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Memento Mori


Mohan Rao

BEING MORTAL: MEDICINE AND WHAT MATTERS IN THE END
By Atul Gawande
Hamish Hamilton, New Delhi, 2014, pp. 283, Rs. 599.00

VOLUME XXXIX NUMBER 2 February 2015

This is an extraordinary book and the author, Atul Gawande, is an extraordinary surgeon, one sensitive to pain, but more importantly, to history. In my review of one of his earlier books, Complications (a collection of essays previously published in the New Yorker), for The Book Review (Vol. XXVI, No. 7, July 2002), I noted that the ’rich case histories are embellished by an impressive reading of the scientific literature and yet written in an eminently accessible language‘. Using similar methods, Being Mortal addresses an extremely troubling and emotive issue namely, aging and dying. The book has been long-listed for the prestigious Samuel Johnson Prize for non-fiction in 2014 which it richly deserves to win. Across the world people are living longer than they ever did. An extremely popular, if somewhat misplaced, history of health attributes improvement in human health to the almost miraculous power of science and technology and, concurrently, the enormous improvements in the practice of medical care. Physicians, surgeons, cardiologists (seldom pathologists or practitioners of para-clinical subjects, without whom of course clinical medicine is impossible), those infallible God-like men (yes, they are largely men) of grace and power, occupy a hallowed centre-stage. This perspective has as much to do with shallow hagiographic history writing as with the enormous economic power and PR clout commanded by the medical-industrial complex, one of the largest industries in the world. In the real world of course doctors are merely tiny cogs, albeit well paid ones, in a large and relentlessly profit-driven world. More importantly, this positivist history ignores the fact that the last thirty odd years, which saw spectacular advances in medical technology, has been accompanied by very little improvement in population health in even the developed world. Indeed, it has been accompanied by increasing health differentials between the rich and the poor, both within and between countries. Of what use these technological marvels to the 40 million people in the US—the richest country in the world—with no access to medical care? While it is true that medical technology has the capacity to reduce suffering, even if it does not improve population health, it is equally true that these advances are not always guided by epidemiological considerations, or indeed the concerns of patients and doctors. Are doctors, then, merely glamorous sales persons of the industry? Gawande makes the point that doctors, while in training, are not taught to confront aging and the inevitable, ...


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