| 1 | 1 | | So the millennium looks like going out in the maelstrom of a worldwide AIDS |
| 2 | | epidemic. And with it, 1 predict, will go a long-standing assumption carefully cultivated |
| 3 | | by doctors, whose notion of medical history is that of a royal road of progress, an |
| 4 | | assumption fostered, too, by credulous journalists fascinated by heart transplantation and |
| 5 | | in-vitro fertilisations. It is quite simply the assumption that by the terminal years of the |
| 6 | | 20th century, medicine has enumerated its final list of diseases and faces its last great |
| 7 | | battle to rid the world of malady. Indeed, those diseases which show a remarkable |
| 8 | | disinclination to be dislodged, are designated in lordly fashion as diseases of civilisation; |
| 9 | | the implication being that heart disease, cancer, hypertension, depression represent the |
| 10 | | price of our progress - a price that the brilliance of medical research and the dedication |
| 11 | | of clinical practice will eventually eliminate. |
| 2 | 12 | | This assumption has been as much a casualty of AIDS as the 600 people who to |
| 13 | | date have perished in Britain of the disease. But how did it come to be so deeply rooted? |
| 14 | | One reason is that few doctors these days know much medical history, and such as they |
| 15 | | do know is the mythology which portrays medical progress as just one remorseless series |
| 16 | | of advances, achievements, conquests. |
| 3 | 17 | | Medicine's history, read carefully, reminds us too that the practice of medicine has |
| 18 | | always been, first and foremost, about sustaining, alleviating, easing, and very much |
| 19 | | secondarily about curing. Again, such a fact constitutes an assault upon another firmly |
| 20 | | held conviction to the effect that medicine cures. The howl of protest that can be heard |
| 21 | | around the land concerning medicine's failure to deliver the goods in relation to AIDS is |
| 22 | | that of a public led to expect that if there is a disease there must be a cure. ft is sobering |
| 23 | | to think of some of today's commoner diseases and identify those for which there are |
| 24 | | genuine and effective cures, as distinct from genuine and effective amelioration: such as |
| 25 | | diabetes, epilepsy, asthma, chronic bronchitis, chronic backache - common, disabling, |
| 26 | | distressing conditions all, and not a single cure among them. Of course medicine does |
| 27 | | boast remarkable cures, which includes treatments for deficiency states, infections, and a |
| 28 | | handful of surgical conditions. But, in general, the portrayal of medicine as a |
| 29 | | triumphantly curative science is misleading. |
| 4 | 30 | | But the most intriguing consequence of AIDS is that doctors are once more under |
| 31 | | pressure to adopt the mantle of moralists. Moralising has always been an occupational |
| 32 | | hazard of medicine. Given that the way people drink, eat, exercise, smoke and make love |
| 33 | | has a profound effect on their health, it is hardly surprising that doctors have firm views. |
| 5 | 34 | | In the Sixties, behaviours were pronounced good if indulging in them made one |
| 35 | | feel good. Doctors bestowed their clinical seal of approval on all manner of sexual |
| 36 | | behaviours which their predecessors a century earlier indicted as immoral. Now the |
| 37 | | wheel turns again. Radicals may find fault with the growing puritanical morality of the |
| 38 | | medical profession as conservatives may welcome it with unrestrained joy. But both |
| 39 | | would do well to ponder the fickle nature of a morality founded on medical |
| 40 | | considerations. Today, doctors may join with clergymen in calling for sexual restraint, |
| 41 | | monogamy, even chastity. But should there be a breakthrough in control of the virus, |
| 42 | | many doctors would leave the pulpit as speedily as they occupied it. |
| 6 | 43 | | This is another lesson to be learned from a study of medical history and it is a |
| 44 | | lesson society would do well to ponder. In the meantime, the stage is set for AIDS to |
| 45 | | become a metaphor, a punishment, a symbol, a sign, a signal for our society to regain its |
| 46 | | sense of moral purpose, an opportunity for us to exercise the Christian compassion we all |
| 47 | | profess, a terrible challenge to our shallow attitudes towards death, grimly timely in its |
| 48 | | arrival as our millennium drifts, a trifle despairingly, to its close. |
| | | |
| | | Anthony Clare in The Listener, January 1, 1987
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