Manuel J, Lipson MDarticles



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Lyceum speaker: Brave new world of medicine awaits

Doctor sees routine delays for elective surgery and various levels of health care

by Jane Eklund
Monadnock Ledger Staff

PETERBOROUGH--Imagine a world in which most people live to be 120. Imagine shopping for genes you'd like your child to have--genes for intelligence or speed, for instance. Imagine being able to have your head transplanted onto the body of a 20-year-old.

It's all going to happen, says Dr. Manuel Lipson, because such things are already scientifically possible.

"The rule in medicine is that if it can be done, it will be done," he said at Sunday's Monadnock Summer Lyceum. "You can't uninvent the atomic bomb; you can't uninvent the television."

Lipson is a pioneer in the study and practice of physical medicine and rehabilitation at Harvard Medical School and Massachusetts General Hospital. In his talk at the Unitarian Church, he presented his predictions for the future of medical care, and its costs.

There's lots of good news on the medical front, Lipson said. New drugs, rehabilitation practices and surgical techniques can prolong life and the quality of life. Drugs will be available to cure cancer, heart disease and strokes.

New growth factors will be implanted into the brain to repair brain injury. Instead of transplanting organs, new cells will be transplanted to help the defective organ repair itself.

Depression and high cholesterol are already being treated effectively with drugs.

The bad news is that costs are rising. In 1974, health costs were seven percent of the gross national product.

Now, they're 12 percent, and still going up.

The government's solution is to pass the costs on to providers, rather than consumers, Lipson said.

That means people with illnesses will receive less care: fewer days in the hospital, fewer physician visits, less hospital staff.

It could also mean increased use of capitation, a physician incentive plan that financially rewards doctors and hospitals that order fewer treatments and tests, he said.

Increased costs could mean routine delays for elective surgery like hip, knee and prostate surgery, under the assumption that the patient may get better of his or her own, may decide against surgery, or may die before the operation is done.

Because people are living longer, healthier lives, the retirement age will likely go up, as will the minimum age for the federal Medicare insurance, Lipson said. "We are five years younger than people who were the same age 10 years ago," he noted.

The number of uninsured will go up, and those who are insured will fall into different levels of care, depending on how much they're able to pay for insurance, he predicts.

People who are financially well off will have access to more and better care, he said. "Some of my patients are starting to tip nurses and therapists and doctors," he added to ensure quality care and attention.

Preventive medicine is seeing a shift in focus, Lipson said.

The most important thing for doctors to identify in a patient, in terms of preventing illness, is depression and stress. That's followed by a focus on cutting down hypertension, smoking and high cholesterol counts.

But, Lipson, who admits he's in the minority on this one, says exercise and balanced diet have little health value, according to scientific studies.

The only diet that has some effects is a diet that leaves one just a bit hungry, he said. Being in good shape does help when it comes to recovering from an illness or operation, he said.

Vitamins, too, have little worth, Lipson said, with the exception of folate, which is critical for pregnant women in terms of increasing the odds of giving birth to a healthy baby, and the possible exception of vitamins B and E, which produce very small benefits.

Nontraditional medicine is growing in use, and now accounts for one-third of health dollars spent, said Lipson, who called most such medicine "bogus."

What also does Lipson see for the future of medicine? Here's a few of his predictions:

  • In addition to implanting beneficial genes, people will be able to have undesirable genes--the gene for grumpiness, for example--knocked out.
  • Genetic diseases, like early Alzheimer's and cystic fibrosis, will be eliminated.
  • Gene implantation will lead to different species of humans, the same way we have different species of cats and dogs.
  • Cloning is inevitable, and could raise legal questions about whether a baby produced exactly from an adult would be the adult's child or sibling, he said.
  • Lifestyle drugs will continue to grow in popularity. These include drugs for diet, hair growth, sexual potency and improving moods, he noted. "Coffee is a lifestyle drug," said Lipson.
  • Whole body transplants will be possible. They're already being done on monkeys, Lipson said. "You keep your old brain, but you get a 20-year-old body," he said.