Ramblings in The Lancet

The Brits seem to have more of a sense of history and our place in it than we do here in the New World. I was reminded of that as my attention was drawn to a piece called “Icarus” in this week’s The Lancet:

“Technology is often treated like it has a soul, and will itself make us better or make our lives easier; but technology is always a relationship between people, expressed in steel and wire. People worked far harder, in more dangerous conditions, after the Industrial Revolution than before. Even now, in the sweatshops of Asia and Africa, it is hard to argue that technology saves labour; nor, looking at offices in London and New York, is technology primarily intended for that purpose.

Medicine, too, is a relationship between people. Modern medicine relies on an engineering metaphor: the patient is essentially inert, and the pill or operation does something to him; so we are very good at procedures where the patient actually is largely inert (sewing a leg back on, taking an appendix out) and often very bad when the patient has a will, a spirit, or a compensatory physiological function. After a few words from the patient, we complete his story with a standard fairy tale. My wife hates me…I am lonely…My hands feel funny turn into Addison’s disease, or depression, or shingles; I think I want to die now turns into ticket number 52, building C, 9:15 am. A relationship between people has become a relationship between systems—or within a system, with the doctor and the patient as characters in an endless drama that is always the same.

Health care has increasingly become a commodity, and the greater amount goes to those who can pay. This might mean that tents of folk healing spring up around the hospital towers. Folk healing can be ramshackle but is likely to be, at least in places, informal and flexible, reflecting a relationship between acquaintances rather than the set targets of impersonal organisations. It may allow people to discuss what they mean by being healthy, and how to get there; although they will still live in the shadow of the corporation’s and state’s definitions of health; and folk healers are not guaranteed to be kinder than their official counterparts.”


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