Medicine in Europe and the United States

Whiggish authors justifiably rave about the "stupendous progress" of medicine in the twentieth century; it was also the century that witnessed the greatest medical crimes in history.

Medical murder and human experimentation.

Enthusiastically serving scientifically deluded politicians and bureaucrats, a large number of doctors turned medical research into a large-scale immoral and deadly science in the Japanese empire, the United States, and, above all, in Nazi Germany. Adopting eugenic policies, Nazi doctors and their collaborators sterilized hundreds of thousands of mentally handicapped and sick persons, epileptics, and alcoholics. Other countries—Sweden and the United States, for example—also pursued sterilization policies. Patients in mental hospitals were starved and, during World War II, gassed. A racial agenda supported cost-effective medicine. Human experimentation carried out by doctors flourished in certain death camps. Beginning with the postwar Nuremberg Code, international declarations have outlawed such medical horrors. A nonethical medicine has a murderous potential; so it is back to Hippocrates, the phoenix of Western medicine, who was also Heinrich Himmler's medical hero.

Medical progress.

By the end of the twentieth century, European medicine was remarkably similar to but not identical with American medicine in terms of clinical science, medical research, and surgery; it was different in its relations with the market economy, in the state's provision of universal primary medical care as a basic service, and in its cultural values. For considerably less cost, Europeans were just as healthy and, in many groups, enjoyed greater longevity than Americans. "Big medicine," which includes giant hospitals, often including extensive imaging and laboratory facilities, enormous bureaucracies, global drug companies, and large medical schools, was of course just as much a feature of the European as the American scene. Nowhere is this clearer than in the "war on cancer," the most useful of diseases in the promotion of the modernization of medicine; cancerology became the growth model of big medicine. The conceptual basis of medicine has changed radically since the eighteenth century. The changes can all be blamed on discoveries in genetics, immunology, neurology, endocrinology, pharmacology, and, the stepchild of medical education, nutritional science.

Still, science cannot escape being part of culture. Even in the new surgical fields that have opened up in organ transplantation and in cardiology, certain cultural differences distinguish medical practice in different countries. German doctors, loving the heart above all other organs, are much more inclined to use drugs than surgery in treating cardiovascular diseases. The number of coronary bypass operations per 100,000 people in 1998 was 202 for the United States, 90 for Germany, and 35 for the United Kingdom; the last figure probably reflected a generally bad state of cardiovascular care. French doctors seem much more concerned with the functioning of the liver than doctors in other cultures; they are also much more conservative in n recommending hysterectomies. French doctors are too generous with the use of ionizing radiation—825 procedures per 1,000 inhabitants—nearly twice as many procedures as in Britain. Wherever one looks, health is a major European growth industry. There is no shortage of disease, including hypochondria. Every age seems to have its "epidemic"—in the early twenty-first century, it is HIV-AIDS. And with the doctor accepting the modern idea that a well person is only an insufficiently diagnosed patient, and genetic medicine aiming to define genetically determined disease susceptibility in individual patients, the normal may become, as in Jules Roman's famous play Knock, the profitable pathological.