We have altered the impact of many acute illnesses - particularly, of course, the infectious diseases - and as a result there are many more us alive on this planet than there would otherwise have been. Those of us who have survived diseases which would have been fatal a few decades ago are now candidates for developing chronic illnesses, and may require increasing health care resources and dollars. (I am myself an example of that - having been successfully treated over several years for dermatomyositis, a condition similar to lupus, and now surviving to be a potential recipient of health care resources in the future!).

What I have just said may, at first, sound horribly cruel - as if I were a subscriber to the 'devil take the hindmost' school of philosophy. I am, of course, not a believer in that social-Darwinian dictum, but even so we do have to look at why the costs of chronic illness are rising, and at what it is that we are doing now (and have done in the past) that contributes to those costs. We need to do this not necessarily to change things, but so that we can understand why the costs are so important and so high.

The first point is the simple one that I have already stated. As more acute illnesses are treated and successfully fixed, there are more people around who may have consequences of those episodes or develop new ones. The examples are legion. Many people now survive heart attacks that would ave killed them in the past, and now need treatment for heart failure, for blood pressure or of clotting disorders. Premature infants can now survive with birth-weights that were a certain death-sentence a few decades ago. Overwhelming acute infections can be cured and chronic infections such as HIV/AIDS can be controlled. Genetic diseases can be treated and the patients can survive for many decades. The list is basically endless and is still (I'm glad to say!) growing.

These are all things of which our species can be justifiably proud. But there are long-term costs as well.

The human gene pool is no longer "genetically cleansed" by people dying of chronic illness. If it is no longer a death-sentence to have, let's say, disease X, then the gene that confers susceptibility to Disease X will not be “removed” from the gene pool, because the bearer of that gene has not died, and can now pass the gene on to his or her children. To some extent, then, our species has reduced the impact of "genetic cleansing" on our gene pool.

Furthermore, we humans seem to like it that way! Acute illnesses and their dramatic cures are very "sexy" and very "Hollywood". We like reading about them, hearing about them and watching them on television and in films. We like stories that can be told briefly and are quickly understandable. A person receiving CPR after a heart attack makes a great sequence for "E.R". A person with moderately severe rheumatoid arthritis or relapsing multiple sclerosis, slowly recovering function does not make such a “good story”. We tend to pay less attention and we tend to pay less money.

Chronic illness is very "unHollywood". It's very unsexy and in many cases it also reduces the patient's ability to contribute to society and so may exact a heavy toll in terms of resources, of carers and in terms of actual cost and of lost income.

For all those reasons, then, chronic illnesses exact a heavy price from any human society that does not "put the old and infirm out on an ice-floe" when they are no longer useful to the community.

The costs of chronic illness are indeed high - and they are going to get higher - but they are the costs that distinguish us from other animals. The price of chronic illness, and our willingness to bear it, is a major part of the process that we call civilization. We have to accept those costs and be proud of our commitment.