Prophet or Pretender?
The text below is something I wrote in 1998/99 as part of a treatment on futurism in Health Care. Be cautious how you handle this. It can give you whiplash:
In Canada, the provinces are locked in danse macabre with the federal
government over their respective shares of national health care
expenditures. Managed care doesn’t have
the same profile as privately-run HMOs do in the U.S., but provincial health
programs exhibit many of the same characteristics. Gaps have appeared in medicare coverage as
provinces have eliminated overlap and
duplication and, in some cases reduced expenditures.
Until the 1990s, equality of access to care
was assumed by most Canadians to be another of their birthrights. However, as public health has become a
commodity as well as a medical service, there are widespread fears that a two-tier
system -- one in which people with the most means will get the best care --
will one day be the norm. The concept
of “two-tier” health care has become the dividing line between those who
consider equal access to high-quality medical treatment to be a sacred trust of
national governance and those who fear that soaring medical costs could sink
the Canadian federation almost as surely as the traditional ideology of Quebec
separatism.
At mid-century,
few people imagined -- the lifestyles editor of The Futurist among them -- that along the way, the economics of distribution
would create bottlenecks that may be more difficult to overcome, in the long
run, than the diseases themselves. As it has turned out in the Nineties, the
cost of health care has become nearly as problematic as disease itself.
Medical technology
has demonstrated repeatedly that it can deliver great advances in the treatment
of many illnesses that have plagued humanity for at least as long as there have
been records of public health. Our faith
in the promise of science has proved to be well-placed as each age-old malady
has succombed to the accumulated knowledge and skill of medical research. By the 1970s, it was common wisdom to declare
that the war of bugs versus drugs had been won decisively. Yet new challenges have emerged with each
success. New diseases, like AIDS, have
probably crossed over from exotic jungle creatures to attack the human organism
as greater numbers of people have ventured into the dark recesses of the
planet. Ebola, a ghastly hemorrhagic
fever that causes the body to ooze streams of blood, was first identified in
western Sudan and Zaire in 1976. It had
likely existed for eons in some forest rodent or bat species. And now old diseases like influenza and
common infections, once thought to have been eradicated, are threatening to
invade us. Technology is surrendering
its power to newly resistant strains of micro-organisms that have co-existed
with us peaceably for generations.
Medical
researchers understand that our weakness for a sure thing is almost certain to
be our downfall. The question is not
whether this will come about, but when it will occur. We have become so accustomed to a life
without the risk of the age-old infections that our very aversion to any such
risk will be our undoing. We insist so
firmly on narrowing the probability of a foreshortened future that our very
insistence will be the death of us. Our
demands for antibiotic insurance against every discomfort have become so strong
that doctors have given in to the pressure.
According to one U.S. study, between 20 and 50 per cent of the
145-million prescriptions given each year to outpatients are unnecessary.[1] Between 25 and 45 per cent of the
190-million antibiotic doses administered in the hospital each year are equally
superfluous, the study found.
Antibiotics are often taken for illnesses that they are not even
designed to fight, like colds or flu, that are caused by viruses.
Bacteria are among
the oldest organisms on the planet. What
they do best of all is to survive. They
were doing this according to Darwinian principles eons before the great 19th
century botanist enunciated his Theory of Evolution. The emergence of resistant bacteria was
inevitable. But nobody predicted how
quickly it would happen. It has taken
these organisms with a genius for adaptation less than half a century to
overcome the most potent concoctions that mankind could devise. Bacteria now exist for which there is no
antibiotic antidote. Some are resistant
not to one drug, but to many.
North America has
become addicted to the antibiotic cocktail.
What happens next may turn out to be the nightmare of all hangovers. The
next pandemic will almost certainly be the result of resistance to the cure. The growing list of dangerously infectious,
drug-resistant microbes is comprised of common household bugs that cause
everyday maladies like sore throats, ear infections and influenza. Headline writers have enthusiastically taken
to calling them the “Superbugs”. As the
headlines tell the story, it’s as though each microbe has assumed heroic
dimensions of virulence. It is an
imperfect caricature. The real story is
far more banal and, because of that, infinitely more menacing. Organisms that live on the skin and in the
nostrils of otherwise healthy people are threatening to overcome all the
miracle drugs now known to medical research.
Their supremacy would be a
terrible thing to behold. More
unsettling than this apocalyptic vision, however, is the consensus among
epidemiologists. They are nearly
unanimous about the high probability of the threat.
Between 20 and 30
million people died world-wide in the Spanish Flu epidemic of 1918-1919. The one-month death toll was more than
200,000 North Americans from a population at the time of less than 60-million.
Epidemiologists agree that athere is a good probability of a pandemic of
similar proportions within the first
five years of the new century, based on the calculation that major epidemics
occur three or four times a century.
Thirty years have elapsed since the last one. The longest span without one in the 20th
Century was 39 years. How prepared is
the medical estabishment? “I don’t think
anyone could ever be ready for something like that,” says Health Canada’s chief
epidemiologist. “How can you prepare?” [2]
Ironically, the
man who created the first miracle drug foresaw where all this was headed. Penicillin was introduced in 1943. Just two years later Alexander Fleming, the
drug’s discoverer, warned in an interview that misuse of penicillin would cause
bacteria to mutate into new strains.
These new organisms would exist solely to resist the new drug. As things have turned out, the evolution of
bacteria into increasingly virulent strains has been occurring faster than the
ability to produce new medicines. In
part that is because drug manufacturers all but abandoned the search for new
antibiotics in the early 1980s, believing that bacterial infections were under
control once and for all.
If medical science
is about to lose its grip on infectious diseases, it couldn happen at a worse time. Hospital
cutbacks mean there is little capacity in the health system to care for the victims of any new pandemic.
Most likely, if one should occur, the corridors would be choked with [seething] masses, like some medieval
mortuary.
