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From the evidence of historical demography and the methods of epidemiological analysis, McKeown’s The Role of Medicine: Dream, Mirage, or Nemesis? raises searching questions about expectations of medicine. His book argues that improvements in the social environment and nutrition are the main determinants of health and mortality. Society’s pursuit of health through medical science and service is a poor investment. McKeown assigns a more modest role to modern medicine than his four critics see justified. Quality of life-as opposed to its extension-has been enhanced by modern medicine, although this accomplishment is obscured by extrapotation from mortality trends. Effective control of disease will require not only a more active role for medicine in changing individual behavior, but also in clinical measures to interrupt the sequence of pathologic processes. The evidence to specify reallocation of health investments is inconclusive and unconvincing; medical science (and all social services) has become a scapegoat for a form of social organization whose real faults lie elsewhere.
Author(s): Walter Holland
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Volume 55, Issue 3 (pages 379–382) Published in 1977
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The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, political, historical, legal, and ethical dimensions of health and health care policy.