A jarring vision of a medical utopia--drawing on the last half-century of medical advancement during which genetic intervention has taken a greater role in the prevention of disease.

The chaotic state of today's health care is the result of an explosion of effective medical technologies. Rising costs will continue to trouble U.S. health care in the coming decades, but new molecular strategies may eventually contain costs. As life expectancy is dramatically extended by molecular medicine, a growing population of the aged will bring new problems. In the next fifty years genetic intervention will shift the focus of medicine in the United States from repairing the ravages of disease to preventing the onset of disease. Understanding the role of genes in human health, says Dr. William B. Schwartz, is the driving force that will change the direction of medical care, and the age-old dream of life without disease may come close to realization by the middle of the next century. Medical care in 2050 will be vastly more effective, Schwartz maintains, and it may also be less expensive than the resource-intensive procedures such as coronary bypass surgery that medicine relies on today. Schwartz's alluring prospect of a medical utopia raises urgent questions, however. What are the scientific and public policy obstacles that must be overcome if such a goal is to become a reality? Restrictions on access imposed by managed care plans, the corporatization of charitable health care institutions, the increasing numbers of citizens without health insurance, the problems with malpractice insurance, and the threatened Medicare bankruptcy—all are the legacy of medicine's great progress in mastering the human body and society's inability to assimilate that mastery into existing economic, ethical, and legal structures. And if the average American life span is 130 years, a genuine possibility by 2050, what social and economic problems will result? Schwartz examines the forces that have brought us to the current health care state and shows how those same forces will exert themselves in the decades ahead. Focusing on the inextricable link between scientific progress and health policy, he encourages a careful examination of these two forces in order to determine the kind of medical utopia that awaits us. The decisions we make will affect not only our own care, but also the system of care we bequeath to our children. This title is part of UC Press's Voices Revived program, which commemorates University of California Press’s mission to seek out and cultivate the brightest minds and give them voice, reach, and impact. Drawing on a backlist dating to 1893, Voices Revived makes high-quality, peer-reviewed scholarship accessible once again using print-on-demand technology. This title was originally published in 1998.

Every man dreams of a utopia in which disease is conquered and the only thing left to die of is old age. In a study of the history and concepts of medicine, René Dubos, who is one of America’s most distinguished scientists, shows that such a utopia is neither possible nor desirable. Organized species such as ants have established a satisfactory equilibrium with their environment and suffer no great waves of disease or changes in their social structure. But man is essentially dynamic, his way of life constantly in flux from century to century. He experiments with synthetic products and changes his diet; he builds cities that breed rats and infection; he builds automobiles and factories which pollute the air; and he constructs radioactive bombs. As life becomes more comfortable and technology more complicated, new factors introduce new dangers; the ingredients for utopia are the agents of new disease. Dr. Dubois’ thesis may sound discouraging to a world looking for a cure-all in medical research, but actually it is affirmative—even hopeful. Once we accept the fact that “complete freedom from disease and from struggle is almost incompatible with the process of living,” we will know that our aspirations cannot be satisfied with health and the easy life. “The viewpoint expressed in Mirage of Health has now become a dominant one in our general culture and encompasses much of current concern with improving lifestyles related to health and promoting greater health consciousness among the public. In this sense, the discussion, although written twenty-five years ago, is perhaps more relevant today than it was then.”—DAVID MECHANIC, University Professor, René Dubos Professor of Behavioral Sciences, and Director of the Institute for Health, Health Care Policy, and Aging Research, Rutgers University

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Insofar as sicknesses are influenced by sociocultural systems, so are means of maintaining the health of individuals. Although much in illness is universal and biological, the health system within any culture is as artificial and changeable as anything else in human society. Indeed, the systems we take for granted can be related to special circumstances of the past century or two. It is the function of anthropology to free us to think about radical changes in our own societies by showing us the many different models which humans have elsewhere developed. The present book does just this, using the forum of an international Congress to discuss also the directions of change.