Tuesday, February 15, 2011

How penicillin fooled us

Perhaps it's the mark of a good book that after you read it, you begin seeing evidence for its thesis in lots of different areas. Since reading Tyler Cowen's "The Great Stagnation," I've been seeing a lot of support for a claim that I'd initially resisted: the idea that the technological advances of the 19th and early 20th centuries were far more important to both the economy and quality of life than what's come since. Take this observation from Atul Gawande's "The Checklist Manifesto":

I think we have been fooled about what we can expect from medicine -- fooled, one could say, by penicillin. Alexander Fleming's 1928 discovery held out a beguiling vision of health care and how it would treat illness and injury in the future: a simple pill or injection would be capable of curing not just one condition but perhaps many. Penicillin, after all, seemed to be effective against an astonishing variety of previously untreatable infectious diseases. So why not a similar cure-all for the different kinds of cancer? And why not something equally simple to melt away skin burns or to reverse cardiovascular disease and strokes?

Medicine didn't turn out this way, though. After a century of incredible discovery, most diseases have proved to be far more particular and difficult to treat. This is true even for the infections doctors once treated with penicillin: not all bacterial strains were susceptible and those that were soon developed resistance. Infections today require highly individualized treatment, sometimes with multiple therapies, based on a given strain's pattern of antibiotic susceptibility, the condition of the patient, and which organ systems are affected....medicine has become the art of managing extreme complexity -- and a test of whether such complexity can, in fact, be humanly mastered.

Compared with penicillin, the therapies we're developing today offer marginal improvements and carry an incredible cost. In fact, I think a lot of them are a net drag on the economy: The problem with medicine is that it's very hard to say no, and that means we often end up paying a lot for treatments that do us very little good, and that squeezes the resources available to sectors that could do us a lot of good but are easier to say no to.



Source: http://feeds.voices.washingtonpost.com/click.phdo?i=e13d43d56c6c625f57840b58acc5e75e

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