From an article in press, based on a talk I gave last year, in which I mull over some of the problems of modern medicine: a dysfunctional research system; a failure to consider what types of rationality underpin medicine; and a broadside on medical education .[Yes, modesty doesn’t figure]. Here is a flavour:
There is a phrase used by engineers, that goes roughly as follows: physics was made by God, but to engineer is human. Engineers have of course to be cognisant of the laws of nature, but that is only part of what they need to know in order to build artefacts. This applies to medicine too. Science may tell us about how the natural world works, but we want more than that, because we also have to know how science and society work. We want to intervene, and the test of our knowledge is how well we can do this in the social and economic systems we inhabit. UVR causes most skin cancer, but if the patient in front of us already has a thick nodular melanoma, we have to ask: was it inevitable that they would present when they did, and what can we do for them now? But the answers to these questions do not just depend on biology. Medical engineers not only have to talk the language of molecules, but also the language of health insurers. Furthermore, medical engineers also have to know how to engineer their own cultures of discovery, along the way.