The Rise and Fall of Modern Medicine by James Le Fanu Page A

in the pursuit of marginal treatment benefits, as in the massive overuse of chemotherapy in the palliation of age-determined cancers or futile attempts to prolong life, as illustrated by the description of General Franco’s final illness. A quarter of all health expenditurein the United States, it will be recalled, is now spent on patients during the last six months of their lives.
    The pharmaceutical industry has also had no alternative, in the absence of new and lucky drug discoveries, other than to keep hammering away. This takes several forms, of which the most obvious is the ‘better mousetrap’ – new and more costly variants of drugs already available. These may well be ‘better’ in the sense of being easier to take and having fewer side-effects, but they are no more effective therapeutically. Alternatively, when there is no effective remedy for a disease the drug companies have adopted the ‘useless mousetrap’ strategy on the grounds that patients and relatives want to be doing ‘something’. Thus new drugs for Alzheimer’s and multiple sclerosis are increasingly widely prescribed even though their efficacy is scarcely detectable.
    The second response to the brick wall was to try and pole-vault over the lack of effective treatments with complex and expensive strategies. The saga of foetal monitoring introduced in the 1970s in the hope of preventing cerebral palsy belongs in this category, as do the national screening programmes for the early detection of cancers of the breast and cervix. Screening certainly can work. There is no simpler and more effective medical intervention than screening every newborn baby to detect those at risk of mental deficiency from an underactive thyroid. A spot of blood obtained from a heel prick can be automatically processed at virtually zero cost to establish the diagnosis, while treatment – thyroxine replacement – is 100 per cent effective. By contrast, the principle behind screening for cancer may be the same – the detection of disease at an early enough stage for it to be curable – but that is all. Cancer screening is logistically very complex to organise, the techniques of diagnosis – cervical smears and mammography – requireconsiderable skill, while the distinction between the normal and the pathological is uncertain. Finally, even though cancer screening involves the dedicated skills of nurses, radiologists, pathologists, gynaecologists and surgeons, the impact is marginal, because the most aggressive cancers that need to be caught early arise so rapidly. 2
    The third option, circumventing the brick wall, sought to bypass the dearth of new treatments by preventing disease in the first place. This was The Social Theory. Its approach, if not examined over-critically, certainly appeared plausible enough and indeed was widely perceived as representing a further stage in the evolution of medicine, where prevention was a more sophisticated response to the problem of illnesses such as cancer and heart disease than an attempt to ‘cure’ them with relatively ineffective medical therapies. Enormous sums of money have been expended on ‘health promotion’ to achieve these ends. Its drawback is that it does not work. The Social Theory fulfilled another important function by expanding the influence of medicine beyond the traditional confines of the consultation between doctor and patient to reach out to the healthy too. It provided apparently authoritative advice to the public on how they should lead their lives, instructing them in what they should and should not eat, while alerting them to previously unsuspected hazards in their everyday lives.
    Finally, The New Genetics sought to undermine the wall by illuminating the workings of the human organism at its most fundamental level with the promise that at some indefinable point in the future the wall would come tumbling down, leaving a long straight road