Dr. Roach: The (slowing) march of medical advancement

Keith Roach
To Your Health

Dear Dr. Roach: Are medical advances going backward? If not, why are so many people dying in their 50s and 60s? Just look at the obituaries. By now, we all should be living into our 80s and 90s. What's your take on this subject?

— R.S.

Dear R.S.: Medicine has made incremental benefits on many fronts. There have also been dramatic, life-changing improvements in a few, and utter failures in others.

If you look at mortality rates in the past two years compared with previous years, the longstanding trend of improvement has been reversed. There are two major reasons.

Dr. Keith Roach

The first is that far too many people are dying as a complication of drug overdose, largely due to prescription drugs. This is both a societal and a medical system failure. Drug addiction treatment is handled terribly by the medical system, and I am ashamed to say, by medical professionals as well. While compassion and correct medical practice can be effective, if not perfect, it is too often never given. Increasing deaths from overdose and suicide have been a major reason that younger and middle-aged people are dying before they should.

The second, of course, is COVID-19. The number of deaths from COVID-19 appears to be far higher than official reports. Recent studies estimate 700,000 to over 900,000 deaths so far in the U.S. from COVID-19, far more than the 580,000 reported deaths as of this writing. While most of these deaths are in people over 70, the excess deaths among middle-aged adults, young adults, adolescents and children due to COVID-19 are still very large. Public health maneuvers and rapid vaccine development have prevented many more deaths and untold suffering and disability, but the public health system of the world could and should have done better. While I admire many of the scientists who developed and tested treatments and vaccines, front-line workers who continue to labor ceaselessly on behalf of their patients and some public health officials who tried to sound the alarm and put in place the measures that could have helped, this is a colossal tragedy that did not have to be as bad as it has been.

Having everyone living with good health into their 80s or 90s is an untenable dream for the foreseeable future. There are too many ways the body can fail, too many ways in which our world can cause even a healthy person to die accidentally and too many barriers to people achieving their best health.

Dear Dr. Roach: I'm a 78-year-old female and sometimes have a burning sensation when I urinate, usually at night. It seems to be when I drink less water. Why is this happening now, and hasn't happened in the past?

— P.P.L.

Dear P.P.L.: Although a urinary tract infection is the first thing to think about, highly concentrated urine — what happens when you haven't been drinking a lot of fluids — is irritating to the lining of the urethra. Since men have a much longer urethra than women, this phenomenon is quite frequent in men. But discomfort when urinating isn't restricted to men. It can be made worse when a person drinks even less, sometimes without being aware they are doing do, in order to urinate less and thus avoid discomfort. Treatment is to dilute the urine so it isn't irritating, by drinking enough water.

In older women, the lining of the urethra may become thinned due to loss of estrogen. This also predisposes a woman to urine infections. The vulva and vagina may also be affected, leading to irritation and sometimes painful intercourse. One common treatment is topical estrogen cream.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.