A New Perception of

Medicine's Role
THEODORE COOPER, MD, PhD, Washington, D.C.
Assistant Secretary for Health, United States Department of Health, Education, and Welfare

BECAUSE OF THE immense contnbution medicine has made to the advancement of human welfare in the last 100 years, there is an understandable inclination to anticipate, indeed to expect, more of the same in the decades ahead. Not only do we take it for granted that the less developed nations of the world will appropriate the principles and techniques of modem medical care for the benefit of their own populations, we also assume that the engine of biomedical research will continue to produce new knowledge that will render the chronic and degenerative diseases as susceptible to medical management as are the communicable diseases. Thus, I think that health professionals and laymen alike accept almost as an article of faith that medicine is and will continue to be a primary avenue toward improvement in the quality of life for all mankind. I would not suggest that such faith is misguided, but I think we in medicine and the public generally are at the risk of taking for granted a role in improving the quality of life that medicine may not be able to play. While I personally find it rather difficult to define "the quality of life" in terms that seem appropriate and meaningful for the vast spectrum of conditions in which human beings live and for the broad range of ideologies, political and otherwise, to which they subscribe, it does seem credible that all people want to enjoy good health and want access to those things, including medical care, that preserve or restore health. But that does not mean that we in the medical profession can expect to advance the quality of life for future generations merely by refining and enlarging the precepts and methods that have made the past century the most productive and successful period in the history of medicine. For it is becoming
Refer to: Cooper T: A new perception of medicine's role, In Medicine and the quality of life-A forum. West J Med 125:2-3, Jul 1976

more and more obvious that further advances in health will likely result less from the provision of medical services than from improved socioeconomic status and changes in man's environment and behavior, none of which is substantially amenable to medical intervention. If up to 80 percent of all cancer results from exposure to carcinogenic agents in the environment, what part does medicine play in solving this health problem? Similarly, if cardiovascular disease and stroke are increasingly found to be associated with life-style, what can medicine expect to accomplish? Much the same question can

"If up to 80 percent of all cancer results from exposure to carcinogenic agents in the environment, what part does medicine play in solving this health problem?"
be posed with respect to accidental injury and death and the vast if uncounted amount of emotional and physical illness that common sense and experience tell us is associated with what has been called "the stress of modern living." Beyond any doubt, all of these diminish the quality of life for the individual person and for society because they compromise health. Yet I think we must concede that contemporary medicine is illequipped to address these problems with the same vigor and confidence of success that has marked the last century. Does this imply, then, that medicine will have a reduced role in the future effort to improve the quality of life? Have we, in fact, passed through the golden age of medical progress only to settle into a period of limited horizons and declining contribution to the welfare of mankind and the quality of human life? I certainly do not think so.

JULY 1976 * 125 * 1

I do think, however, that the future contribution of medicine will have to be distinctly different from that of the past. For one thing, medicine will have to give more than lip service to its responsibilities in the broadening field of prevention. In order to contribute to improving the quality of life, medicine will have to shift from its traditionally passive roleproviding care when the patient asks for it, an essentially remedial role-to one of active involvement in seeking to address conditions in society that give rise to the very health problems that medicine is expected to solve. I am not suggesting that every physician become some kind of social activist or instant expert on problems of the economy, community planning, education, or any of the other societal factors that influence health and the quality of life. Not all of us are cut out for such things, and certainly no practicing physician can place some other concern ahead of the needs of his or her patients. But it does not make sense for the medical profession as a collective force to remain aloof from the very etiologic factors that cause a great many patients to seek help. Where once medicine had to concern itself with microbes, now it must focus on a new class of societal pathogens, one perhaps no less strange and baffling, and certainly no less important, than the invisible organisms that our predecessors learned to identify and to cope with. There will always be room, I hope, for further advances in diagnosis, treatment and rehabilita-

tion. We will find better and better ways to treat cancer and heart disease, to ease mental illness and to arrest the degenerative diseases. And every time such measures are brought to bear, the

4 . . . medicine will have to give more than lip service to its responsibilities in the broadening field of prevention."

quality of a life will be improved. But improving the quality of all our lives and of the lives of future generations will demand more of medical science and practice, more of medical training, and more of the profession itself than the gradual accretion of new weapons and new skills. It will require a new perception of the role of medicine in society, a perception toward which I believe we are beginning to move-and none too soon.

A More Effective, Efficient and Equitable System

VICTOR R. FUCHS, PhD, Stanford
Professor of Economics, Stanford University Vice President, National Bureau of Economic Research, Inc.

MEDICINE HAS MADE many important contributions to the quality of life in America. During the past half century mortality has declined significantly for infants, children and young adults. True, part of this decline is attributable to non-

medical factors such as a higher standard of living, but in my opinion most of it stems from great advances in medicine's ability to prevent or treat infectious diseases, to deal with trauma and to intervene surgically with greater safety and efficacy.
THE WESTERN JOURNAL OF MEDICINE