Money, morals and the conquest of mortality.

A RECENT EDITORIAL in the New York Times makes disturbing reading. It says, in part:. .. the number of Americans without insurance. .. stood at 39 million even at the end of the booming 1990s. .. more than 2 million Americans lost their insurance last year. The soaring costs are driven, in part, by the biomedical revolution of the past decade, which has produced an array of expensive new treatments for an ageing population, from drugs to fight osteoporosis to high-tech heart pumps. The result is a health care system filled with great promise and inequity — such as wonder drugs that many of the nation's elderly must struggle to afford. Dr Janelle Walhout sees the paradox every day at the community clinic in Seattle where she works. " I've been thinking lately about the mismatch, " Dr Walhout said, " between how very high-tech medicine has become, with all these genetic tests for everything, mixing your medicines like fine cocktails, and our patients, who can't afford them, can't understand it, can't get interpreters to explain it and are just not accessing those things. " 1 This is a newspaper editorial from the world's wealthiest country — the country that is the paradigm for development in the Western world. If the United States leads, can we be far behind? I have been asked to speak broadly about the ethics of healthcare, as a background to a discourse of healthcare reform. There seem to be good grounds to pursue reform; and yet there's been so much that is good that has happened in the last 50 years. To take but one example, cancer survival overall has risen from 30% to 50%. Some malignancies, such as Hodgkin's disease and some kinds of testicular cancer, are curable, even when they're quite advanced. Prevention and early detection have changed the whole history of malignant melanoma, that most Australian of cancers. The genetic basis of a few cancers has been determined, and that may lead to preventive or even curative approaches. However, there is an obdurate residue that we cannot shift. Advanced bowel cancer is common and generally unresponsive. Lung cancer still has a poor outlook. We will all die of something, and strokes, heart disease and cancer remain the three most common causes. These are the sad facts that govern our lives, but my concern here is to talk about the social and political …