The Audacity of Health

The Audacity of Health

The Audacity of Health

Science, technology, and life.
May 2 2008 12:26 PM

The Audacity of Health

Here's one story you'll find there and in this morning's news batch: U.S. surgeons have begun the long process of repairing a 15-year-old Filipino girl, Jingle Luis, whose feet are so clubbed that they've twisted upside down and backward . The AP story explains:

William Saletan William Saletan

Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right.

Jingle's case is more severe than those usually seen by doctors in industrialized countries. "Generally speaking, with modern technology, it doesn't get to this point," said Dr. Terry Amaral, a pediatric orthopedic surgeon who performed the surgery. ... Clubfoot is a relatively common deformity, occurring in about one in 1,000 births. Children are usually treated in infancy with casts or braces that gradually bring the feet into correct alignment. The condition becomes harder to treat if it is not corrected early on.


It sounds like Jingle wasn't treated as a baby because the Philippines lacked the necessary technology. But that's not what happened. Read further:

Amaral said Jingle's case was complicated by the fact that her clubfoot was associated with spina bifida. ... He said doctors who saw Jingle as a baby thought that her spina bifida would shorten her life span and prevent her from walking, so they did not treat the clubfoot. "They felt it wasn't worth managing because of the life expectancy, so they decided to leave it alone," Amaral said.

This is a major factor in treatment decisions around the world. Often, the problem isn't that doctors in less-developed countries can't fix you. It's that resources are limited and that in this context, life-expectancy projections come into play.

In Jingle's case, doctors misjudged the severity of her spina bifida. If she'd been born in the U.S., it's likely that her doctors would have recognized that the defect wasn't so bad. But it's also likely that they would have calculated her prospects differently altogether. That's because life expectancies differ significantly between rich and poor countries, and life expectancies for infants with significant health problems differ even more. Life expectancy isn't a purely biological calculation. It's a socioeconomic calculation.

The interplay of economic progress, life expectancy, and treatment decisions doesn't end in childhood, or with the case of one disabled girl. In fact, it's going to be one of the most powerful forces driving the world in this century and beyond. Thanks to economic and technological progress, life expectancies are rising around the world. Some of this is due to reductions in child mortality. But a lot of it, if not most, is due to increases in the length of old age. As we conquer diseases and improve public health, people in India, China, and elsewhere can expect to live many years longer. That, in turn, is transforming calculations about which conditions are worth treating. If the average woman in Shanghai is probably going to make it to 75 instead of 65, a disease that strikes her at 60 and would take five years to kill her becomes, in utilitarian terms, a disease worth treating.

What's happening, in short, is an increase not just in our technological ability, but in our moral expectations. It's a wonderful thing. But it's going to be incredibly expensive.