Ray Moynihan
ABC Books, $A19.95, pp 308 
ISBN 0 7333 0652 7
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Rating: ★★★
This is a meticulous and thoughtful critique of the amount of investigation and treatment experienced by patients in modern medicine. Take, for example, the worldwide explosion of diagnostic endoscopy for indigestion. Firstly, there is no evidence that it has resulted in a major improvement in health outcome. Secondly, an army of endoscopists has been created, who see this as all or most of their life’s work. Thirdly, armouries of ingenious but expensive endoscopes have been manufactured by a major new industry. Lastly, physicians have, as endoscopists, joined the league of big surgical earners for the first time (except for invasive cardiologists, who arrived there some time ago). So even if there were, as there may be, good reasons for restraint, what chance is there of achieving it? Might a careful history together with the minimum of investigation (a red cell count, for example) and the simplest of treatment be the first and, in many young adults, the safest and most cost effective approach?
Moynihan is young and a journalist, but he is not an angry young man, not even a latter-day Illich. He is talented: you will enjoy his clear and critical examination of complicated issues, and the trustees of the Harkness Foundation have this year awarded him a scholarship to Harvard. He has already won prizes for both medical and science journalism.
He is concerned at the inability of doctors to stand back from the treadmill of professional practice to examine and re-examine what we do and why. He sees us as driven by technological and pharmacological advance, by uncritical press and public opinion (regarding therapeutic and diagnostic fashion), and more than a little driven by financial interests—our own and those of industry. His purpose is to encourage public scrutiny and healthy scepticism of doctors, to weigh the risks, benefits, and fundamental uncertainties of medical practice, and to consider what is sensible, safe, and necessary.
We may have heard most of this before, but the issues have probably never been put more clearly, coherently, and sympathetically. The public has not yet taken these issues to heart, but the medical profession is starting to take seriously damage from “friendly fire.” That we still have a long way to go is neither surprising nor necessarily a criticism, but it makes a spur to greater effort welcome.