Sick To Death > Foreword

Sick To Death book cover This extract from the online edition of Sick to Death and Not Going to Take It Anymore! is used with permission.

Sick To Death : Foreword

The Milbank Memorial Fund [ ] is an endowed operating foundation that engages in nonpartisan analysis, study, research, and communication on significant issues in health policy. Since 1905 the Fund has worked to improve and maintain health by encouraging persons who make and implement health policy to use the best available evidence. The Fund convenes meetings of leaders in the public and private sectors and publishes reports, articles, and books.

This is the tenth of the California/Milbank Books on Health and the Public. The publishing partnership between the Fund and the University of California Press seeks to encourage the synthesis and communication of findings from research that could contribute to more effective health policy.

Joanne Lynn is a pioneering clinician in geriatric medicine, an innovative researcher, and an inspiring speaker. Throughout her distinguished career, she has emphasized that the care received by people who are approaching the end of life requires considerable improvement and reorganization from the moment they are diagnosed as having a serious chronic disease.

In recent years, Lynn and her colleagues have conducted extensive research on the experience of persons with severe chronic disease. They also have supported scores of clinical teams trying to improve the services they offer. This research and its pragmatic applications led Lynn to organize data and services around a small number of trajectories of the course of major groups of diseases. These trajectories are models confirmed by the analysis of substantial data. Lynn also assessed the care that patients currently receive as they live these trajectories. This assessment revealed remarkable shortcomings in the usual approaches to care for people nearing the end of life. The most obvious of these flaws are inadequate treatment of pain and other symptoms, ineffectual prevention of disabilities and lack of support for people who must live with disabilities, and insufficient guidance to patients and their families in organizing financial and living arrangements.

This book builds on Lynn’s research and that of others to describe how, in her words, "health care and community services simply do not meet the needs of the large number of people facing a prolonged period of progressive illness and disability before death." Because American society does not "even have the language with which to discuss" this phase of life, physicians and other health professionals and the media too often ignore it.

In this book, Lynn combines knowledge based on research with passionate advocacy of an agenda for far-reaching reforms. She is precise about how policy makers and health professionals could improve care for the growing number of persons with severe chronic disease - and how reliable care could be in place in time for the aging of the baby boom.

Daniel M. Fox

Samuel L. Milbank