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The Rise And Fall Of Modern Medicine
James LeFanu, MD
Carroll &Graf Publishers, Inc., New York 2002
448 pp. $16.00
ISBN 0786709677
Lefanu, a medical columnist as well as a doctor, brings a contagious enthusiasm to his description of the early achievements of modern medicine. From the 1940s to the 1970s, the 20th century experienced what he calls definitive moments. Among them are the discovery of penicillin, cortisone, streptomycin, smoking as a cause of cancer, the cure of childhood leukemia, and the identification of mild to moderate hypertension for the prevention of strokes.
The atmosphere surrounding these achievements is made even more heady by the lack of theory to explain their discovery. Lefanu is a good storyteller. These breakthroughs are really accidents, essentially unpredictable. This is LeFanu's main point. These achievements do not spring from the kind of medical knowledge that is truly explanatory. Therefore we cannot expect the lucky trend to continue over time. As a result-- and here comes the down side, the absence of truly original drugs, rather than newly patented variations of the originals, is to be expected.
From the 1980s on to the present we have experienced decades of disappointment met by attempts at explanation that have failed to produce the hoped for results. The consequences are "disillusioned doctors, the worried well, the soaring popularity of alternative treatments, and the spiraling costs of health care."
Perhaps LeFanu's skepticism is a useful corrective to those who expect medicine to be a continual record of upward progress. We have lived through a great deal of bubble bursting of enthusiasm for highly advertised drugs that turned out to be a source of side effects sometimes more dangerous than the disease.
However the picture he paints ignores some important successes, and even more importantly, the persistence of the hope that research will bring in a new world. Who could have expected terminal AIDS to turn out to be treatable? This condition alone shows that concerted efforts can produce extraordinary results. The support of stem cell research as potential for eliminating chronic disease is firm in spite of cultural and political opposition. Fertility techniques have proliferated to a mind boggling degree, both in popularity and expertise. Certainly the epidemiologists, who LeFanu dismisses, are worrying about SARS or the avian flu and are being closely watched by an anxious public concerned about possible pandemics spread by modern travel.
So--the question arises--has modern medicine really fallen? In spite of the prevalence of me-too drugs, we have many improvements in the period of the 90s to the present. Even if we had no more to show than cataract surgery instead of blindness or hip replacements instead of life as a cripple, the public would still keep the faith. We will continue to buy our expensive nutrition and food supplements, enjoy our new expectations of healthy and active longevity, whatever the cause, and offer a hopeful, if anxious, thank you to our doctors.
Phyllis Ehrenfeld has received the Arnold Gingrich Award in prose for the most highly evaluated fellowship from the New Jersey State Council for the Arts. She has been Editor of the American Anorexia Bulima Associaton for many years. Several of her plays have been presented as staged readings in the Bergen County area. She is presently representative to the united Nations for the National Service Conference of the American Ethical Union.
The Rise And Fall Of Modern Medicine
James LeFanu, MD
Carroll &Graf Publishers, Inc., New York 2002
448 pp. $16.00
ISBN 0786709677
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