NEW YORK -- Ezekiel Emanuel, MD, holds up a from the AARP featuring two aging hikers. "When the view goes on forever, I feel like I can too," it reads. "Go long."
Emanuel, interviewed here today at the , was perplexed: "What is that about?"
What it might have been about was Emanuel's provocative piece in this month's Atlantic, "." That piece made one physician say Emanuel's ideas were dangerous, and also sparked a robust discussion about whether the goals of healthcare should be different in old age.
For Emanuel himself, that means stopping statins and antihypertensives, and declining antibiotics. "That's the most controversial thing," he said, adding, "There's no compulsion, requirement, necessity that says you need to take antibiotics."
Today, Emanuel acknowledged that while 75 was based on studies of when disability begins to overtake productivity and creativity, it was a "slightly random number."
What it's really about, he said: "You've got 75 years. What are you going to make of it? I want to substitute quality for quantity in the meaning of life."
In the early 1900s, longer and healthier life became possible as public health made great strides in infant mortality and prevention and treatment of infectious diseases. The extra years we gained in the last half of the 20th century, however, have meant a different bargain.
"Almost all of the advances since that time have really been about getting older people with chronic illness to live a little bit longer," Emanuel said.
"As we've added more years of life, we've added more years of disability," he added. "That doesn't strike me as a great deal."
The U.S. needs to refocus energies on infant morbidity and mortality, he said, citing high preterm birth rates, and on adolescence, during which accidents and violence strike more teens than in any other country.
But the final stages of life also demand attention: "We need to guarantee that anyone who wants palliative care for their symptoms gets it, whether in the hospital or in the home." Seventy percent of people with cancer used to die in the hospital, Emanuel said. Now, in a bit of what he called progress, that figure is 22%.
Random number or not, Emanuel was serious about 75. But he wanted to clear things up: "I'm not planning at 75 to commit suicide and ask my doctor for euthanasia."