Clipping Board » Medical Myths ─ The truth about healthcare is often different from what you intuitively think.
The traditional medical goal of "curing diseases and preventing death" faces serious challenges.
The medical model that seeks to treat diseases with high technology inevitably leads to a medical crisis in all countries sooner or later.
Human health depends on the cooperation between health and non-health sectors.
Without adjusting the goals of medicine, it is difficult to achieve the objectives of accessibility and equity in healthcare and to overcome the medical crisis.
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Tracing the Goals of Medicine
By Du Zhizheng, Editor-in-Chief of *Medicine and Philosophy*
1. The Proposal of Research on the Goals of Medicine (GOM)
The issue of the goals of medicine was raised by Daniel Callahan, Director of the Hastings Center in the United States, in the 1980s and early 1990s. Since 1980, the Hastings Center has organized a series of discussions on issues related to medicine, law, resource allocation, and the difficulties faced by medicine in the context of the goals of medicine. In 1992, Callahan was elected as a member of the National Academy of Sciences and organized a conference with renowned biologists and physicians, where he proposed reconsidering the goals of medicine to address various contradictions in healthcare.
The Hastings Center raised this issue based on the following four assumptions:
(1) All countries will eventually face a crisis in their healthcare systems.
(2) Modern medicine cannot solve the problems of disease, aging, and death.
(3) Modern medicine mistakenly regards curing diseases and preventing death as its primary goals.
(4) There is a significant difference between pursuing good health and curing or alleviating diseases.
The proposal of GOM immediately attracted attention from the medical and philosophical communities worldwide. Initially, nine industrialized countries participated (the United States, Germany, Sweden, the United Kingdom, the Netherlands, Italy, Spain, Czechoslovakia, and Hungary). The then Director-General of the World Health Organization, Halfdan Mahler, wrote to Callahan, suggesting that developing countries should also have representatives. Subsequently, China, Indonesia, Chile, Denmark, and Slovakia joined, forming an international GOM research project involving 14 countries. These countries conducted academic research based on the Hastings Center's plans and participated in discussions organized by the center.
During the GOM research process, four international academic conferences were held: the first Prague conference in July 1993, the second Prague conference in October 1994, the third Prague conference in November 1995, and the Naples conference in July 1997. Additionally, a meeting was held in Detroit, USA, in 1996, with Chinese scholars participating in several of these conferences.
The first Prague conference mainly focused on defining the research objectives and plans for GOM. Callahan and other scholars from the center introduced and explained that the GOM project aimed to provide answers to the following three questions: What should be the future goals of medical research? What should be the future goals of medical services? What should be the future goals of medical education?
The second Prague conference discussed ten issues based on survey findings: 1. Concepts of health, illness, and disease; 2. Premature death; 3. Aging; 4. The scope of medicine; 5. Medical progress; 6. Historical perspectives on the goals of medicine; 7. Proposals for the goals of medicine; 8. Medical services; 9. Medical research; 10. Medical education.
The third Prague conference primarily discussed the fourth draft of the unified statement formed by the GOM research. This statement integrated the main issues discussed previously and listed 23 questions.As traditional medical purposes, reasons for reconstruction, the "is" and "ought" of medicine, market forces and public demand, cultural pressures, medicalization of life, and human enhancement. This statement was discussed multiple times and eventually formed a document titled "The Purpose of Medicine: Determining Priority Development Strategies." However, the Slovak and Danish groups expressed differing opinions on the declaration regarding family planning, infertility regulation, and the notion that civilized societies should provide decent medical care to citizens regardless of their ability to pay.
At the 1996 Detroit conference, Callahan delivered speeches at the beginning and end titled "Why We Need to Reconsider the Purpose of Medicine" and "Redefining the Purpose of Medicine," respectively. He also introduced background information on the three-year international research project on the purpose of medicine. The conference was divided into six sessions: the purpose of medicine and the future of healthcare in the United States; the relationship between medicine and healthcare; the purpose of medicine and the history of medicine in the United States; American social values; pain relief and life preservation; chronic diseases and human enhancement; and medical services and medical education.
The Detroit conference featured many insightful speeches, some of which offered thought-provoking perspectives:
— The purpose of medicine should be reconstructed, including changing attitudes toward death, shifting from cure to care, and narrowing the scope of medicine.
— Treatment goals should be determined separately for different diseases. For example, the treatment goals for chronic diseases should be addressed specifically.
— The purpose of medicine is a social construct.
— Healthcare services should be divided into ordinary and luxury systems.
— To change the purpose of medicine, the social value system must also change.
— It is reasonable to set the clinical treatment endpoint at eliminating pathogenicity.
This GOM research concluded with a press conference held in New York in November 1996. The conference announced that the 14-nation declaration called for a review of the "purpose of medicine," urging a shift from cure and high technology to care, with a focus on public health and disease prevention. The international research group warned that the current development strategy of medicine is creating unaffordable and unjust medical systems worldwide.
### II. The Dilemma of Traditional Medical Purposes
The GOM research suggests that current international responses to healthcare reform are merely technical, acknowledging only management or organizational issues. Solutions often revolve around discussions of markets, privatization, government regulation, price controls, and cost-benefit analysis. While these are necessary, they are not fundamental. Ultimately, the problem lies in the purpose of medicine rather than its methods. Without this understanding, the ongoing global healthcare reforms are likely to fail.
Traditional medical purposes can be summarized as: curing diseases and preventing death.
#### 1. Challenges Facing Traditional Medical Purposes
**Challenge One:** One of the traditional purposes of medicine is to save and prolong life. But what does this purpose mean when machines can sustain lives that were previously unsustainable? Genetics may extend life, but is this an appropriate medical purpose? Should medicine necessarily be the enemy of death and aging?
**Challenge Two:** Another traditional purpose of medicine is to promote and maintain health. But what does this purpose mean when it is possible to sustain the lives of infants weighing less than 500 grams or elderly individuals over 100 years old at great cost? Should disease and suffering be unacceptable and eradicated?
**Challenge Three:** The traditional purpose of medicine is to relieve pain and suffering. Does this mean that euthanasia and physician-assisted suicide should become part of medicine? Should medicine consider everyday anxieties, social violence, and environmental hazards within its scope and attempt to find medical or other methods to address these issues? These factors may cause pain and suffering, but they do not stem from disease and can harm health.So, what are the legitimate fields of medicine and the reasonable boundaries of healthcare?
Challenge Four: Traditionally, the goals of medicine have been individual-focused and primarily determined by doctors, but nowadays, doctors are increasingly constrained by external conditions. Due to the tremendous progress in medicine, it has become a source of money and profit, a force in the national economy; while individuals find it increasingly difficult to afford healthcare, the government plays an increasingly major role in health preservation. At the same time, today's medicine is more open than ever and increasingly subject to external influences, with the role of doctors relatively diminishing.
Challenge Five: The traditional purpose of medicine is medicine-centered, with medical means being decisive in achieving medical goals. However, since the last century, methods for promoting health have become increasingly broad, and the role of medical treatment in health preservation has relatively diminished; medical treatment is placed within the health preservation system, which in turn is part of a broader social and political system. This has led to unclear interfaces and contradictions between the medical system, the health preservation system, and the larger social system in terms of health preservation roles.
2. Reasons for the Dilemma Facing Traditional Medical Goals
Today, medicine is under immense pressure. The reasons for these pressures are multifaceted, but one important reason is the success of medicine, not its failure. Therefore, it is necessary to review the development strategy of medicine to see if there is a problem with the development approach of medicine itself?
Reason One: Medicine is overly pursuing cutting-edge technology. Today's medicine believes that curing diseases relies entirely on cutting-edge technology. Medical education guides doctors to use cutting-edge technology, the pharmaceutical and medical device industry is committed to manufacturing and supplying cutting-edge technology, and healthcare is committed to deploying and paying for it. This has resulted in increasingly enormous medical costs, forming a direction where medicine is becoming more expensive and serving fewer people, with the benefits often being marginal.
Reason Two: A preference for the treatment perspective. In the consciousness of modern medicine, medicine is treatment, and the concept of being committed to treatment has not softened at all and increasingly neglects care. In the fight against cancer, heart disease, and stroke, care and compassion are often blurred. The endless pursuit of high-tech solutions to these diseases has been a hallmark of medicine over the past 50 years, but it has also pushed medicine to the brink of unsustainability in many countries.
Reason Three: The impact of the elderly population on medicine. Some evidence suggests that the growth of the elderly population does not necessarily lead to a significant increase in costs, but an aging society combined with intensive medical and health services for the elderly inevitably leads to high costs, while improving the biological barriers of the elderly has not achieved significant results. Inappropriate health preservation policies for the elderly also put medicine in a dilemma.
Reason Four: The increasing influence of the market on medicine.
— The progress of medicine is largely driven by public demand, and public demand for medicine is largely influenced by the market. The rise of chronic diseases has intensified the market's demand for medicine.
— The market creates public demand for medical innovation and invests heavily in research, constantly refreshing medical technology, making those applicable technologies that could continue to function rapidly obsolete to win profits.
— The market is basically aimed at individual needs, and it is not necessarily beneficial to the public good. Individual needs and social needs are not always consistent. The medical market, like tobacco consumption, may itself be a source of disease and suffering.
— The market tends to create high-quality healthcare for the privileged, while providing comparable care for the poor is often difficult. Market-driven efficiency often contradicts the principles of justice.
— The market may make medicine a captive of commercial forces, severely impacting the central values and traditional purposes of medicine; the trust between doctors and patients, medical altruism, and public trust in medicine are all affected.
Reason Five: The integration of medicine into daily life has brought new challenges to medicine.Medicine possesses the formidable capability to alter and modify the human body, opening up possibilities for new biological systems and extensively medicalizing life in various aspects. However, this not only amplifies public expectations of medicine but also thrusts it into broader societal issues. This escalation not only increases healthcare costs but also creates uncertainty about the essence and scope of medicine, further blurring its boundaries.
3. Negative Consequences of Traditional Medical Goals
- Traditional medical goals reinforce the sacredness of life concept, neglecting the quality of life.
- They are incompatible with the biopsychosocial medical model.
- They do not align with the goal of health for all.
- They severely conflict with the principle of equitable distribution of health resources.
- They hinder the transformation of healthcare service models.
III. Defining New Medical Goals
When medicine has the capacity to determine its own course, it is largely influenced by societal norms, values, economics, and politics. The ideal transformation of medical goals must also involve societal transformation. Reconsidering medical goals requires considering societal goals and values, as well as the cultural and value context of society. Defining new medical goals necessitates finding a convergence point between medical and societal objectives. The new medical goals should be:
(1) Preventing disease and injury, promoting and maintaining health. This is the core value of medicine. Reasons: Firstly, it may prevent disease and injury; secondly, it brings significant benefits to both society and individuals; thirdly, it benefits the economy by reducing the scope of morbidity, thereby alleviating economic burdens. However, since diseases cannot be entirely overcome, and anyone can fall ill, get injured, or become disabled, this goal is not absolute. At times, other medical goals will take precedence.
(2) Relieving pain and suffering caused by diseases. This is the oldest and most traditional goal of medicine, yet modern medicine has not fully met this requirement due to the significant gap between doctors' understanding of pain and the implementation of pain therapies, and between pain caused by physical ailments and suffering caused by mental and psychological issues. The current challenge is determining how far we can go in relieving pain and suffering? Issues such as euthanasia and physician-assisted suicide remain problematic in achieving this medical goal.
(3) Care and treatment of diseases (including incurable ones). Traditionally, medicine first seeks the cause of a disease, then looks for a treatment to restore the patient to functional health, often neglecting care. However, many diseases, especially those of the elderly and chronic conditions, have no cure, making care the most common and direct goal of medicine. The primary role of medical professionals is managing diseases rather than curing them.
(4) Avoiding premature death and pursuing a peaceful death. Fighting against death is a significant goal of medicine, but medicine should maintain a healthy balance with various forms of death. Medicine should provide services for a peaceful death rather than preventing the possibility of death. To achieve this goal, medicine must correctly handle: A. Avoiding premature death, B. Pursuing a peaceful death, C. Properly managing the cessation of life-sustaining therapies, establishing ethical and medical standards for such therapies.
Premature death: Refers to death occurring before the natural life cycle. Avoiding premature death helps medicine escape certain dead ends. Preventing death is impossible. Death is not the enemy of medicine, but death occurring at the wrong time, for the wrong reasons, and in the wrong manner is the enemy of medicine.Given the rapid development of medicine, people's expectations of medicine are increasingly high, and society's influence on medicine is growing. Medicine is becoming an increasingly important component of society. It is essential to re-examine the goals of medicine and determine what the tasks of medicine truly are:
(1) It is beneficial for determining the priority strategies for future biomedical research:
A. Vigorously develop the biopsychosocial medical model to promote the improvement of clinical standards. Medical anthropology and medical sociology should become important disciplines. B. Increase investment in epidemiological and public health research. It is a decisive factor in preventing diseases and promoting health. Epidemiological surveys worldwide should be given the same importance as the Human Genome Project, as their significance is no less than that of the genome project.
(2) It is beneficial for scientifically designing the healthcare service system:
A. Determine prioritization strategies. This includes effectively and rationally arranging medical resources, finding a balance between individual and collective interests, ensuring that the healthcare system first meets public health needs, and then provides sophisticated medicine to meet certain individual needs. B. Prioritize community and rural healthcare services.
(3) It is beneficial for properly managing the relationship between medicine and the market. The market offers greater possibilities for medicine and healthcare in attracting funds, promoting technological advancement, and meeting the needs of special populations, but it also carries greater risks. The market encourages medicine to endlessly adopt new technologies and create healthcare demands, leading to endlessly rising healthcare costs. Medicine should not be market-driven but should utilize the market to a limited extent.
(4) It is beneficial for improving medical education and training doctors to better serve the goals of medicine:
A. The current "diagnosis and treatment" model of medical education, while having its merits, has serious drawbacks: it neglects the medical and social complexity of chronic diseases, overlooks prevention, distorts the doctor-patient relationship, ignores the holistic nature of patients, and neglects medical humanism, all of which need to be addressed. B. Medical humanism, especially in law, ethics, communication skills, medical philosophy, and medical anthropology, should be strengthened in education.
The GOM research concludes that future medicine should be:
1. A restrained and cautious medicine;
2. An affordable and economically sustainable medicine;
3. A socially responsive and diverse medicine;
4. A just and fair medicine;
5. A medicine that respects human choice and dignity.
Is medicine an art or a science? Is it a humanitarian endeavor with scientific components or a scientific endeavor with humanitarian components? There is no clear answer yet. However, it is essential to firmly believe that in the face of uncertainty, the core values of humanity and morality, and new scientific discoveries, the goals of medicine should be combined with the art of human judgment. Pursue a respected, affordable, sustainable, and fair medicine. Only through the joint efforts of doctors and patients, and medicine and society, can the future of medicine be fully shaped. The starting point of these efforts is the purpose of medicine.
IV. Promoting the Transformation of Traditional Medical Goals
1. Adjust medical goals according to the changes of the times.
The ultimate goal of medicine is consistent, but different countries and regions in different periods should determine medical goals suitable for their own conditions and circumstances. Therefore, medical goals should be distinguished into broad and narrow medical goals, macro and micro-level medical goals, ideal and realistic medical goals, and the social goals of medicine and the specific goals of medical activities. According to the different times, determine the goals of health work in different countries and regions, and formulate corresponding policies.2. The future purpose of medicine should be oriented towards healthy populations.
While it is necessary for traditional medical purposes to serve individual patients in certain situations, it has many drawbacks and cannot avoid the impending medical crisis. Only by shifting the focus of medical purposes to primarily serve healthy populations can we overcome the current dilemmas faced by medicine. This requires a clear definition of health, the establishment of health goals, the awakening of public health awareness, and a transformation in the understanding of medical objectives among both medical professionals and the general public.
3. Elevate public health to the main agenda.
Traditional medical purposes have hindered the development of public health, and without the full development of public health, medical goals are difficult to achieve. Clinical medicine is only a part of medicine, not the whole; the medical purpose of curing diseases and avoiding death has excluded public health from medicine or placed it in an unimportant position, which is a significant reason why contemporary medicine is in trouble. Only by focusing health services on health rather than just disease, on populations rather than individuals, and making public health and disease prevention the mainstay of health services, can we achieve the scientific purpose of medicine.
4. Correctly handle the economic impact on medicine.
The development of medicine towards privatization and marketization will inevitably distort the inherent functions of medicine. Society must determine the extent, scope, measures, and methods of the market's role in medicine; otherwise, medicine will be in a tense relationship, and its goals will be difficult to achieve.
5. Emphasize the role of non-health sectors in health.
Various facts indicate that environmental protection, sports, food, living environments, communities, and lifestyles are increasingly affecting health. Achieving medical purposes and the goal of health for all depends on the cooperation between health and non-health sectors. The outdated notion that disease prevention and health promotion can only be achieved through the efforts of the health sector must be reconsidered.
6. Value the role of traditional medicine (Chinese medicine) in achieving medical purposes.
The medical philosophy of traditional medicine (Chinese medicine) emphasizes preventing disease before it occurs, strengthening the body to eliminate pathogens, the unity of body and mind, and nurturing life and energy, thus aligning more closely with the scientific purpose of medicine. The exclusion of traditional medicine is a bias of modern medicine.
V. Reflections on Health Reform
The Hastings Center's initiative to study the purpose of medicine is based on the context of Western developed countries, but it is also meaningful for developing countries like ours. Scholars in our country, in the process of studying the purpose of medicine, believe that developing countries also face some of the main contradictions in healthcare services that developed countries face, and medical crises exist to varying degrees. Therefore, for developing countries, re-examining the purpose of medicine also has practical significance.
Some scholars in our country believe that China is actually facing a medical crisis. The sharp rise in medical costs, the inability of the majority of the population to afford medical care, the small coverage of health insurance; the unreasonable distribution of medical resources; the prominent structural contradictions in the health service system; the coexistence of insufficient resources and resource waste; the deterioration of doctor-patient relationships, and the increasing social dissatisfaction all indicate that our country's healthcare is facing a crisis. However, current measures are all centered around how to control costs, expand health insurance coverage, and increase investment, etc. As the GOM research results show, the medical problems we face now are due to the development strategy of contemporary medicine that seeks high-tech treatments for diseases and provides health services. As long as this strategy does not change, the root causes of the above problems will persist. They can only be alleviated to some extent but cannot be fundamentally resolved.
Can the current countermeasures overcome this medical crisis? It's difficult. The health service system centered around large hospitals, which has been formed over hundreds of years, is supported by high technology and maintains its vitality by continuously phasing out old technologies and adopting new ones, and it is closely related to the personal interests of hospitals and doctors.Imagine, how could a large hospital equipped with high-tech facilities possibly give up the pursuit of high profits to engage in disease prevention, guide the public in adjusting their lifestyles and habits, and improve health knowledge levels to reduce the incidence of diseases? Without patients, how could hospitals exist? Perhaps, it might be necessary to establish another system aimed at improving the health level of the entire population to achieve medical goals.
Therefore, if the medical development strategy that seeks to develop high-tech treatments for diseases is not changed, attempting to control medical costs would be like climbing a tree to catch fish. It would be very difficult to achieve the goals of medical justice and universal health care. For this reason, it is essential to accurately define the purpose of medicine, thereby adjusting the development strategies of medicine, services, education, and research.
Given that it is almost impossible to expect the existing health care service system to undergo such a radical transformation, a bolder idea is to unite the existing departments directly related to health (such as environmental protection, family planning, sports, disease control, health insurance, etc.) to form a health promotion department, and to form an alliance with the medical department to advance the realization of the goal of health for all.
Source: http://www. kjzg. com. cn/ newver/ browarticle. php? articleid=1146
Tracing the Purpose of Medicine
The medical model that seeks to treat diseases with high technology inevitably leads to a medical crisis in all countries sooner or later.
Human health depends on the cooperation between health and non-health sectors.
Without adjusting the goals of medicine, it is difficult to achieve the objectives of accessibility and equity in healthcare and to overcome the medical crisis.
---
Tracing the Goals of Medicine
By Du Zhizheng, Editor-in-Chief of *Medicine and Philosophy*
1. The Proposal of Research on the Goals of Medicine (GOM)
The issue of the goals of medicine was raised by Daniel Callahan, Director of the Hastings Center in the United States, in the 1980s and early 1990s. Since 1980, the Hastings Center has organized a series of discussions on issues related to medicine, law, resource allocation, and the difficulties faced by medicine in the context of the goals of medicine. In 1992, Callahan was elected as a member of the National Academy of Sciences and organized a conference with renowned biologists and physicians, where he proposed reconsidering the goals of medicine to address various contradictions in healthcare.
The Hastings Center raised this issue based on the following four assumptions:
(1) All countries will eventually face a crisis in their healthcare systems.
(2) Modern medicine cannot solve the problems of disease, aging, and death.
(3) Modern medicine mistakenly regards curing diseases and preventing death as its primary goals.
(4) There is a significant difference between pursuing good health and curing or alleviating diseases.
The proposal of GOM immediately attracted attention from the medical and philosophical communities worldwide. Initially, nine industrialized countries participated (the United States, Germany, Sweden, the United Kingdom, the Netherlands, Italy, Spain, Czechoslovakia, and Hungary). The then Director-General of the World Health Organization, Halfdan Mahler, wrote to Callahan, suggesting that developing countries should also have representatives. Subsequently, China, Indonesia, Chile, Denmark, and Slovakia joined, forming an international GOM research project involving 14 countries. These countries conducted academic research based on the Hastings Center's plans and participated in discussions organized by the center.
During the GOM research process, four international academic conferences were held: the first Prague conference in July 1993, the second Prague conference in October 1994, the third Prague conference in November 1995, and the Naples conference in July 1997. Additionally, a meeting was held in Detroit, USA, in 1996, with Chinese scholars participating in several of these conferences.
The first Prague conference mainly focused on defining the research objectives and plans for GOM. Callahan and other scholars from the center introduced and explained that the GOM project aimed to provide answers to the following three questions: What should be the future goals of medical research? What should be the future goals of medical services? What should be the future goals of medical education?
The second Prague conference discussed ten issues based on survey findings: 1. Concepts of health, illness, and disease; 2. Premature death; 3. Aging; 4. The scope of medicine; 5. Medical progress; 6. Historical perspectives on the goals of medicine; 7. Proposals for the goals of medicine; 8. Medical services; 9. Medical research; 10. Medical education.
The third Prague conference primarily discussed the fourth draft of the unified statement formed by the GOM research. This statement integrated the main issues discussed previously and listed 23 questions.As traditional medical purposes, reasons for reconstruction, the "is" and "ought" of medicine, market forces and public demand, cultural pressures, medicalization of life, and human enhancement. This statement was discussed multiple times and eventually formed a document titled "The Purpose of Medicine: Determining Priority Development Strategies." However, the Slovak and Danish groups expressed differing opinions on the declaration regarding family planning, infertility regulation, and the notion that civilized societies should provide decent medical care to citizens regardless of their ability to pay.
At the 1996 Detroit conference, Callahan delivered speeches at the beginning and end titled "Why We Need to Reconsider the Purpose of Medicine" and "Redefining the Purpose of Medicine," respectively. He also introduced background information on the three-year international research project on the purpose of medicine. The conference was divided into six sessions: the purpose of medicine and the future of healthcare in the United States; the relationship between medicine and healthcare; the purpose of medicine and the history of medicine in the United States; American social values; pain relief and life preservation; chronic diseases and human enhancement; and medical services and medical education.
The Detroit conference featured many insightful speeches, some of which offered thought-provoking perspectives:
— The purpose of medicine should be reconstructed, including changing attitudes toward death, shifting from cure to care, and narrowing the scope of medicine.
— Treatment goals should be determined separately for different diseases. For example, the treatment goals for chronic diseases should be addressed specifically.
— The purpose of medicine is a social construct.
— Healthcare services should be divided into ordinary and luxury systems.
— To change the purpose of medicine, the social value system must also change.
— It is reasonable to set the clinical treatment endpoint at eliminating pathogenicity.
This GOM research concluded with a press conference held in New York in November 1996. The conference announced that the 14-nation declaration called for a review of the "purpose of medicine," urging a shift from cure and high technology to care, with a focus on public health and disease prevention. The international research group warned that the current development strategy of medicine is creating unaffordable and unjust medical systems worldwide.
### II. The Dilemma of Traditional Medical Purposes
The GOM research suggests that current international responses to healthcare reform are merely technical, acknowledging only management or organizational issues. Solutions often revolve around discussions of markets, privatization, government regulation, price controls, and cost-benefit analysis. While these are necessary, they are not fundamental. Ultimately, the problem lies in the purpose of medicine rather than its methods. Without this understanding, the ongoing global healthcare reforms are likely to fail.
Traditional medical purposes can be summarized as: curing diseases and preventing death.
#### 1. Challenges Facing Traditional Medical Purposes
**Challenge One:** One of the traditional purposes of medicine is to save and prolong life. But what does this purpose mean when machines can sustain lives that were previously unsustainable? Genetics may extend life, but is this an appropriate medical purpose? Should medicine necessarily be the enemy of death and aging?
**Challenge Two:** Another traditional purpose of medicine is to promote and maintain health. But what does this purpose mean when it is possible to sustain the lives of infants weighing less than 500 grams or elderly individuals over 100 years old at great cost? Should disease and suffering be unacceptable and eradicated?
**Challenge Three:** The traditional purpose of medicine is to relieve pain and suffering. Does this mean that euthanasia and physician-assisted suicide should become part of medicine? Should medicine consider everyday anxieties, social violence, and environmental hazards within its scope and attempt to find medical or other methods to address these issues? These factors may cause pain and suffering, but they do not stem from disease and can harm health.So, what are the legitimate fields of medicine and the reasonable boundaries of healthcare?
Challenge Four: Traditionally, the goals of medicine have been individual-focused and primarily determined by doctors, but nowadays, doctors are increasingly constrained by external conditions. Due to the tremendous progress in medicine, it has become a source of money and profit, a force in the national economy; while individuals find it increasingly difficult to afford healthcare, the government plays an increasingly major role in health preservation. At the same time, today's medicine is more open than ever and increasingly subject to external influences, with the role of doctors relatively diminishing.
Challenge Five: The traditional purpose of medicine is medicine-centered, with medical means being decisive in achieving medical goals. However, since the last century, methods for promoting health have become increasingly broad, and the role of medical treatment in health preservation has relatively diminished; medical treatment is placed within the health preservation system, which in turn is part of a broader social and political system. This has led to unclear interfaces and contradictions between the medical system, the health preservation system, and the larger social system in terms of health preservation roles.
2. Reasons for the Dilemma Facing Traditional Medical Goals
Today, medicine is under immense pressure. The reasons for these pressures are multifaceted, but one important reason is the success of medicine, not its failure. Therefore, it is necessary to review the development strategy of medicine to see if there is a problem with the development approach of medicine itself?
Reason One: Medicine is overly pursuing cutting-edge technology. Today's medicine believes that curing diseases relies entirely on cutting-edge technology. Medical education guides doctors to use cutting-edge technology, the pharmaceutical and medical device industry is committed to manufacturing and supplying cutting-edge technology, and healthcare is committed to deploying and paying for it. This has resulted in increasingly enormous medical costs, forming a direction where medicine is becoming more expensive and serving fewer people, with the benefits often being marginal.
Reason Two: A preference for the treatment perspective. In the consciousness of modern medicine, medicine is treatment, and the concept of being committed to treatment has not softened at all and increasingly neglects care. In the fight against cancer, heart disease, and stroke, care and compassion are often blurred. The endless pursuit of high-tech solutions to these diseases has been a hallmark of medicine over the past 50 years, but it has also pushed medicine to the brink of unsustainability in many countries.
Reason Three: The impact of the elderly population on medicine. Some evidence suggests that the growth of the elderly population does not necessarily lead to a significant increase in costs, but an aging society combined with intensive medical and health services for the elderly inevitably leads to high costs, while improving the biological barriers of the elderly has not achieved significant results. Inappropriate health preservation policies for the elderly also put medicine in a dilemma.
Reason Four: The increasing influence of the market on medicine.
— The progress of medicine is largely driven by public demand, and public demand for medicine is largely influenced by the market. The rise of chronic diseases has intensified the market's demand for medicine.
— The market creates public demand for medical innovation and invests heavily in research, constantly refreshing medical technology, making those applicable technologies that could continue to function rapidly obsolete to win profits.
— The market is basically aimed at individual needs, and it is not necessarily beneficial to the public good. Individual needs and social needs are not always consistent. The medical market, like tobacco consumption, may itself be a source of disease and suffering.
— The market tends to create high-quality healthcare for the privileged, while providing comparable care for the poor is often difficult. Market-driven efficiency often contradicts the principles of justice.
— The market may make medicine a captive of commercial forces, severely impacting the central values and traditional purposes of medicine; the trust between doctors and patients, medical altruism, and public trust in medicine are all affected.
Reason Five: The integration of medicine into daily life has brought new challenges to medicine.Medicine possesses the formidable capability to alter and modify the human body, opening up possibilities for new biological systems and extensively medicalizing life in various aspects. However, this not only amplifies public expectations of medicine but also thrusts it into broader societal issues. This escalation not only increases healthcare costs but also creates uncertainty about the essence and scope of medicine, further blurring its boundaries.
3. Negative Consequences of Traditional Medical Goals
- Traditional medical goals reinforce the sacredness of life concept, neglecting the quality of life.
- They are incompatible with the biopsychosocial medical model.
- They do not align with the goal of health for all.
- They severely conflict with the principle of equitable distribution of health resources.
- They hinder the transformation of healthcare service models.
III. Defining New Medical Goals
When medicine has the capacity to determine its own course, it is largely influenced by societal norms, values, economics, and politics. The ideal transformation of medical goals must also involve societal transformation. Reconsidering medical goals requires considering societal goals and values, as well as the cultural and value context of society. Defining new medical goals necessitates finding a convergence point between medical and societal objectives. The new medical goals should be:
(1) Preventing disease and injury, promoting and maintaining health. This is the core value of medicine. Reasons: Firstly, it may prevent disease and injury; secondly, it brings significant benefits to both society and individuals; thirdly, it benefits the economy by reducing the scope of morbidity, thereby alleviating economic burdens. However, since diseases cannot be entirely overcome, and anyone can fall ill, get injured, or become disabled, this goal is not absolute. At times, other medical goals will take precedence.
(2) Relieving pain and suffering caused by diseases. This is the oldest and most traditional goal of medicine, yet modern medicine has not fully met this requirement due to the significant gap between doctors' understanding of pain and the implementation of pain therapies, and between pain caused by physical ailments and suffering caused by mental and psychological issues. The current challenge is determining how far we can go in relieving pain and suffering? Issues such as euthanasia and physician-assisted suicide remain problematic in achieving this medical goal.
(3) Care and treatment of diseases (including incurable ones). Traditionally, medicine first seeks the cause of a disease, then looks for a treatment to restore the patient to functional health, often neglecting care. However, many diseases, especially those of the elderly and chronic conditions, have no cure, making care the most common and direct goal of medicine. The primary role of medical professionals is managing diseases rather than curing them.
(4) Avoiding premature death and pursuing a peaceful death. Fighting against death is a significant goal of medicine, but medicine should maintain a healthy balance with various forms of death. Medicine should provide services for a peaceful death rather than preventing the possibility of death. To achieve this goal, medicine must correctly handle: A. Avoiding premature death, B. Pursuing a peaceful death, C. Properly managing the cessation of life-sustaining therapies, establishing ethical and medical standards for such therapies.
Premature death: Refers to death occurring before the natural life cycle. Avoiding premature death helps medicine escape certain dead ends. Preventing death is impossible. Death is not the enemy of medicine, but death occurring at the wrong time, for the wrong reasons, and in the wrong manner is the enemy of medicine.Given the rapid development of medicine, people's expectations of medicine are increasingly high, and society's influence on medicine is growing. Medicine is becoming an increasingly important component of society. It is essential to re-examine the goals of medicine and determine what the tasks of medicine truly are:
(1) It is beneficial for determining the priority strategies for future biomedical research:
A. Vigorously develop the biopsychosocial medical model to promote the improvement of clinical standards. Medical anthropology and medical sociology should become important disciplines. B. Increase investment in epidemiological and public health research. It is a decisive factor in preventing diseases and promoting health. Epidemiological surveys worldwide should be given the same importance as the Human Genome Project, as their significance is no less than that of the genome project.
(2) It is beneficial for scientifically designing the healthcare service system:
A. Determine prioritization strategies. This includes effectively and rationally arranging medical resources, finding a balance between individual and collective interests, ensuring that the healthcare system first meets public health needs, and then provides sophisticated medicine to meet certain individual needs. B. Prioritize community and rural healthcare services.
(3) It is beneficial for properly managing the relationship between medicine and the market. The market offers greater possibilities for medicine and healthcare in attracting funds, promoting technological advancement, and meeting the needs of special populations, but it also carries greater risks. The market encourages medicine to endlessly adopt new technologies and create healthcare demands, leading to endlessly rising healthcare costs. Medicine should not be market-driven but should utilize the market to a limited extent.
(4) It is beneficial for improving medical education and training doctors to better serve the goals of medicine:
A. The current "diagnosis and treatment" model of medical education, while having its merits, has serious drawbacks: it neglects the medical and social complexity of chronic diseases, overlooks prevention, distorts the doctor-patient relationship, ignores the holistic nature of patients, and neglects medical humanism, all of which need to be addressed. B. Medical humanism, especially in law, ethics, communication skills, medical philosophy, and medical anthropology, should be strengthened in education.
The GOM research concludes that future medicine should be:
1. A restrained and cautious medicine;
2. An affordable and economically sustainable medicine;
3. A socially responsive and diverse medicine;
4. A just and fair medicine;
5. A medicine that respects human choice and dignity.
Is medicine an art or a science? Is it a humanitarian endeavor with scientific components or a scientific endeavor with humanitarian components? There is no clear answer yet. However, it is essential to firmly believe that in the face of uncertainty, the core values of humanity and morality, and new scientific discoveries, the goals of medicine should be combined with the art of human judgment. Pursue a respected, affordable, sustainable, and fair medicine. Only through the joint efforts of doctors and patients, and medicine and society, can the future of medicine be fully shaped. The starting point of these efforts is the purpose of medicine.
IV. Promoting the Transformation of Traditional Medical Goals
1. Adjust medical goals according to the changes of the times.
The ultimate goal of medicine is consistent, but different countries and regions in different periods should determine medical goals suitable for their own conditions and circumstances. Therefore, medical goals should be distinguished into broad and narrow medical goals, macro and micro-level medical goals, ideal and realistic medical goals, and the social goals of medicine and the specific goals of medical activities. According to the different times, determine the goals of health work in different countries and regions, and formulate corresponding policies.2. The future purpose of medicine should be oriented towards healthy populations.
While it is necessary for traditional medical purposes to serve individual patients in certain situations, it has many drawbacks and cannot avoid the impending medical crisis. Only by shifting the focus of medical purposes to primarily serve healthy populations can we overcome the current dilemmas faced by medicine. This requires a clear definition of health, the establishment of health goals, the awakening of public health awareness, and a transformation in the understanding of medical objectives among both medical professionals and the general public.
3. Elevate public health to the main agenda.
Traditional medical purposes have hindered the development of public health, and without the full development of public health, medical goals are difficult to achieve. Clinical medicine is only a part of medicine, not the whole; the medical purpose of curing diseases and avoiding death has excluded public health from medicine or placed it in an unimportant position, which is a significant reason why contemporary medicine is in trouble. Only by focusing health services on health rather than just disease, on populations rather than individuals, and making public health and disease prevention the mainstay of health services, can we achieve the scientific purpose of medicine.
4. Correctly handle the economic impact on medicine.
The development of medicine towards privatization and marketization will inevitably distort the inherent functions of medicine. Society must determine the extent, scope, measures, and methods of the market's role in medicine; otherwise, medicine will be in a tense relationship, and its goals will be difficult to achieve.
5. Emphasize the role of non-health sectors in health.
Various facts indicate that environmental protection, sports, food, living environments, communities, and lifestyles are increasingly affecting health. Achieving medical purposes and the goal of health for all depends on the cooperation between health and non-health sectors. The outdated notion that disease prevention and health promotion can only be achieved through the efforts of the health sector must be reconsidered.
6. Value the role of traditional medicine (Chinese medicine) in achieving medical purposes.
The medical philosophy of traditional medicine (Chinese medicine) emphasizes preventing disease before it occurs, strengthening the body to eliminate pathogens, the unity of body and mind, and nurturing life and energy, thus aligning more closely with the scientific purpose of medicine. The exclusion of traditional medicine is a bias of modern medicine.
V. Reflections on Health Reform
The Hastings Center's initiative to study the purpose of medicine is based on the context of Western developed countries, but it is also meaningful for developing countries like ours. Scholars in our country, in the process of studying the purpose of medicine, believe that developing countries also face some of the main contradictions in healthcare services that developed countries face, and medical crises exist to varying degrees. Therefore, for developing countries, re-examining the purpose of medicine also has practical significance.
Some scholars in our country believe that China is actually facing a medical crisis. The sharp rise in medical costs, the inability of the majority of the population to afford medical care, the small coverage of health insurance; the unreasonable distribution of medical resources; the prominent structural contradictions in the health service system; the coexistence of insufficient resources and resource waste; the deterioration of doctor-patient relationships, and the increasing social dissatisfaction all indicate that our country's healthcare is facing a crisis. However, current measures are all centered around how to control costs, expand health insurance coverage, and increase investment, etc. As the GOM research results show, the medical problems we face now are due to the development strategy of contemporary medicine that seeks high-tech treatments for diseases and provides health services. As long as this strategy does not change, the root causes of the above problems will persist. They can only be alleviated to some extent but cannot be fundamentally resolved.
Can the current countermeasures overcome this medical crisis? It's difficult. The health service system centered around large hospitals, which has been formed over hundreds of years, is supported by high technology and maintains its vitality by continuously phasing out old technologies and adopting new ones, and it is closely related to the personal interests of hospitals and doctors.Imagine, how could a large hospital equipped with high-tech facilities possibly give up the pursuit of high profits to engage in disease prevention, guide the public in adjusting their lifestyles and habits, and improve health knowledge levels to reduce the incidence of diseases? Without patients, how could hospitals exist? Perhaps, it might be necessary to establish another system aimed at improving the health level of the entire population to achieve medical goals.
Therefore, if the medical development strategy that seeks to develop high-tech treatments for diseases is not changed, attempting to control medical costs would be like climbing a tree to catch fish. It would be very difficult to achieve the goals of medical justice and universal health care. For this reason, it is essential to accurately define the purpose of medicine, thereby adjusting the development strategies of medicine, services, education, and research.
Given that it is almost impossible to expect the existing health care service system to undergo such a radical transformation, a bolder idea is to unite the existing departments directly related to health (such as environmental protection, family planning, sports, disease control, health insurance, etc.) to form a health promotion department, and to form an alliance with the medical department to advance the realization of the goal of health for all.
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