Observations Life and Death

The price of wishful thinking

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c4632 (Published 08 September 2010) Cite this as: BMJ 2010;341:c4632
  1. Iona Heath, general practitioner, London
  1. iona.heath22{at}yahoo.co.uk

    Medicine must acknowledge the degree of uncertainty at every level of practice, even at the expense of admitting impotence

    Over the past century medicine has made some spectacular advances, most particularly in the development of effective antibiotics and vaccines and in improved surgical techniques. However, none of this can detract from a feeling that we have somehow lost our way in the management of chronic non-communicable diseases. In this arena the largely unexpressed sense of medical impotence seems to have led to the frequent exaggeration of treatment effects and to an excessive emphasis on unproved preventive interventions. The belief that treatments are effective and that prevention works are profoundly seductive to patients, who wish to benefit; to doctors, who want to be helpful and who fear failure; to politicians, who want the health service to be cost effective; and to the whole of the medical industrial complex, whose technologies and pharmaceuticals drive enormous profits.

    All treatments have the potential for damaging side effects, and all screening for early diagnosis and prevention has the potential to cause harm. The wishful …

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