Medicine has never been more valuable to humanity as it is now. It delivers relief from pain, cure from disease, remedies for decay or breakage and so much more. There are ever greater possibilities ahead as researchers strive for new breakthroughs. No wonder we carefully guard whatever access we have to the best that medicine has to offer. Those who find themselves priced out of medical services endure far more ill health and higher risk of premature death.
However, whilst medical resources are getting more sophisticated and expensive, there are growing doubts about the efficacy of many common medicines. Pharmaceutical companies have been implicated and prosecuted for a wide range of research and sales misdemeanours that cast doubt on the value of their products. Precautionary prescription for large swathes of the population for drugs such as statins also raises questions about the balance between side-effects and efficacy. We find ourselves juggling more possibilities with more doubts.
The concept of ‘evidence-based medicine’ reveals an uncomfortable tension. It implies that professional judgement is subjective, and that doctors need constant nudging to adopt proven treatment pathways. Despite their denials, doctors are influenced by the classic sales techniques of pharmaceutical companies. Now they also face the growing democratisation of medical knowledge through web-based resources. Patients come with a raft of knowledge that enable them to engage more substantially in the decision-process for treatment.
One simple indicator is revealing. Many doctors still routinely prescribe antibiotics when patients present themselves with a cold or flu, despite these being proven ineffective. And indeed this is clearly dangerous in the face of antibiotic-resistant bacteria. If this elementary rule of evidence-based medicine is consistently ignored, patients will question what this says about other areas of medicine. To what extent can they trust the judgement of their doctors?
Policy makers have to harness the medical professionals and resources at their disposal. Popular feeling about medical services runs high, so politicians are very likely to deploy medical issues in their campaigning strategies. The resulting politicking clouds issues and leads to major errors in the management of medical services. Whether through regulation of the private sector, or direct management of publicly controlled services, the challenges of harnessing medicine are onerous. The public needs to understand the issues at hand to avoid falling for political posturing and media hype.
Medicine may never have been more valuable to us, but its application to our health is far from straightforward.
The articles in this section help to pick through these issues so that better understanding may emerge. How might we benefit most from what medicine has to offer, and how can we avoid its excesses and errors?