Monday, December 7, 2009

PAGING DR. TRUDEAU


A hundred years ago people mattered in healthcare. They had to, since we knew so much less about medical science.

The leading incurable disease of that day was tuberculosis. A prominent specialist, Dr. Edward Livingston Trudeau, having long pondered what could be done for these people, developed the first sanitarium. There, on the shores of Lake Saranac, New York, he gave his patients standard contemporary treatment and also offered them respite from cities’ crowded tenements. Residents benefited from clean air, decent food, and a serene environment. My own aunt’s two years at Trudeau’s establishment granted her another seven decades of life.

The sanitarium is now a research facility. Vines partly cover a statue of Trudeau. A brass plaque at its base commemorates his treatment motto:

“Cure sometimes,
Relieve often,
Comfort always.”

After Trudeau’s era, tremendous scientific advances treated tuberculosis so effectively that sanitoria closed. Antibiotics saved thousands or even millions who would previously have died from other infections. Immunizations and public health measures fairly wiped out polio, and smallpox now exists only in vials in a few laboratories. We’ve learned to sew on limbs and transplant most vital organs. Scientific success has been so brilliant, as a matter of fact, that sick people’s softer requirements can appear rather dull and mundane in comparison.

Scientific success has a curious shadow, though: in reducing deaths from acute infectious diseases and trauma, it’s created a sea-change in disease demographics.

I mentioned in an earlier blog entry that the proportion of short-term to long-term diseases reversed during the past fifty years. Whereas two-thirds of medical visits had been for short-term problems, now two-thirds are for long-term problems. That’s pretty dry info until you realize that long-term problems are long-term only because we can’t cure them.

Most cases of today’s leading diseases—arthritis, cancer, and cardiovascular, autoimmune, and metabolic disorders—are entities people need to live with the rest of their lives. We docs can ameliorate symptoms and probably extend survival, but we can’t cure these diseases. In other words, tuberculosis is under far better control than it was in Dr. Trudeau’s time, but now we’re confronted with equivalents just as frustrating.

It makes sense, then, to revive his motto,

“Cure sometimes,
Relieve often,
Comfort always.”

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