There are certainly “heroic measures” in oncology where the success rate is low enough to question whether its worth undertaking at all, but there are also plenty of procedures that have a very strong and easy to measure positive effect on survival rates.

I think Steve Jobs had the right idea and probably prolonged his life by first declining surgeries that would have resulted in metastasis.

How many women would be better off NOT knowing about every little node before it gets reabsorbed by the body? It’s as if mastectomies (and prostate therapies like Rudolf Julie-Annie submitted to) are signifiers for upper-middle class health insurance coverage or something.

However, the “low hanging fruit” is always the first, the fastest, the simplest, and the cheapest to pluck. Since the mid 1800′s, scientists and engineers have been plucking the low hanging fruit – and gradually moving higher. As we invent increasingly powerful medicines and machines, the expectations of patients and users has also risen. Perhaps for the first time in history, some people consider metaphysical perfection to be at least a possibility in the real world.

The challenges ahead of us are exponentially more expensive and difficult to master than the ones we have already achieved. But our tools are far more powerful and sophistocated than ever before. Science, and scientists, are not failing anybody.

“(According to the Centers for Disease Control and Prevention, things like clean water and improved sanitation—and not necessarily advances in medical technology—accounted for at least 25 of the more than 30 years added to the lifespan of Americans during the 20th century.)”

But those are part of advances in medicine, in a more broad sense. Doctors do public health too, and were involved in the beginnings of clean water as a public health idea.

One thing that has surprised me about the rise of India and China is that they haven’t done more drug and medical device development themselves, given that they can set their own ethics requirements, and that setting them lower than the west (which there’s a good bit of scope to do, without getting horrifying about it) should speed time to market. I’m sure with data from sufficient actual patients in those countries the EU and US would yield to customer pressure to allow them licences in the rich world.