Neil Schluger
Professor; Columbia Univ. Medical Center; Columbia Mailman School of Public Health

How much medicine is too much medicine?

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With the global population exploding, is there a limit to how much effort we should put into keeping everyone alive as long as possible?

Neil Schluger

Dr. Neil W. Schluger's  main area of academic interest has been in tuberculosis, including clinical trials, molecular epidemiology, development and evaluation of diagnostics, and human host immune responses. He is the principal investigator at Columbia University for the Tuberculosis Trials Consortium, a CDC-funded collaboration in clinical trials in which patients are enrolled in trials of treatment of latent tuberculosis infection and active tuberculosis disease. In addition, Dr. Schluger has led studies examining the transmission dynamics of tuberculosis in New York City, using tools of molecular epidemiology. He has a long standing interest in the development and evaluation of new tools for the diagnosis of tuberculosis.

 More recently, in addition to his studies in tuberculosis, he has led clinical trials for the use of retinoids in the treatment of emphysema and for the use of interferon gamma in the treatment of idiopathic pulmonary fibrosis.


Question: With the global population exploding, how much health care is too much?


Neil Schluger: Well, the natural life span is probably between 100 and 120 years. That seems to be about what people can handle. It’s true that in the United States and other established market economy countries, wealthy countries, we spend a tremendous amount of money at the end of life. Now I’m one of these people who thinks that everybody’s life is of equal value. The life of an 85-year-old is just as precious as a 12-year-old and they’re entitled to as many efforts to save their life as a younger person, and I don’t think one can say that well, a 12-year-old or a 20-year-old because they have so much more potential years ahead of them is more valuable as a human being than someone who is 85. On the other hand, I think we have to be cognizant that when we spend money for health care it should be for health care. Sometimes we spend money just prolonging the dying process and that’s clearly I think the wrong thing to do not just from a financial point of view but from a human point of view. If all we’re doing is increasing someone’s suffering and not really doing anything that can meaningfully prolong their life in a way that has value to them, then I think we shouldn’t do that, but it sort of raises I think a larger issue, your question, about how we can make the population generally healthier. As everyone knows and it’s been widely reported, we spend more money on health care in the United States than any other country but we don’t seem to be the healthiest people on earth. We don’t live longer than other people. In fact, we live less long than people in many countries. Infant mortality in the United States is higher than it is in many countries who spend less money on health care than we do so I think we could be getting more out of the money we spend on health care, and one of the ways to do that is to think about public health approaches to improving the health of the population. And I always like to point out that frankly the person who’s done more for the health of New Yorkers in the last several years than anyone is the mayor and that’s because he’s really made it so difficult to smoke cigarettes in New York. It’s very expensive and you can’t do it in public and smoking rates have dropped quite a bit in New York. That’s a good example of a public health approach to a problem. All sorts of things affect health, not just medicine, legal things, economic things, cultural things, social things. All these things address health, impact health, and I think if we realized that we’d get a lot more out of the money we spend on health care.


Recorded on: 04/25/2008