FALSE HOPES

Medical ethicist Callahan (The Troubled Dream of Life, 1993, etc.) proposes a new way of looking at the nature of medicine that sharply challenges traditional beliefs in progress and perfectibility. At the Hastings Center in 1992 the author initiated a four-year project, —The Goals of Medicine: Setting New Priorities,— in which research groups from 14 countries addressed questions about the future of medicine. This book is a parallel project. If Callahan had a bumper sticker, its message might well be “Enough Already,” but slogans aren’t his weapons of choice. His forte is critical analysis, which he applies rigorously to the values of modern medicine. In his view, faith in limitless progress and the drive to dominate nature (through expensive high-tech procedures and the attempt to conquer death), and expansion of its domain into social problems such as teenage pregnancy and drug abuse make modern medicine neither socially equitable nor economically sustainable. Callahan proceeds to define a sustainable and equitable medicine and its implications for health policy: The focus must shift from individual health improvement to population health improvement through —a comprehensive system of primary care medicine— oriented to health promotion and disease prevention. Further, the drive toward total risk reduction and medical perfectionism must be curbed. And finally, efforts to overcome death must be replaced by the goal of improving the quality of life within a limited life cycle, i.e., the average life span now attained in developed countries. Not only must research rein in its goals and promises of ever-improving life, but patients must lower their demands and expectations. In brief, sustainable and equitable medicine means decent care for all, not state-of-the-art care for the few. Callahan is a powerful presenter of ideas, anticipating challenges and providing persuasive arguments, and his controversial thoughts on the future of medicine are sure to stimulate discussion among health-care policymakers.