ViewpointPostmodern medicine
Section snippets
Science on trial
World War II showed how science, properly managed, could produce the goods, and the Manhatten Project was a clear example of science delivering an awesome product. Less well known, but perhaps even more important, was the achievement of the original whizzkids, those experts in management seconded in to the aeroplane industry by the USA in World War II to revolutionise the number and quality of the planes produced. One of those engineers, Robert Macnamara, moved on to be the Secretary of State
Celebrating modern medicine
The process of postmodernisation did not start with the technological breakthroughs after World War II, but with the sceptical advances of the late 1960s, epitomised in the UK by the publication and reception of the book Effectiveness and efficiency by Archie Cochrane8 and in the USA by the work of Avedis Donabedian.9
Premodern health care with its uncritical enthusiasm for technology has been partially supplanted by modern health care (panel 1). The characteristics shown in the panel are
Creating postmodern health care
People modernise health care in an attempt to absorb the effect of rising need and demand resulting from demographic, technical, and social changes that lie in the path of every health-care system. To cope, postmodern health will not only have to retain, and improve, the achievements of the modern era, but also respond to the priorities of postmodern society—namely: concern about the values as well as evidence; preoccupation with risk rather than benefit; the rise of the well-informed patient.
Adapting to the postmodern environment
It may seem unrealistic to say that medicine should move on from the modern era when not all of clinical practice or health-service delivery can be said to have reached it. However, social evolution, like biological evolution, consists of multiple small changes in which, medicine will hopefully avoid a social cataclysm analogous to the geological catastrophe that is said to have wiped out the dinosaurs. For medicine to retain all that is good of the modern revolution while adapting to the
The boldest course is always the safest
The Chindits, a famous British task force that fought in the jungle behind the enemy lines, had the motto that the boldest course is the safest: the same motto would suit medicine well as it looks at postmodern society. Medicine must be modern—sceptical, evidence—based, and self-critical—but a self-centred preoccupation with excellent science will be no protection against the criticisms of a well-educated public; openness is the only option.
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Systematic De-escalation of Successful Triple Antiretroviral Therapy to Dual Therapy with Dolutegravir plus Emtricitabine or Lamivudine in Swiss HIV-positive Persons
2018, EClinicalMedicineCitation Excerpt :This may surprise given that ART is covered by Swiss insurance carriers and our clinic is located in a resource-rich country. In our clinic, many patients try to pursue a healthy lifestyle, seek medical information from multiple sources including the internet, perhaps increasingly reflecting phenomena that have been interpreted in the setting of trends towards “postmodern medicine” [23] and “healthism” [24], including (possibly increasing) skepticism towards the pharmaceutical industry. The effectiveness of dual, dolutegravir-based ART was recently recorded in a systematic review and meta-analysis [25] and is receiving increasing attention at scientific meetings [21].
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2017, Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesenwhat does it mean for general practice?
2023, British Journal of General PracticeThe Intersection of Health Literacy and Public Health: A Machine Learning-Enhanced Bibliometric Investigation
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