McKeown’s “The Role of Medicine”: Advancing Backwards

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): Julian Tudor Hart

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Volume 55, Issue 3 (pages 383–388)
Published in 1977