Editorial: The Use of Medical Knowledge

PERSPECTIVES IN BIOLOGY AND MEDICINE Volume VII · Number ? · Autumn 1963 EDITORIAL: THE USE OF MEDICAL KNOWLEDGE A basic aim of medical research and education is to promote public health. This it does, but almost never to full potential. It is plausible that the effective application of knowledge already at hand might contribute more to health and longevity than any medical discovery yet to come. In all cases, the prevention ofdisease is more effective than attempts to cure. Food factors necessary for good nutrition are known, yet starvation remains one ofthe major medical problems ofthe world. In a few countries, the United States included, overnutrition contributes importantly to poor health. Most communicable diseases can beprevented bysanitation, immunization , and control ofvectors ofillness, but such diseases remain prevalent in many parts ofthe world. Antibiotics are almost unknown among some populations but are overused by others. Fluoridation of water to reduce the incidence ofdental caries is not yet widely practiced. Although evidence of the role ofair pollution and tobacco smoking in causing diseases is circumstantial, it is so strong that each should be presumed to be a remediable cause of disease. Other illnesses caused by overuse of alcohol and drugs can be prevented by abstention. Lives are lost and suffering results from preventable accidents. We hopefully think that war is preventable . There is another method of controlling disease which would seem to have great potential, although extensively tested only in experimental animals; it is selective reproduction. There is strong evidence that genetic factors are present in the causal pattern ofcancer, mental diseases, cardiovascular diseases, diabetes, and many others. Since the population increase has already expanded human misery, it would make sense to link a program ofeugenics to the control ofconception. Müller [1] and Huxley [2] have written about eugenics in perspectives in biology and medicine. The use of eugenics would involve grave risks in a world where central governments continue to achieve greater and greater control of personal freedoms without accompanying advances in ethics and wisdom. The barriers to better application ofmedical knowledge are sometimes economic and sometimes political and even statutory, but more often are ignorance, dogma, and superstition—all existing within and without certain religions. There remain conflicts between science and some religions, although we are past the days when some religious groups opposed the dissection ofbodies, surgery, and shedding ofblood, vaccination, inoculation , narcosis, anesthesia, and the practice ofobstetrics and gynecology by male physicians. Barriers to the application of knowledge for the treatment of disease and the relief of suffering also exist within the traditions and "etxiics" of medicine itself. There is, for example, little debate and even less serious study ofeuthanasia. Most important ofall, the practice ofmedicine is more oriented toward the treatment ofdisease than toward its prevention. What is said above is rather obvious; what we need are new, practical ideas for extending the application ofmedical knowledge. Ofcourse, increased communication of knowledge and wise leadership are essential. I would like to close this editorial with some useful wisdom, but cannot and, instead, invite essays on one aspect or another ofthe general problem. D. J. I. REFERENCES i. H.J. Müller. Perspect. Biol. Med., 3:1, 1959. 2. J. Huxley. Perspect. Biol. Med., 6:155, 1963. MATTER UES Matter lies. The truth is in desire. The stones ofart stand up to shape a city in the wild, the granite valleys cup to hold the cattle and die fruit, the powers ofthe elements unfold praising the constellation ofa world so lightly taught that earth can make a garden, love, a child. J. R. Platt Editorial Perspectives in Biology and Medicine · Autumn 1963 ...