Lynn PayerRosemary BiggsElizabeth Jane BridgerPatricia Frances de Carteret Coles (née Falle)Margaret Balfour DempsterPamela Jill Marsden (née Coope)Valerie Joyce Metcalf (née Richardson)Roza MerzerMarie-Luise Barbara Seidler

BMJ 2001; 323 doi: (Published 13 October 2001) Cite this as: BMJ 2001;323:871

Lynn Payer

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Journalist and author New York (b 1945), died from breast cancer on 22 September 2001.

In 1988, Lynn Payer's book Medicine and Culture challenged the popular view that medicine was grounded in objective science. In a style that was at once engaging and droll, but never confrontational, Payer showed how cultural values and opinion profoundly influenced medical practices. Diagnosis, treatment, and even the determination of what can be called disease vary by culture. Gently, Payer urged doctors not to “hide behind a screen of science.” She introduced to the general public the ideas that medicine should be backed by high quality evidence and that patients should carefully consider what kind of care they prefer. The book is still in print and has been translated into several languages.

Medicine and Culture grew from her years covering medicine in the United States and Europe. Payer showed how cultural values in the United States, Great Britain, Germany (then West Germany), and France resulted in very different medical practices. Each country had a unique approach to medicine. Americans were enamoured of technology and often adopted the most aggressive treatments. They were impatient, not appreciating the merits of gathering data. Recently, Payer observed that Americans built an entire infrastructure for bone marrow transplants for breast cancer—and rushed to embrace tamoxifen even before European trial data were in. An avid fan of the randomised controlled trial, she admired the British for their pride in doing carefully planned trials.

Initially surprised by different treatment recommendations for uterine fibroids adopted around the world, she showed how the French looked to preserve fertility, considering myomectomy the treatment of choice. However, in the US, the more aggressive total hysterectomy was favored. These cultural differences continue in prophylactic gynaecological surgery recommendations for women carrying BRCA1 and 2 gene mutations.

Payer's wry …

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