Medicine At The Crossroads

A new series which examines questions raised by the modern high-tech approach to medical science, Medicine at the Crossroads features eight programs devoted to subjects ranging from life support in the future to the changing nature of the patient-doctor relationship. We watched Temple of Science and Conceiving the Future, the first and fourth episodes in the series, respectively. Temple of Science suggests that Johns Hopkins' teaching program for young doctors does a poor job of preparing its students for daily practice. The charge is based on the fact that at Johns Hopkins, interns work the emergency room and often see illnesses in their critical stages, rather than when they're still treatable. The program, which is often unpleasant to watch, follows a few interns who are working on various problems, including a woman whose drug and alcohol abuse have led to severe kidney failure, requiring a painful draining process; and another woman whose swift and progressive mental deterioration baffles the doctors (she spontaneously begins to recover following a brain biopsy). Long shifts, huge case loads, and the frequent loss of terminal patients, has led some of the interns to develop internal calluses early on. These experiences are contrasted with the work in the AIDS ward, where medical staff are rediscovering the seemingly lost art of personalized medicine. Conceiving the Future, a better episode, raises some provocative questions about the future due to the increasing ability of prenatal testing to determine whether the fetus is carrying a genetically transmitted disease. The program travels to Sydney, Australia where a couple whose family history puts their offspring at moderately high risk for muscular dystrophy are tested, and to New York where another woman facing a 20% risk of bearing a child with Down's syndrome decides against testing (because it will have no effect on her decision to have the baby). On the island of Sardinia, the local epidemic of thalassemia is being slowly eradicated through pre-natal genetic testing. Good and humane uses of new scientific knowledge all, yet serious questions are raised. The second part of the program looks at the history of eugenics in Nazi Germany where it was obvious, but also in England where it was born, and in the U.S. where the "American Eugenics Society" flourished during the 1920s. The episode concludes by contrasting two physicians' approaches to Tourette's Syndrome: one doctor treating the illness, the other doctor treating the person. Although the programs have a tendency to bounce around, Medicine at the Crossroads is a thought-provoking series, and is recommended. (See AMERICA'S EDUCATION REVOLUTION for availability.)