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September
2001
Eating Your Heart
Out
Anyone who has survived
a brush with death deserves to celebrate. And, so, on the one-month
anniversary of getting the world's first self-contained artificial
heart transplant, Robert Tools celebrated, with his doctors' blessings,
by eating ice cream and cheesecake.
With two previous heart
attacks, bypass surgery, congestive heart failure and diabetes behind
him, Mr. Tools was, in that moment, the very picture that illustrates
both the triumph of American medicine and its Achilles heel.
The triumph is that our
romance with the quick fix for health has come true.
Want your muscles to
ripple without touching the weights? Load up on legal megadoses
of creatine. Sat on your couch all your life and your heart is giving
out? Sign up for a self-contained cardiac implant. Ate yourself
into blimpdom? Get medically safe gastric bypass surgery. High tech
medicine not working? Join the 42 percent of Americans who spend
$27 billion annually on alternative therapies.
And the romance continues
to grow and thrive as scientists promise cures for devastating and
costly diseases, such as cancer and Alzheimer's disease, pending
the investment in, first, the decoding of the human genome and,
now, stem cell research.
Don't get me wrong. The
potential of modern medicine to improve health is breathtaking.
But Robert Tools, with his ice cream and cheesecake, is the symbol
of medicine's Achilles heel - human behavior, the thing that stands
between the promise of biomedicine and its fulfillment.
Behavior - mine, yours,
our family's, our doctor's, our health plan administrator's, our
politicians' - mediates every application of biomedical technology.
Whether it is taking the right medicine the right way or having
access to and making the best possible use of an expensive artificial
heart or a precious human one, the success of the technology depends
on behavior.
While we know quite a
bit about behavior, we have a tremendous amount still to learn and
apply. Only 10 percent of the NIH budget for research is spent on
behavioral and social sciences. At a time when the NIH funding is
being doubled, we must ask two questions: Can it absorb all that
money in useful biomedical research? When it comes to behavior is
a 10 percent solution enough?
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