Ian Kennedy on prevention and cure

I forgot to file away this bit from Ian Kennedy's 1980 Reith Lecture. Again, nothing that isn't basic public health stuff, I just liked the way he put it. It seems like a good moment to mention that Ian Roberts is booked in for September's Street Talks, where I expect he will cover similar ground.

Secondly, we must curb our predilection for medicine in the form of ever more complex technology. Note I do not say abandon it. We must keep it and its advocates, doctors and commercial entrepreneurs, under control. Hospitals, with their massive costs, expensive equipment and commitment to technology have elbowed themselves into the centre of the medical stage, consuming now some 70 per cent of available resources. The debate concerning the merits of heart transplants offers a useful lesson. It has been carried on largely by doctors as if what was at stake was a narrow technical matter instead of a profound question as to the proper direction of our health care resources. In reality, heart transplants are only an example and because of their rarity and relative uselessness virtually an irrelevance. There are, after all, 400 deaths a day from heart disease. The real debate is much wider. It concerns advanced technology, interventionist, last-ditch, patch- and-repair medicine as against other measures aimed at reducing the need for such intervention. The debate should not be in terms of ???either or???. It must be in terms of how much of each do we need and can we afford. … What we do not need and must guard against is a mentality which conceives of medical care only, or primarily, in terms of such technological approaches. Instead, we need to direct more of our energy and resources towards the promotion of good health. One tragic but often overlooked feature of the defence of heart transplant surgery is that it is so clearly an example of the crazy contradictions of our society. We can only transplant hearts if we have otherwise healthy corpses from which to take them. Where do we get such corpses? We depend on the appalling death rate from road accidents, much of which is preventable.

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