The Rise and Fall of Modern Medicine Read Free Page A

S. Eliot – ‘the historical sense involves the perception not only of the pastness of the past, but of its presence’ – maintain it is not possible to understand the present, and in particular present discontents, outside of the context of this recent past. And what is the nature of these ‘present discontents’? Any account of modern medicine has to come to terms with a most perplexing four-layered paradox that at first sight seems quite incompatible with its prodigious and indubitable success.
Paradox 1 : Disillusioned Doctors
    The success of modern medicine should make it a particularly satisfying career, which indeed it is, but recent surveys reveal the proportion of doctors ‘with regrets’ about their chosen career increased steadily from 14 per cent of the 1966 cohort to 26 per cent of the 1976 cohort to 44 per cent of the 1981 cohort and to 58 per cent of the 1986 cohort. 2 These findings should not be taken at face value, as spasms of self-doubt may become commoner for any number of reasons. Nonetheless, they would seem to be symptomatic of a genuine – and serious – trend. Until very recently – and in marked contrast to the experience of the other liberal professions – virtually all medical graduates went on to practise medicine. But no more. In 1996 one-quarter had no plans to work in the National Health Service,accounting for both the progressive decline in the numbers entering general practice and many hospitals reporting difficulties in recruiting junior doctors. Why should it be that today’s young doctors are so much less content than those who qualified thirty or more years ago?
Paradox 2 : The Worried Well
    The benefits of modern medicine in alleviating the fear of illness and untimely death should have meant that people are now less worried about their health than in the past. But once again, the trend is the reverse of that anticipated. The proportion of the population claiming to be ‘concerned about their health’ over the last thirty years has also increased in direct parallel to the rise in the number of ‘regretful’ doctors – from one in ten to one in two. 3 And the most curious thing about this phenomenon of the ‘worried well’ who are ‘well’ but ‘worried’ (that they might not be) is that it is not simply symptomatic of privileged life in the West, where ‘people don’t know when they are well-off’, but that it is medically inspired. The ‘well’ are ‘worried’ because they have been led to believe their lives are threatened by hidden hazards. The simple admonition of thirty years ago – ‘Don’t smoke, and eat sensibly’ – has metamorphosed into an all-embracing condemnation of not just tobacco but every sensuous pleasure, including food, alcohol, sunbathing and sex. Further, every year brings a new wave of ‘dangers’, posed by low-fat milk and margarine, computer screens, head-lice shampoo, mobile phones and much else besides, with Britain’s Chief Medical Officer warning that eating three lamb chops a day or its equivalent increased the risk of cancer. 4 This is ‘Healthism’ – a medically inspired obsession with trivial or non-existentthreats to health whose assertions would in the past, quite rightly, have been dismissed as quackery. 5
Paradox 3 : The Soaring Popularity of Alternative Medicine
    The demonstrable success and effectiveness of modern medicine should have marginalised alternatives such as homeopathy and naturopathy into oblivion. Not so. In the United States there are more visits to providers of ‘unconventional therapy’ (425 million) than to ‘primary care physicians’ (388 million annually). As the efficacy of alternative therapies is not routinely tested in clinical trials (which does not mean they do not work), it is only natural to ask why the public should appear to have so much