Too much medicine?

摘要

Most doctors believe medicine to be a force for good. Why else would they have become doctors? Yet while all know medicine's power to harm individual patients and whole populations, presumably few would agree with Ivan Illich that "The medical establishment has become a major threat to health." Many might, however, accept the concept of the health economist Alain Enthoven that increasing medical inputs will at some point become counterproductive and produce more harm than good. So where is that point, and might we have reached it already? Readers of the BMJ voted in a poll for us to explore these questions in a theme issue of the BMJ, and this is that issue. Unsurprisingly, we reach no clear answers, but the questions deserve far more intense debate in a world where many countries are steadily increasing their investment in health care. Presumably no one wants to keep cutting back on education, the arts, scientific research, good food, travel, and much else as we spend more and more of our resources on an unwinnable bat-tie against death, pain, and sickness-particularly if Illich is right that in doing so we destroy our humanity. And do we in the rich world want to keep developing increasingly expensive treatments that achieve marginal benefits when most in the developing world do not have the undoubted benefits that come with simple measures like sanitation, clean water, and immunisation?