A few years ago an American physician, Leon Kass, drew attention to a remarkable paradox: that at a time when medical knowledge is greater and technology more powerful than ever before, medicine is assailed by doubts about its role and purpose. Some reasons for the doubts are clear enough: uncertainty about the respective responsibilities of public and private agencies for the finance and administration of health services; rapidly rising costs of medical care and the lack of an acceptable basis for limiting them; gross inequalities in health between continents, between countries, and between different sections of the population of the same country; ethical issues which arise particularly from the ability to prolong or terminate life; and formidable problems of litigation attributable to the difficulty of distinguishing clearly between errors of clinical judgment and negligence. But perhaps the most telling source of uncertainty about medical activities is the possibility that we have overestimated what has been achieved, indeed what can be achieved, by treatment of the sick. We begin to suspect that some disease problems may prove to be, as J.B.S. Haldane said of the universe, 'not only queerer than we suppose but queerer than we can suppose'.

LRB 6 August 1981 | PDF Download