Sometimes it is easy to place one’s faith in medical technology, or, at the worst, in some far off future technology capable of curing all our ailments; from the threat of cancer to the inconvenience of every imaginable blemish. Yet I often wonder how is it that we can reconcile this faith in progress and technology when there are place both in the developing as well as the developed world that, medically speaking, may have been better of in the middle ages. It seems that the medical gurus of every age have relied more upon our trust in them then in their knowledge of the hows and whys of human health.
Often, in the case of cancer, surgeons will “re-seed” cancerous cells in the same operation they use to remove their target. Being sent to a dermatologist by a local clinic, you may find that that strange rash you’ve developed is in fact, after much waiting, a case of nonspecific inflammation. Going to a neurologist, you may watch your diagnosis in progress on the pages of Wikipedia. While I am ready to admit that my own encounters with the medical profession probably have been more unorthodox than most, there is something disquieting in not feeling like I can trust the only people in out society who have a legitimate right to see to my well-being.
In few scientific fields is the connection between science and society so painfully clear as in medicine. In the field of diagnostic cytology, “litigation cells” stand as a warning to impressionable tyros that legal matters come first. This can also be seen in the advent of x-ray technologies into general usage:
it was claimed that many x rays were taken not from medical necessity but, rather, out of fear of lawsuits. This type of argument has been recreated near the end of the century in concerns about the ordering of expensive, unnecessary tests, so-called defensive medicine. Second, the article concludes with a not-very-well-veiled threat that, if the x ray is held by the courts to be essential for the care of fractures, ‘the prospect of litigation will prevent those most competent from undertaking the care and treatment of cases of these character.’ Again, this concern is being recreated in the 1990s, as some obstetricians, viewing increasingly expensive malpractice insurance premiums, are electing not to deliver babies.
The mechanisms put in place to supposedly ensure quality and efficiency have, in many cases, ensured the exact opposite. Limited liability is valued over curing, curing is valued over prevention. In diagnostic cytology quotas are still the measure of a cytologists efficacy, instead of the quality of their diagnostics. What can be made of this?
Culture is at the heart of health. Tools and technology, systems, syringes, specialists, do not make people better again, not in the final count. Individual idiosyncrasies, cultural support systems, and cultures of healing and care should be the foundation of modern medicine. Without them, despite its genius, technology is only a jury-rigged patch-job on the fabric of human affairs.