Moving Mountains – A Socratic Challenge to the Theory and Practice of Population Medicine, by Dr Michel Accad
(available from Amazon.com)
This small book is an accessible and readible account of the philosophical basis of public policy relating to medicine, which has dominated government health policy for the last 30 years at least. It arises from a branch of medicine called epidemiology, which studies the possible control of disease by statistical analysis of human behaviour and the frequency of the occurance of symptoms and disease in population groups and any population as a whole.
The writer, Dr Michel Accad is a medical doctor who regularly publishes peer-reviewed articles on the philosophical aspects of healthcare and medicine and a Catholic who is concerned especially about the de-personalization of healthcare in the US. In this book, by reference to real policies and their effects, and with analysis backed up by scientific research, he explains why, in his opinion, it has gone so wrong. He does so through the vehicle of a conversation in the style of a dialogue that one might read in Plato’s works. It is an imagined conversation between the ancient Greek philosopher Socrates and Geoffrey Rose, an Englishman who died in 1993 and who was one of the intellectual founders of population health medicine.
I would urge all doctors and anyone involved in the formulation of public health policy to read this book and consider its implications.
The starting point for our consideration is the bell curve showing the links between particular behaviour and risk of a particular in the population. In the examples given, which one assumes are typical, they appear to indicate that a certain proportion of the population is always at risk. So far so good.
The public policy that is implemented as a result of this analysis is based on an assumption that if the overal pattern of the symptoms or behaviours of risk in the population can be controlled so that a smaller proportion of the population appear to be at risk, the rate occurance of the disease of individuals will go down too and therefore, the general health of the population will go up. So for example, blood pressure can lead to heart disease so, the argument runs, if you reduce the average blood pressure of the whole population, you reduce the rate of heart disease in the population as a whole because fewer people are (Read More)