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

Table of contents :
The Role of Medicine - Front Cover
Flyleaf - Front
Flyleaf - Rear
Half-title
Title Page
Printer's Imprint
CONTENTS
Preface to the second edition
Quotation from Fernand Braudel
Introduction
PART ONE. CONCEPTS OF HEALTH AND DISEASE
1 Evolution of Health Concepts
2 Inheritance, Environment and Disease
PART TWO. DETERMINANTS OF HEALTH
3 Decline of Mortality
4 Infectious Diseases
5 Non-infective Conditions
6 Health in the Past
7 Health in the Future
8 Medical Achievement
PART THREE. THE ROLE OF MEDICINE
9 Non-Personal Health Services
10 Clinical Services
11 Medical Education
12 Medical Research
13 Dream, Mirage or Nemesis?
14 Medicine as an Institution
Index
LoC Catalogue data
Rear Cover

Citation preview

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