The United States currently spends 17-18 percent of its gross annual income on health care, about double what most European Union countries spend, said Robert Martensen, director of the Office of History at the National Institutes of Health, while on campus April 12. Most of this money is spent on older patients in their last years.

"However, when we look at longevity, the United States is only about 24th in the world in average life expectancy," said Martensen in a Malott Hall keynote address for the weeklong array of lectures and discussions in Cornell's second annual Sick in America series, this year focusing on "Chronic Illness and Health Care." "We're spending a lot, but we are not adding any survivability," he said.

Martensen has studied the history of medicine, health and science as well as the origins of neuroscience in the so-called scientific revolution, the development of nuclear medicine, and the scientific transformation of U.S. medicine that occurred during the Progressive Era. His most recent book is "A Life Worth Living: A Doctor's Reflections on Illness in a High-Tech Era."

Yet the high spending is not leading to proportional returns on patients' happiness, function or longevity, he said, identifying overuse and misuse of intensive treatments as two of many reasons.

Another problem is that patients' desires are not always taken into account. Survey results show that patients in their final years don't want to be in pain and want their symptoms treated. "They want to avoid inappropriate elongation of the dying process, and they want to have some sense that they know what is going on, that their integrity as a person is being respected," Martensen said.

But instead they often experience what Martensen calls the "agonizing shuttle" of moving back and forth between hospitals and skilled nursing homes.

Hospitals need to facilitate more discussion among patients, families and medical professionals, he said, to ensure that patient desires are respected. He argued that many patients are left in acute hospitals or nursing homes because they never discussed their disease, disease trajectory or options with their families. "Most people don't want to be treated and treated aggressively just to stay technically alive," he said.

Part of the reason why high spending leads to only minimal improvement in care might have to do with the fact that the United States has too many specialists and too few generalists, he said.

"If you look at Boca Raton, Fla., which has the highest density of medical specialists per capita in the world, and compare the risk-adjusted longest living people to that in Pierre, S.D., which has a high density of generalists, people live longer in Pierre, and with higher function in their late years," he said.

Palliative care, he said, is a better form of health care. It centers on the desires of patients and their families and on pain relief and symptom management, rather than treating the disease.

The Sick in America series unites Cornell's seven undergraduate colleges with the Johnson School and Weill Cornell Medical College to lead the discourse on health care problems and solutions.

Farrah Tan '10 is a writer intern for the Cornell Chronicle.