Modern Medicine's Shortcomings: Can We Really Conquer Disease?

MODERN MEDICINE'S SHORTCOMINGS: CAN WE REALLY CONQjUER DISEASE?* DAVID P. GOLDBLATTt Medical science is in a predicament; it has the responsibility of finding ways of reducing the amount of sickness and death that pervades our society. Infectious and nutritional diseases, the scourge of the nineteenth century, are now largely under control; but we are still left with the unchecked ravages of chronic diseases (in particular, coronaryartery disease, stroke, and cancer) and accidents. Chronic diseases are affecting more and more people who suffer with them for long periods of their lives; these diseases are also responsible for the majority ofdeaths each year. Motor vehicle accidents account for more.years of potential life lost than any other cause, and they continue to contribute to the increasing number ofdisabled individuals within our society [I]. Medicine's existing ability to cope with these diseases is severely limited ; most of the treatment offered is little more than palliation [2]. While it fulfills its vital function of alleviating suffering and reducing the severity of disease and disability, medicine often cannot offer a "cure" to those who seek its help. Consequently, increasing emphasis is being placed on medical research to provide the means of controlling widespread suffering and premature death. However, this is where the problems begin. Billions of dollars have already been poured into research, without much to show for it. We are not really much closer to the "cure for cancer." The incidence of strokes may be reduced by widespread screening and treatment of hypertension , but the problem of asymptomatic individuals not taking their medication as well as the reluctance of physicians to prescribe antihypertensives to them makes early detection of hypertension as the means of reducing the number of strokes little more than academic [3]. Alcohol is a major contributor to road accidents, but at present there seems no *This paper was submitted as an entry in the firstPerspectives Writing Award competition for authors 35 years old or younger. tDepartment of Epidemiology and Health, McGiIl University, Montreal, Quebec, Canada H3A 2B4. 450 I David P. Goldblatt · Modern Medicine's Shortcomings practical way ofeffectively removing its influence on drivers. Finally, the optimism expressed towards the modification of "risk factors" (e.g., hypertension, elevated serum cholesterol, smoking) as the major public health measure in the control ofcoronary-artery disease is already being challenged [4-8]. It is little wonder, then, that more and more editorials are pleading for massive research attacks on the mechanisms of these diseases in order to provide us with the missing pieces of information; if we do not spend more time and money on basic research, we may be reduced to a state of "scientific bankruptcy" [4]. However, there seems to be little questioning of our whole approach to the solutions of our health problems. We all accept the role of the medical profession, armed with its sophisticated technology, as the agent of intervention in the health-disease continuum; we assume that, with enough time and money, the unconquered diseases will surely come under its control. Before we do embark upon another multimillion dollar research campaign, however, perhaps we should first take the time to consider the basis of our present assumptions and expectations. Rise ofModern Medical Thought Modern medicine holds to an essentially deterministic and mechanistic view of disease, in which the individual has no control over his disease and consequently must submit himselfto the intervention of an external agent. In order to understand why this is so, we must go back to the rise of modern science. Modern scientific thought began in the sixteenth and seventeenth centuries. The creators of science—Copernicus, Kepler, Galileo, and Newton, with their meticulous observations and bold hypotheses, and Descartes with his philosophical insight—released the world from its medieval outlook. Through the discovery of "immutable and eternal" laws of motion, Newton completed the new outlook on the physical world that would remain as the basis of scientific discovery for the next few hundred years: the real world was quantitative and mathematical. Space, time, and matter were absolute and could be precisely measured through objective study. Man was seen as part of an impersonal, mechanistic, and deterministic universe; every event was both the result...