[00:08.08]It is said that in England death is pressing,
[00:11.41]in Canada inevitable and in California optional.
[00:18.32]Americans' life expectancy has nearly doubled
[00:21.43]over the past century.
[00:24.06]Failing hips can be replaced,
[00:26.28]clinical depression controlled,
[00:28.80]cataracts removed in a 30-minuts surgical procedure.
[00:32.73]Such advances offer the aging population a quality of life
[00:36.80]that was unimaginable when I entered medicine 50 years ago.
[00:41.84]But not even a great health-care system
[00:44.22]can cure death--and our failure to confront
[00:47.45]that reality now threatens this greatness of ours.
[00:52.29]Death is normal;
[00:53.49]we are genetically programmed to disintegrate and perish,
[00:57.32]even under ideal conditions.
[01:00.34]We all understand that at some level,
[01:03.37]yet as medical consumers we treat death
[01:05.99]as a problem to be solved.
[01:08.21]Shielded by third-party payers from the cost of our care,
[01:12.75]we demand everything that can possibly be done for us,
[01:16.28]even if it's useless.
[01:18.19]The most obvious example is late-stage cancer care.
[01:22.83]Physicians--frustrated by their inability
[01:25.56]to cure the disease and fearing
[01:27.67]loss of hope in the patient
[01:29.89]--too often offer aggressive treatment far beyond
[01:33.71]what is scientifically justified.
[01:36.84]In 1950, the U.S. spent $12.7 billion on health care.
[01:42.91]In 2002, the cost will be $1,540 billion.
[01:50.27]Anyone can see this trend is unsustainable.
[01:53.80]Yet few seem willing to try to reverse it.
[01:57.12]Some scholars conclude that a government
[01:59.65]with finite resources should simply
[02:01.70]stop paying for medical care
[02:03.91]that sustains life beyond a certain age--say 83 or so.
[02:09.56]Former Colorado governor Richard Lamm
[02:12.21]has been quoted as saying
[02:14.33]that the old and infirm
[02:16.24]"have a duty to die and get out of the way"
[02:19.26]so that younger, healthier people can
[02:21.28]realize their potential.
[02:23.80]I would not go that far.
[02:26.31]Energetic people now routinely work
[02:28.80]through their 60s and beyond,
[02:31.02]and remain dazzlingly productive.
[02:33.84]At 78, Viacom chairman Sumner Redstone jokingly
[02:37.98]claims to be 53.
[02:40.60]Supreme Court Justice Sandra Day O'Connor
[02:44.02]is in her 70s,
[02:45.43]and former surgeon general C. Everett Koop chairs
[02:49.03]an Internet start-up in his 80s.
[02:52.16]These leaders are living proof
[02:54.25]that prevention works and
[02:56.08]that we can manage the health problems
[02:58.19]that come naturally with age.
[03:00.51]As a mere 68-year-old, I wish to age
[03:03.74]as productively as they have.
[03:07.05]Yet there are limits to
[03:08.31]what a society can spend in this pursuit.
[03:11.73]As a physician,
[03:12.94]I know the most costly and dramatic measures
[03:16.16]may be ineffective and painful.
[03:19.50]I also know that people in Japan and Sweden,
[03:22.92]countries that spend far less on medical care,
[03:25.84]have achieved longer, healthier lives than we have.
[03:30.18]As a nation,
[03:31.31]we may be overfunding the quest for unlikely cures
[03:34.95]while underfunding research on humbler therapies
[03:38.48]that could improve people's lives.内容来自 听力课堂网：http://www.tingclass.net/show-8686-251450-1.html