The Rise and Fall of Modern Medicine Read Free Page B

faith in them. 6
Paradox 4 : The Spiralling Costs of Health Care
    The more that medicine ‘can do’, the higher will be its cost, which will be further compounded by the continuing rise in the numbers with the greatest need – the elderly. Neither of these two factors, however, can begin to account for the massive escalation in the resources allocated to health care. Thus the budget of Britain’s famously ‘cheap and cheerful’ National Health Service doubled from £ 23.5 billion in 1988 to £ 45 billion in 1998. This financial largesse suggests that the almost universal belief that the problems of the Health Service would simply be solved by more generous funding, must be incorrect. 7
    In summary, then, the four-layered paradox of modern medicine is why its spectacular success over the past fifty yearshas had such apparently perverse consequences, leaving doctors less professionally fulfilled, the public more neurotic about its health, alternative medicine in the ascendancy and an unaccounted-for explosion in Health Service costs.
    It is important to keep a sense of proportion about all this. In general, doctors do find fulfilment in their work, and in general people appreciate the benefits of modern medicine, as anyone whose mobility has been restored by a hip replacement or whose spirits have been lifted by an antidepressant will testify. But the same point could be put the other way. It is precisely because medicine does work so well that the discontents reflected by these paradoxes are worthy of explanation.
    These are complex matters and there are many reasons for each of these paradoxes. But ‘History is a high point of advantage from which alone men can see the age in which they are living’ (G. K. Chesterton), and from the high point of advantage of a historical perspective on medicine’s last fifty years it is possible to perceive there might also be a unifying explanation that can be inferred from the chronology of Definitive Moments – with the massive concentration of important innovations from the 1940s through to the 1970s followed by a marked decline. There has been, as suggested in the title of this book, a ‘Rise and Fall’, which provides the key to understanding the paradoxical discontents of modern times.
    But when this historical account opens, such matters are still a long way off. Imagine, rather, that Europe is in the throes of war, children are still dying from whooping cough and polio, the inmates of mental asylums are lucky to see a doctor from one year’s end to the next, and curing cancer or transplanting organs seem like unattainable fantasies. And yet there is a terrific sense of optimism in the air. Medicine’s greatest epoch has already begun, and the possibilities of science seem limitless.

The Lord hath created medicines out of the earth;
and he that is wise will not abhor them.
    E CCLESIASTICUS 38:4

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M EDICINE’S B IG B ANG
    I n an influential essay, ‘Science: the Endless Frontier’, published in 1946, the American physicist Vannevar Bush described science as ‘a largely unexplored hinterland’ that would provide the ‘essential key’ to the economic prosperity of the post-war years. He himself had participated in ‘the greatest mobilisation of scientific power in the history of the world’, the Manhattan Project, which at a cost of $2 billion had built from scratch in under five years the first atomic bombs, which had been dropped with such devastating effect on the Japanese cities of Hiroshima and Nagasaki. This awesome power unleashed by atomic fission would, predicted Bush, soon cease to be a ‘jealously guarded military secret’, becoming instead ‘a source limitless energy’ in the service of peace and industrial progress.
    Vannevar Bush’s optimistic anticipation of science’s ‘endless frontier’ was to be repeatedly vindicated over the following twenty