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medicine's woes « Previous | |Next »
June 1, 2007

Is medicine facing an era of perplexing stagnation? It would appear to be so. Consider the remarks below by Richard Horton in the New York Review of Books, made whilst reviewing James Le Fanu's The Rise and Fall of Modern Medicine: The argument of the book is that despite the significant advances in combatting disease which reached their peak in the post-war years, the promise of modern medicine at the end of the century has failed to materialise. Horton says:

Doctors are disillusioned by their profession; they increasingly have to deal with "the worried well" rather than the genuinely sick; they have to contend with the puzzling and, for many physicians, irritating popularity of alternative medicine; and the costs of diagnosis and treatment are escalating at a rate that is not matched by advances in knowledge. From the 1970s onward, there has been "a marked decline" in innovation. And, worst of all, doctors have experienced a "subversion, by authoritarian managers and litigious patients, of the authority and dignity of the profession.

The medical profession has problems and is in trouble. Le Fanu's account is one of the fall of medicine. After the golden age---when medical science has reached its natural limit---medicine has suffered from the retreat from rationality that marked the latter part of the twentieth century.

Le Fanu, who longs for the past authority enjoyed by doctors and for the deference that such authority demanded from patients, argues that the intellectual vacuum of the late 1970s was filled by two different sets of ideas, which emerged from two specialities which up until then had played only a marginal role in postwar medicine: genetics and epidemiology (the study of the patterns of disease). The developments in "the new (molecular) genetics," opened up the possibility of identifying the contribution of defective genes to disease. The epidemiologists insisted that most common diseases, such as cancer, strokes and heart disease, were due to social habits-an unhealthy lifestyle or exposure to environmental pollutants. Le Fanu says:

the great promise of the new genetics or of the social theory of disease has not held up according to the author. The amazing strides in our knowledge derived from molecular biology led to the rapid acceptance of the possibilities of gene therapy but these have emphatically failed to deliver, despite the intellectual satisfaction that these smart ideas generate. Similarly, in the wake of studies showing a clear epidemiological correlation between smoking and lung cancer the social theory has sought to link almost every disease for which there is not an obvious infectious cause to some lifestyle or nutritional source mostly blamed on Western society.

Le Fanu's opposition to the social theory of disease---how you live influences how you die-- is greater than his skepticism of genetics.

Their failure explains "the fall" of modern medicine and the source of its present discontents associated with unhappy doctors and the worried well. Raymond Tallis in Hippocratic Oaths: Medicine and Its Discontents gives expression to the former.The crisis in medicine is not a crisis in the practice of medicine or within the system of our health care. The crisis lies within the profession and is due to the acute loss in status that doctors have felt in recent years. Medicine is in danger of becoming "the first blue-collar profession". Doctors are now little more than tradesmen. Tallis sees medicine through doctors' eyes--not the eyes of autonomous patients'.


| Posted by Gary Sauer-Thompson at 2:41 PM |