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The politics of medicine.

Medicine and politics are inextricably intertwined, and yet they are very different enterprises. Political conditions can have a dramatic effect upon life expectancy: famine, for example, is now believed to occur only in conditions where there are few freedoms, including that of information.1 In the modern state, the institutional arrangements under which medicine is practised are determined by the central government, according to its political philosophy. Medical achievements, real or imagined, have often been used to make political points: the Dean of St Paul’s, the Rev. Hewlett Johnson, once extolled blood transfusion as if it were unique to the Soviet Union,2 the thought of Mao Tse-Tung was once credited with astonishing medical powers,3 and not only by the Chinese,4,,5 one visitor saw a political lesson in the absence of acne in Hanoi,6 and Cuba’s health-care system has frequently been used to justify the revolution there (e.g. reference 7). By contrast, the fact that by the end of Franco’s rule in Spain, the Spanish population had one of the highest life expectancies in the world8 has rarely, if ever, been used to justify the nationalist rebellion, and quite rightly so.

Given that almost everyone finds it difficult to be politically even-handed, and resorts at some time to the rhetorical devices of suppressio veri and suggestio falsi , to what extent should medical journals, especially those such as the NEJM, JAMA, BMJ and the Lancet that are designed for a general medical audience, indulge in ex cathedra political commentary? Should they confine themselves to severely technical matters such as the effect of enalapril on 12-year survival and life expectancy in patients with left ventricular systolic dysfunction,9 to take one example at random? If they cannot be expected to obey such a self-denying ordinance, …