The Role of Medicine: Dream, Mirage or Nemesis? [2 ed.] 0691082359

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Thomas McKeown

THE ROLE OF

MEDICINE Dream) Mirage) or Nemesis?

The Role of M edicine Dream , ;\;Iira}?l', or N emesis? TH OMAS M cKEOWN

In an alyz ing th e factors that ha ve impro ved h ealth an d enh anced longevity during th e last three cen t uries. Thomas McK cown contends that nutritional , en viro n m en tal, and be havioral changes h ave be en and wi ll be more important tha n spe cific medi cal measu res, esp ecially clini cal or "cu ra tive" mea sur es . Dr. M cKeown argu es that. be cau se of the assumption-widely held since th e seve n teen th centu ry- that the bod y can be regarded as a machine whos e protection from disease d epends pr imarily o n intern al in te rve ntio n ; the role of medi cin e is di st o rt ed , medi cal science and ser vic es ar c mi sdirected, and soc iety's in vestment in health is misused. H e suggests that mu ch gr eater attention sho uld be gi ven to exter na l influences. whi ch might in pr inciple be controlled , and to the majo rity of patient s-particularly the mentally ill, th e aged sick, and the mentally deficien t- w ho hav e completed in vestigation and tr eatment but who n evertheless ar c in need of carl' . What thi s calls for , Dr. McKeo wn co n clu des , is a greater emphasis o n th e origins o f di sease and on the ca re of pati en ts who p ro vide no sco pe for activ e measures .

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Im po rtan t features of this bo o k arc an int erpr etation of h uman health histor y, a co m prehe ns ive analys is of m edical ach ievem ent, a new classificat io n of disease, cons ide ration of the significance for m edi cal pr actice of the conclusion s conce rning the m aj o r influences on health , and an ex tende d discussion of co nce pts of health and dise ase, parti cularly as they relate to th e part s played by nature and n urt ure. T he autho r also em phas izes the im po rtan ce of dist ingu ishing betw een the role of m edi cine as clinical pr actice, and its larger ro le as an institu tio n tha t m ust be conce rne d w ith no nper son al and behavior al influen ces o n health , as well as w ith per sonal care. Tho mas M cK eo wn is Pro fessor of Socia l M ed icine Em eritu s at the Un ivers ity of Birm ingh am in England . T his book is a revision of his 1