HOW MEDICINE WORKS AND WHEN IT DOESN'T

There is a crisis of trust permeating the medical profession, according to this insightful book by a leading researcher.

The practice of medicine is “a science of percentages, a science of intelligent guesses, a science of hedging bets,” writes Wilson, director of Yale’s Clinical and Translational Research Accelerator. “Medicine continues to evolve, with new discoveries overturning old beliefs, inching us closer to real truth.” The problem is that many patients do not want reasonable guesses but immediate, sure-fire answers. The gap has been filled by alternative healers, naturopaths, and internet marketers who provide diagnoses and cures that range from the esoteric to the foolish. What they are really selling, Wilson suggests, is certainty, a desirable commodity in a chaotic world. Most of the “cures” are harmless, some help patients via the placebo effect, and a few are actually dangerous. Yet the public perception of practitioners of alternative medicine is above that of the pharmaceutical industry. “The marketing of foxglove extract, reiki and qigong is peaceful and patient-centric,” writes the author. “And, of course, no one is paying $80,000 a year for Saint-John’s-wort.” Given these circumstances, Wilson argues persuasively that doctors should spend more time with patients instead of rushing them through as if on a conveyor belt. This would also give them the opportunity to explain the limitations of a proposed treatment. Equally, doctors should be ready to move away from drug-based solutions. Wilson sees an epidemic of “deaths of despair”: drugs, alcoholism, and suicide, driven by isolation and loneliness. These cannot be addressed with pills; lifestyle changes are needed, which means building a trust relationship. Mixing hard data with personal anecdotes, Wilson sets out a convincing case, and he does not ignore the difficulties of making these changes. If nothing is done, the prognosis for the practice of medicine is grim.

In an unstinting appraisal of the profession, Wilson effectively diagnoses the issues and looks for new paths forward.