Next medicine
Authors: Stanley Goldfarb
Journal: Journal of Clinical Investigation (2011)

The United States is going through a wrenching period, confronting an age-old conflict in democratic societies: the struggle between individual responsibility and equality of outcome, also known as social justice. The clearest example of this conflict is found in the debate over health care reform, and the current political battle involving the 2010 Patient Protection and Affordable Care Act centers precisely around this schism. Walter Bortz, a gerontologist, a former co-chairman of the American Medical Association’s Task Force on Aging, a past president of the American Geriatrics Society, a marathon runner, and an all-around healthy 80 year old, has waded into this debate with his book, Next Medicine: The Science and Civics of Health. 

The awkward title is a pretty good indicator of the overall awkwardness of the book. In it, Bortz purports to present the “next” health care model that he believes will cure what ails us. Bortz does manage to charm his reader at times, particularly at the beginning of the book, which is a whirlwind and surprisingly engaging trip through the history of medicine, natural science, biology, and health economics. However, the text then veers off into a new-age, self-discovery trope and a critique of our now thoroughly beaten down health care system.

After the flyover of two or three millennia of intellectual and scientific history, Bortz, the model of the engaged, active, and healthy octogenarian, lays out a prescription for a new approach to health care that emphasizes some very old ideas. He extols the virtues of exercise and fitness as the best approach to creating a healthy nation. He marshals a host of data to support this idea and goes on to propose a 100-year life expectancy for those who maintain a Plato-inspired life that is in harmony with nature and is focused on achieving the “Golden Mean” as the true source of happiness. So far so good, but this is not a very revolutionary concept, and his prescription for longevity is less charming than his prose about the history of medicine. Moreover, Bortz’s vision is simplistic and perhaps overly optimistic in a nation in which a high percentage of the citizens engage in unhealthy activities like smoking. It is undeniable that disease prevention and fitness are crucial to improving the health of the country, but Bortz offers little insight into how the nation might achieve these goals.

Bortz takes on the issue of how to organize a health care system, and here too, the assessments seem rather stale. He is very upset at the high cost and unequal access that plague the American health care system. He points a finger at the pharmaceutical and medical device industries, a good chunk of the medical establishment, and the capitalist nature of the health care economy as the real source of these problems. He ties advances in medical technology to increases in cost and believes that the ever increasing reliance on technology dooms the American health care system to failure. He even implies that the American system actively discourages the sort of simple and effective approaches to preventive care that would actually reduce the cost of care. Finally, he makes an impassioned plea for the application of social justice to the delivery of health care and decries what he sees as the inherent inequality of the American economic system. All of these points have been debated and continue to be debated in the health policy sphere, but in Bortz’s work I fail to find any new insights or an attempt to provide a realistic set of solutions to deal with the burden of an aging population confronting ever increasing health care costs. Creating a nation of fitness buffs may be a worthy goal, but it does not seem like a sufficient plan for a Medicare system that is facing massive future deficits.

Unfortunately, Bortz does not seem to appreciate the inconsistencies in his own proposals to reform the American health care system. His espousal of social justice is undercut by his suggestion that anyone who refuses to become fit through exercise and careful dietary choices should pay more for their health insurance. He promotes universal health coverage, but apparently he does not support alternative insurance approaches like high deductible plans or health savings accounts that, like marathon running, place a burden on the individual to make responsible choices about how they spend their health care dollars and how they maintain their health. You really cannot have it both ways in proposing a functional national health care insurance plan.

Reading this book, particularly the portion devoted to extolling Bortz’s ideas about disease prevention, is a rather tedious endeavor. I do not think that many scientists or clinicians will find this work very satisfying or useful. On the other hand, it is not a bad self-help book for educated, non-science-oriented individuals, looking for an overview of preventative medicine and the history of science.