Life Without Disease: The Pursuit of Medical Utopia.

• Author: Bailey, Ronald

by William B. Schwartz, Berkeley: University of California Press, 178 pages, $22.00

In False Hopes, Daniel Callahan stands athwart medical progress yelling "Stop!" His anti-technology, anti-freedom screed would be dismissed as the ravings of a Unabomber-style lunatic if it weren't for the fact that Callahan is the co-founder of The Hastings Center, a prestigious bioethics think tank in New York.

Borrowing the concept of "sustainability" from radical environmentalism, Callahan calls for "steady-state medicine." He imagines a future "in which a socially agreed upon proportion of the GNP is devoted to health care, with a set limit (which may be tacit as well as explicit); in which technological changes are slow to come and are rigorously screened for efficacy and affordability; in which changes in the health care system from year to year are relatively slight; in which budgets remain stable (allowed to increase only in proportion to an increase in the GNP or the rate of annual inflation); in which the public for the most part expects only slightly incremental improvement in the level and quality of health care; and in which further scientific gains are not deployed until earlier ones are fully utilized." In other words, the government should forbid medical advances that threaten to make some better off than others. Underlying this harsh prescription is Callahan's quest for "equity," coupled with a profound misunderstanding of economics.

Like many other allegedly deep thinkers in the area of health care, Callahan decries the growing percentage of the U.S. economy devoted to medical spending. This is much like deploring the fact that the automobile sector represents a much bigger share of the economy today than it did in 1910, or the fact that U.S. spending on computers has grown dramatically during the last decade. In the case of medicine, Callahan seems to believe that the additional benefits are not worth the cost. But in making that judgment, he is imposing his values on the patients who seek more and better medical care. He has decided that they are wrong.

Callahan blames rising medical costs on technological improvements. As an example, he notes that ultrasound imaging for prenatal screening, rarely used at first, is now routine. But that's because the cost of an ultrasound has fallen dramatically relative to wages.

Research conducted in recent years has also reduced the cost of ulcer treatments. Physicians now recognize that 90 percent of ulcers are caused by a bacterium. These ulcers can be cured with a combination of antibiotics and acid blockers such as cimetidine (Tagamet) and ranitidin (Zantac), avoiding the need for surgery. This development has saved billions of dollars and spared millions of people intense pain.

Yet it is precisely this sort of continual improvement in medical care that seems to upset Callahan. "The criteria for normality are constantly raised, keeping in step with medical possibilities," he complains. "No longer is sixty-five thought to be a reasonable age after which death is not 'premature.' No infant mortality rate, however low, is good enough. No ache or pain should go unrelieved if relief is desired. Most important, what would have been accepted as a decent level of health in one generation is unacceptable in the next." If it was good enough...