reagan lived what anyone would consider a full and interesting life, but he died a horrible and depressing death. One can hope that Alzheimer's victims remain unaware of their actual situation as they live on in oblivion. I suspect that's overly optimistic, and that even in the late stages of the disease, occasional flashes of lucidity illuminate the ghastliness of their circumstances. It's estimated that by the middle of this century there will be something like 14 million Americans living with some form of Alzheimer's. This means that tens of millions of others will be put through the excruciating ordeal that Nancy Reagan and the rest of the late President's family endured over the course of the last decade. The natural - one might even say the characteristically American - response to this dire prediction is to redouble efforts to cure the disease. And certainly such efforts should be encouraged. Still, there is a certain irony to looking to medicine to solve the immense social problems presented by our rapidly aging population, of which the increasing prevalence of Alzheimer's is merely one example. For modern medicine created those problems in the first place. When Ronald Reagan was born, average life expectancy in America was barely more than 50 years. Today it is approaching 80 years, and still climbing steadily. Among many subgroups it is a good deal higher. Middle-aged nonsmoking white women now have a life expectancy of close to 85, and many if not most of their daughters can probably expect to live to see their 90th birthdays. Alzheimer's is just one of many diseases that are almost exclusively products of old age. While around one in 40 70-year-olds show signs of the disease, the rate among 90-year-olds is roughly one in two. Some medical researchers believe everyone would get Alzheimer's if they lived long enough. This is worth thinking about when one hears pronouncements from public health authorities about "preventable causes of death." The World Health Organization recently estimated that perhaps half of all deaths from heart disease and cancer could be eliminated through appropriate behavior modification. In March, a highly publicized article by researchers at the Centers for Disease Control claimed that 850,000 of America's 2.4 million annual deaths could be avoided by changes in smoking habits, diet and sedentary lifestyle. It so happens that there are good reasons to think these figures are greatly exaggerated. Even so, a question public health authorities never raise is this: if medicine were to someday cure, for example, heart disease altogether, would that on the whole be a good thing? As life expectancy in the developed world climbs into the 80s, such questions begin to take on more than theoretical interest. To use an admittedly simplistic example, would it not have been better for everyone, not least of all Ronald Reagan himself, if he had died of a heart attack several years ago? Broaching such questions does not mean, of course, that we should stop trying to improve treatments for heart disease, or for Alzheimer's, and to prevent them in the first place. But it does highlight that a cure for this or that disease does not eliminate the fundamental irony that advances in medicine ultimately produce other medical problems, and that the trade-offs involved are by no means always beneficial. Public health policy in America has usually been based on the implicit assumption that the main point of life is to stay alive for as long as possible. Ronald Reagan's life, and still more his death, illustrate how false that assumption is.