Bird’s-Eye: Modern medicine is challenging: how can doctors keep up with new developments? How can society afford all the possible treatments for all possible diseases— and if it can’t, how do those decisions get made? And by whom? Some modern medicine is being challenged: we have two articles, one looking at the positive side of such challenges (reduction of antibiotic use in Norway has cut infection rates) and one at the negative (a faked article about vaccine dangers has led to a whooping cough epidemic.) And we lead with the New Yorker and a very fine commencement speech that looks at some of those Big Medical Questions.

* The Velluvial Matrix Atul Gawande The New Yorker

This is a deeper, more fundamental problem than we acknowledge. The truth is that the volume and complexity of the knowledge that we need to master has grown exponentially beyond our capacity as individuals. Worse, the fear is that the knowledge has grown beyond our capacity as a society. When we talk about the uncontrollable explosion in the costs of health care in America, for instance—about the reality that we in medicine are gradually bankrupting the country—we’re not talking about a problem rooted in economics. We’re talking about a problem rooted in scientific complexity.

Half a century ago, medicine was neither costly nor effective. Since then, however, science has combatted our ignorance. It has enumerated and identified, according to the international disease-classification system, more than 13,600 diagnoses—13,600 different ways our bodies can fail. And for each one we’ve discovered beneficial remedies—remedies that can reduce suffering, extend lives, and sometimes stop a disease altogether. But those remedies now include more than six thousand drugs and four thousand medical and surgical procedures. Our job in medicine is to make sure that all of this capability is deployed, town by town, in the right way at the right time, without harm or waste of resources, for every person alive. And we’re struggling. There is no industry in the world with 13,600 different service lines to deliver.

* Norway Conquers Infections By Cutting Use Of Antibiotics Miami Herald

Twenty-five years ago, Norwegians were also losing their lives to this bacteria. But Norway’s public health system fought back with an aggressive program that made it the most infection-free country in the world. A key part of that program was cutting back severely on the use of antibiotics.

Now a spate of new studies from around the world prove that Norway’s model can be replicated with extraordinary success, and public health experts are saying these deaths — 19,000 in the U.S. each year alone, more than from AIDS — are unnecessary.

* Whooping Cough Is Declared An Epidemic In California Parenting

After 910 cases of whooping cough that have left five babies dead, California has officially declared the outbreak an epidemic. If that isn’t bad enough, the case load is 400 percent higher this year than last, putting the state on track to break a 50-year record. With an additional 600 pertussis cases currently under investigation, officials believe things are about to get worse. Those most at risk? Unimmunized or incompletely immunized babies, whose lungs are still developing.

… Of course, this recent outbreak calls into question whether parents who choose not to vaccinate children could be to blame. According to Kidshealth.org, the advent of the pertussis vaccine reduced the annual whooping-cough deaths in the U.S. from between 5,000 and 10,000 people to just 30 a year. Now, like the measles resurgence in 2008, which targeted children whose parents had refused to have their kids inoculated, whooping cough is back on the rise. Last year, the number of whooping cough cases spiked past 25,000, the highest level it’s been since the 1950s.