Bioethics expert: Medical advances, technology barriers to healthcare utopia

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Let's face it: Conference luncheon sessions can be a little, shall we say, sleepy. But a mid-day lecture at the annual congress of the American College of Healthcare Executives (ACHE) yesterday definitely kept attendees awake.

Dan Callahan, Ph.D., (pictured) co-founder and president emeritus of the Hastings Center, a nonpartisan bio-ethics research institute, described what he called a "utopian" healthcare system of the future that delivers ethical and equitable healthcare.

But first, he described what he sees as the barriers to that utopia that exist today.

Those barriers include an aging population and Americans who demand the best care, expect their doctors to perform miracles and are not happy when they don't deliver.

The American public is "terribly confused about the U.S. healthcare system," Callahan said. They don't want barriers to their access to expensive healthcare but aren't willing to pay more for it, either.  

Another problem: technical advances that do improve care for only a handful of people while at the same time drive up the cost of healthcare.

You read that right: Technology is one of the barriers to an equitable and sustainable healthcare system. Research that advances healthcare's capabilities, such as innovations in genetic screening and biologics, also drives up costs with little return on investment, he said.

"Most research allows us to find expensive ways of keeping people alive longer," Callahan said.

Further, it's unlikely there will be a cure for major diseases such as cancer or conditions such as heart disease, he said. Rather, the treatments will become more complex and expensive--and keep the patients who are the most expensive to treat alive longer. And what does it matter? A person saved from one disease will only die of something else.

It's the rare (and lucky) 70 year-old who drops dead after running a marathon, he said--getting a laugh (albeit a nervous one) from the audience.

But his theories are not black humor, he said. There is empirical evidence that adults who are cured of one disease will likely contract another. And if they're cured of that, they'll develop another. And so on.

Medical progress and innovation, Callahan said, are open and unlimited. It's also costly and, while "wonderful" for patients, it's not necessarily good for the healthcare system.

So what's Callahan's vision of a utopic healthcare system--one that offers quality, affordable, sustainable, efficient and equitable care?

"We have to learn to set limits and openly talk about rationing," he said. "Medicine is where we need the next revolution." That includes making public health and preventative medicine at the top of the priority list--and expensive, high-tech treatment for older patients with chronic conditions at the bottom.

Although the talk got everyone at the session buzzing, the typical response (within my earshot, anyway) was pretty simple: Good luck with that.

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