MEDICINE AT THE CROSSROADS

Konner (Psychology, Neurology, and Anthropology/Emory Univ.; Why the Reckless Survive, 1990, etc.) analyzes our sociocultural system of medicine—and finds it wanting. Here, Konner considers eight spheres of medicine—doctor- patient relationships; training of physicians; use and misuse of drugs; genetic engineering; the role of surgery and related interventions; treatment of serious mental illness; care of the aged; and the AIDS pandemic—drawing comparisons between how things are done in the US and elsewhere. Ireland, Konner says, does a more humane job of caring for its elderly, and Australia has handled the AIDS crisis with more thought and less emotion than we have. Overall, the author is impressed with the scientific and technical power of medicine in the US but is highly critical of its emphasis on specialization and of the consequent neglect of primary care and prevention. As an anthropologist, Konner examines society as a whole, not just the medical profession: Even patients who abuse the health-care system come under his scrutiny. An advocate of a national health plan along the lines of the Canadian system, he sees such a plan not as a panacea but as way to bring decent care to the millions who cannot now afford it. At the same time, he isn't afraid to discuss rationing health care, asserting that we are doing so already by failing to provide an ordinary level of care to the poor. Meanwhile, Konner's proposal that we stop doing everything possible for some patients at the very beginning or end of life may anger many. There's not much new here, but Konner's arguments for reforming our health-care system are forceful, and his recommendations for change are specific.