The Role of Medicine: Dream, Mirage or Nemesis?

Germ theory; biological terrain; iatrogenic damage; vaccination. Flyleaf notes: // In analyzing the factors that have improved health and enhanced longevity during the last three centuries, Thomas McKeown contends that nutritional, environmental, and behavioral changes have been and will be more important than specific medical measures, especially clinical or "curative" measures. Dr. McKeown argues that, because of the assumption--widely held since the seventeenth century--that the body can be regarded as a machine whose protection from disease depends primarily on internal intervention; the role of medicine is distorted, medical science and services are misdirected, and society's investment in health is misused. He suggests that much greater attention should be given to external influences, which might in principle be controlled, and to the majority of patients--particularly the mentally ill, the aged sick, and the mentally deficient--who have completed investigation and treatment but who nevertheless are in need of care. What this calls for, Dr. McKeown concludes, is a greater emphasis on the origins of disease and on the care of patients who provide no scope for active measures. // Important features of this book are an interpretation of human health history, a comprehensive analysis of medical achievement, a new classification of disease, consideration of the significance for medical practice of the conclusions concerning the major influences on health, and an extended discussion of concepts of health and disease, particularly as they relate to the parts played by nature and nurture. The author also emphasizes the importance of distinguishing between the role of medicine as clinical practice, and its larger role as an institution that must be concerned with nonpersonal and behavioral influences on health, as well as with personal care. // Thomas McKeown is Professor of Social Medicine Emeritus at the University of Birmingham in England. This book is a revision of his 1976 Rock Carling Lecture, previously published in a small edition.