Dr. Seamus O’Mahony began studying gastroenterology in the mid-1980s, a time he associates with the end of the “golden age of medicine,” which he claims began in the mid-1930s. In this 2019 Lancet editorial, O’Mahony contrasts the golden age with the present “age of disappointment,” arguing medical science has been corrupted by Big Pharma and bloated with research and data that fail to help patients. He claims the medical industry has become more focused on the production, accumulation, and deployment of unreliable information than on helping people.
The golden age, as O’Mahony considers it, witnessed scientific advancements that led to dramatic improvements in the quality of care and health. In the 1930s, diseases such as tuberculosis, tetanus, pneumonia, polio, and syphilis were as worrisome as heart disease and cancer are today. Golden age innovations such as penicillin, CT and MRI scanning, organ transplantation, and the development of the randomized controlled trial eradicated many 30s-era worries. These innovations also increased faith in the medical field, and as a result, biomedical research became “globalised, professionalised, and commercialised,” O’Mahony explains.
Such growth should have led to further improvements in patient care and quality of life. O’Mahony, however, paints a bleaker picture: “Research has grown exponentially, but when compared with the achievements of the golden age, advances that benefit patients have been modest and unspectacular.”
O’Mahony attributes such shortcomings, in part, to the proliferation of unhelpful and untrustworthy data. “Big Science is incentivised to produce data rather than original ideas,” he writes. He associates these “perverse incentives, such as publication metrics, careerism, and commercialisation,” with the replication crisis in the sciences.
The effectiveness of the medical-industrial complex also has been compromised through its corruption by Big Pharma: “Evidence-based medicine … was to some extent hijacked by the pharmaceutical industry,” O’Mahony argues.
This seachange in both perspective and practice from the time of medicine’s golden age has produced a complicated landscape where treatment has replaced healing as the ultimate goal of medicine, to the profound detriment of both practitioner and patient. O’Mahony concludes:
Clinical practice has, I would argue, become a vast industry, concerned mainly with degenerative disease and old age, and the herding of entire populations — through screening, awareness raising, disease mongering, and preventative prescribing — into patienthood.
Doctors are just as unhappy. They know that their powers are limited, yet ever more responsibilities and demands are laid at their door. Hospitals have partly become clearing houses for old people in need of social care; normal variations in human behavior and emotion are now the object of pharmaceutical intervention; life’s inevitable existential problems are brought to the doctor to solve. What can we do? Medicine has become a pseudo-religion; our patients must be gently encouraged into apostasy and renunciation. […]
The priorities of medicine — with the cathedral-like teaching hospitals and biomedical research at the top, and community and hospice care at the bottom — will have to be turned upside down. I am not optimistic that this will happen. Strong societal forces will almost certainly ensure that the current consensus prevails. These forces include the commodification of our lives, the over-weening power of giant international corporations, the decline of politics and the professions, the sclerosis of compliance and regulation, the narcissism of the Internet and social media, and above all the spiritual dwarfishness of our age that would reduce us to digitised machines in need of constant surveillance and maintenance. The medical-industrial complex is not some vast, organised conspiracy; it is as fallible, messy, and irrational as the people who created it. It has become so powerful, however, that medicine has now passed the Illichian tipping point where, I suspect, it is doing more harm than good to the people it is supposed to serve.
Seamus O’Mahony is a consultant gastroenterologist at Cork University Hospital and author of The Way We Die Now and Can Medicine Be Cured? The Corruption of a Profession.
Comments on After the Golden Age: What is Medicine for?
That is exactly why doctors shouldn't have exclusivity of treating diseases. That is where trainers and other professionals in health need to step up by educating themself and acting as professionals to become part of the solution.
This is a heck of an editorial, it's a shame it's behind a paywall.
Mahony makes an interesting point about our current need for, and at times fascination with, meta-science, and what it says about the current state of medicine and the incentives that drive it. Through changes both deliberate and accidental, we have reached a place where the scientific literature, on average, is so untrustworthy and of so little value that we need research about research to help us understand which research to pay attention to. While it's a necessary evil in the current scientific reality, it speaks to the more fundamental issues that have muddied both basic and clinical research.
A key question is whether the current situation was inevitable. Mahony suggests it was largely a consequence of the golden age itself - that is, that the substantial advances of the 1930s and 40s gave medicine a position in society that created the excesses and incentives that led to our current state. If that is the case, it unfortunately may not be solvable. But if there are specific institutions, specific behavioral patterns, specific ways medicine functions in our society, that are not inevitable and do not need to exist, we may be able to have another golden age. That said, it's a long ways away if that's the case.
Note: this editorial is accessible if you create a free account with The Lancet. If anyone makes an account and still has trouble accessing the piece, drop a comment here and I'll post a PDF.
The current medical landscape, with an emphasis on prescribing and managing chronic conditions, underscores the importance of best practices to optimize health and *prevent* or at least delay/mitigate the conditions and afflictions of our industrialized society. A sound diet, regular exercise, and consistent sleep should be emphasized and prioritized in our society to promote a foundation of overall health.
Sadly, the current system is also contributing to physician burnout. This is a parallel issue and another unintended consequence of the modern medical paradigms. We have a lot of work to do if the golden era is to return.
After the Golden Age: What is Medicine for?
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