Q J Med 2004; 97: 309
QJM vol. 97 no. 5 (c) Association of Physicians 2004; all rights reserved.
Correspondence |
Technical medical interventions and the health of populations
Sir,In their recent editorial on politics and health, Barr et al. suggest that ‘technical medical interventions play only a minor role in affecting the health of populations’.1 Two of the statements that they made to provide support for this belief are that ‘the steep decline of TB prevalence in the developed world preceded the use of antibiotics or Bacillus Calmette-Guerin vaccine, and reflected instead an improvement in living conditions’, and that ‘in the UK today, differences in health status across geographical and social groups do not result from differences in medical management, but from determinants such as poverty’.1 Le Fanu has produced cogent arguments why such statements need qualification.2,3 First, he points out that medical intervention—the identification of those with TB by examining their sputum and their subsequent incarceration in a sanatorium—was also very important in the decline of TB.2 Second, he concedes that absolute poverty, which may be associated with an inadequate diet, overcrowding, poor hygiene and lack of protection from the elements, can harm the human organism and cause disease, but he emphasizes that relative poverty, the type of poverty that exists in the UK, is an unlikely cause of disease.3
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Department of Gastrointestinal and Liver Diseases Academic Medical Center Amsterdam The Netherlands e-mail: tjones{at}xs4all.nl
References
1. Barr D, Fenton L, Edwards D. Politics and health. Q J Med 2004; 97:61–2.
2. Le Fanu J. Seduced by the social theory. In: The Rise and Fall of Modern Medicine. London, Little, Brown and Company, 1999:312–21.
3. Le Fanu J. Poverty and health—a phantom carnage. In: The Rise and Fall of Modern Medicine. London, Little, Brown and Company, 1999:362–71.
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