In Print

A Medical Utopia?

Life Without Disease:
The Pursuit of Medical Utopia
William B. Schwartz, M.D.
University of California Press, $22
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IMAGINE A WORLD where the deadly effects of chronic diseases like Alzheimer’s and cancer have been eliminated.
In this medical utopia, a baby’s genetic profile is determined at birth and then medical interventions abolish any genetic mutations, leaving the child to mature without chronic or life-threatening disease. Instead of dying in their 70s, 80s or 90s, most adults would live to be 130.
Such a world is not that far away, predicts William B. Schwartz, professor of medicine and a renowned medical economist, in his new book Life Without Disease: The Pursuit of Medical Utopia.
“I think what we look forward to now is a completely new paradigm, a completely new way of thinking about medicine,” he says. “Instead of dealing with the consequences of disease by replacing a hip or doing an angioplasty, we will be thinking about avoiding disease, about preventing human suffering, about making certain we intervene early enough so that these diseases of all sorts will be treated without the expensive interventions that we now are engaged in.”

HOWEVER, SCHWARTZ cautions, getting to this utopia will be very expensive and will require difficult decisions and resource allocation as health care rationing becomes a certainty.
“Without question, as we de-velop these new methods of clinical intervention – gene therapy or ways of neutralizing the effects of the abnormal proteins which mutant genes induce – we’re going to have a long period in which therapy is quite costly,” he says. “This is because these therapies will not be fully effective at first and we’ll spend a lot of money trying them out.”
That means, he says, that society will have to learn to accept rationing of medical care, particularly care that yields small benefit.
For example, Magnetic Resonance Imaging (MRI) can be life-saving for some-one with a head injury. But for someone with recurrent headaches, there is only a one-in-2,000 chance that an MRI will find a treatable tumor or aneurysm. “We’re just not going to be able to do a $1,000 MRI on every patient who has an occasional head-ache, because the cost per case discovery will be $2 million,” he says.
Schwartz, who is also a fellow at USC’s Pacific Center for Health Policy and Ethics, is quick to note that most people in the U.S. do not readily accept the idea of rationing.
“If it’s me or my family, I want the test even if the chances are only one in 2,000,” he says. “What this means is we’ve got to help the public understand that there is a wide range of benefits from these expensive technologies and ask the question, ‘Are you willing to pay the bill for the one in 2,000 chance that you’ll be helped?’
“If so, we’ve got to let health care costs go up sharply. If we’re not willing to pay that bill, then we’ve got to limit the availability of this care and the public has to recognize and accept that reality.”

– Monika Guttman


Winning ’Em Over: A New Model for Management in the Age of Persuasion
by Jay Conger
Simon & Schuster, $25.00

The key to success in the 21st century may well be persuasive leadership. That applies to organizations as well as to individuals, and Jay A. Conger, professor and executive director of the Leadership Institute at the USC Marshall School of Business, argues that today’s most effective managers influence others through constructive forms of persuasion, resulting in levels of employee commitment that earlier managers could only dream of.

Biographical Objects: How Things Tell the Stories of People’s Lives
by Janet Hoskins
Routledge, $19.99

A study of the domestic possessions of six women and men from the Kodi folk of eastern Indonesia forms this ethnography by Janet Hoskins, associate professor of anthropology. In a society steeped in exchange, objects serve as metaphors and things take on biographical significance. In her field studies, Hoskins writes, she learned she “could not collect the histories of objects and the life histories of persons separately. People and the things they
valued were so complexly intertwined they could not be disentangled.”

Domestic Society and International Cooperation: The Impact of Protest on U.S. Arms Control Policy
by Jeffrey W. Knopf
Cambridge University Press, $19.00

Jeffrey W. Knopf, assistant professor in the School of International Relations, examines whether public protest against nuclear weapons – viewed by many experts as only marginally effective – influenced U.S. decisions to enter strategic arms talks. His finding that protest had a major impact suggests that the relationship between domestic politics and international cooperation needs to be broadened. “Peace movements can make a difference,” he writes.

 
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