Elsevier

The Lancet

Volume 354, Issue 9189, 30 October 1999, Pages 1550-1553
The Lancet

Viewpoint
Postmodern medicine

https://doi.org/10.1016/S0140-6736(98)08482-7Get rights and content

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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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