The role of medicine. Dream, mirage or nemesis?

Bernard Dixon's Beyond the magic bullet is an extended essay on the failure of modern medicine to cope with the important problems of health care. This failure, he contends, is the result of the confrontation of an inappropriate idea and the real world. "The dazzling achievements of [the idea of] specific aetiology have been followed by a situation where all our major health problems. .. represent areas where the theory has failed" (p. 3), and elsewhere "the notion that there is a specific cure for everything. . .has retarded our thinking about alternative approaches to health and disease." (p. 226). Except when he enters the historical arena, where the errors are too numerous to mention, Dr. Dixon buttresses his contention with an impressive array of well-researched evidence that displays the vast amount of money, resources, dedication, and intellectual output that is channelled into searching for the cure for cancer or the cause of heart disease. Conversely he shows how little effort, even in the third world, is directed towards sanitation schemes and health education programmes. Dr. Dixon's idealist case is plausible and utterly false. To begin with the idea of specific aetiology does not necessarily negate the possibility of what he calls "the interpretation of ill health in terms of bodily or social disharmony" (p. 3). Quite the reverse: for a long time now anthropologists have been at pains to point out that the people they study have remarkably well-developed ideas of specific aetiology, witchcraft, soul loss, possession, etc., coupled with therapeutic systems whose aim is the promotion of bodily harmony and social integration. It is hardly the idea of specific aetiology alone that maintains the bizarre deployment of resources sometimes found in the third world. Dr. Dixon is being peculiarly disingenuous when he states ".. . in Asia, Africa and South America improved sanitation is infinitely more important than supplies of the newest antibiotics from multinational drug companies" (p. 227). The unscrupulous behaviour of some multinationals, which a journal as bland as The Listener can catalogue in horrifying detail, can hardly be interpreted in terms of a failed idea, a sort of misguided philanthropy.1 Any reader ofthis book will find it a repository ofalarming facts about twentieth-century medicine. Only the most intransigent Platonist will take comfort from the author's interpretation of them. Thomas McKeown's theses must by now be well known to the medical, demographic, and historical professions. These …