THE LIMITS OF MEDICINE: How Science Shapes Our Hope for the Cure

Deft questioning of our basic assumptions about health, disease, and medicine. Golub, director of the Pacific Center for Ethics and Applied Biology, asserts that throughout most of human history little changed in the way health and sickness were regarded. From 500 BC to about AD 1850, people believed that health depended on the body's being in balance -- and the general level of health was pretty dreadful, with sickness and early death being omnipresent. In the 19th century, however, science began to reframe thinking about health and disease. Indeed, Golub claims that the major contributions science has made to our lives are in changing our view of ourselves, how medicine is practiced, and what we expect from medicine. Through myth-shattering stories about standard heroes and praise for some lesser-known figures, Golub recounts how the authority of science was brought to medicine by Pasteur, Lister, and others whose work contributed to the soaring popular faith in scientific medicine. Once diseases were seen as having specific causes, the course was clear: determine the cause and then develop a vaccine to prevent the disease or a chemical to cure it. This concept of specificity still prevails, according to Golub. But it does not serve us well in an era of complex chronic diseases and the degenerative conditions of old age. Golub cautions against reliance on costly high-tech solutions, especially gene therapy, warning that the complexity of biology calls for more innovative and integrative approaches. Finally, he urges serious rethinking of what we want from medicine and argues that we should view aging and dying as an integral part of life rather than as the Great Enemy of medicine. Highly enjoyable as a brief and opinionated history of medicine, but more valuable as a provocative essay on the direction in which science and technology are moving medicine today.