Is There Too Much Science in Medicine or Not Enough?

A Position Paper
  • Leon Eisenberg


The purpose of this chapter is to discuss the interface between science and the practice of medicine. A frequent complaint made about contemporary physicians is that they are not sufficiently kind and understanding. The implication, sometimes a bald statement and other times implicit, is that physicians are overly scientific and insufficiently empathic. This chapter critically addresses this position. A series of propositions will be made and each of these discussed.


Acute Lymphocytic Leukemia England Journal Acquire Immune Deficiency Syndrome General Medical Service Acquire Immune Deficiency Syndrome Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Almy, T. P. (1981). The role of the primary physician and the health care “industry.” New England Journal of Medicine, 304, 225–228.PubMedCrossRefGoogle Scholar
  2. Auerbach, D. M., Darrow, W. W., Jaffe, H. W., & Curran, J. W. (1984). Cluster of cases of the acquired immune deficiency syndrome: patients linked by sexual contact. American Journal of Medicine, 76, 487–492.PubMedCrossRefGoogle Scholar
  3. Barre-Sinoussi, F., Chermann, J. C., Rey, F., et al. (1983). Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science, 220, 868–871.PubMedCrossRefGoogle Scholar
  4. Beeson, P. B. (1980). Changes in medical therapy during the past half century. Medicine, 59, 79–99.PubMedCrossRefGoogle Scholar
  5. Breman, J. G., & Arita, I. (1980). Confirmation and maintenance of smallpox eradication. New England Journal of Medicine, 303, 1263–1273.PubMedCrossRefGoogle Scholar
  6. Budiansky, S. (1985). Blood test trials inconclusive. Nature, 316, 96.PubMedGoogle Scholar
  7. Bunker, J. P., & Brown, B. W. (1974). The physician-patient as an informed consumer of surgical services. New England Journal of Medicine, 29 0, 1051– 1055.PubMedCrossRefGoogle Scholar
  8. Centers for Disease Control. (1981). Kaposi’s sarcoma and Pneumocystis pneumonia among homosexual men -New York City and California. The Morbidity and Mortality Weekly Report, 30, 305–308.Google Scholar
  9. Centers for Disease Control. (1984). Years of potential life lost. The Morbidity and Mortality Weekly Report, 32, 109.Google Scholar
  10. Centers for Disease Control. (1985). Update: acquired immunodeficiency syndrome -United States. The Morbidity and Mortality Weekly Report, 34, 245–248.Google Scholar
  11. Chen, L. C. (1984, March 18). Primary health care in the developing world: technological and social interactions. Delivered in the Takemi Lecture Series at the Harvard School of Public Health, Boston.Google Scholar
  12. Chen, L. C., Huq, E., & D’Souza, S. (1981). Sex bias in the family allocation of food and health care in rural Bangladesh. Population and Development Review, 7 ,54–70.Google Scholar
  13. Clumeck, N., Van de Perre, P., Carael, M., et al. (1985). Heterosexual promiscuity among African patients with AIDS. New England Journal of Medicine, 313, 182.Google Scholar
  14. Dagleish, A. C., Beverly, P. C. L., Clapham, P. R., et al. (1984). The CD4 (T4) antigen is an essential component of the receptor for the AIDS retrovirus. Nature, 312, 763–767.CrossRefGoogle Scholar
  15. Dyck, F. J., Murphy, F. A., Murphy, J. K., et al. (1977). Effect of surveillance on the number of hysterectomies in the Province of Saskatchewan. New England Journal of Medicine, 296, 1326–1328.PubMedCrossRefGoogle Scholar
  16. Eisenberg, L. (1977). Disease and illness: distinctions between professional and popular ideas of sickness. Culture, Medicine and Psychiatry, 1, 9–23.PubMedCrossRefGoogle Scholar
  17. Eisenberg, L. (1980). What makes persons “patients” and patients “well”?. American Journal of Medicine, 69, 277–286.PubMedCrossRefGoogle Scholar
  18. Eisenberg, L. (1984). Rudolf Ludwig Karl Virchow, where are you now that we need you? American Journal of Medicine, 77, 524–532.PubMedCrossRefGoogle Scholar
  19. Eisenberg, L., & Kleinman, A. (1981). The Relevance of Social Science for Medicine. Boston: Reidel.CrossRefGoogle Scholar
  20. Gallo, R. C., Salahuddin, S. Z., Popovic, M., et al. (1984). Frequent detection and isolation of cytopathic retroviruses (HTLV-III) from patients with AIDS and at risk for AIDS. Science, 224, 500–503.PubMedCrossRefGoogle Scholar
  21. Glassroth, J., Robins, A. G., & Snider, D. E. (1980). Tuberculosis in the 1980!s. New England Journal of Medicine, 302, 1441–1450.PubMedCrossRefGoogle Scholar
  22. Haley, R. W., Culver, D. H., White, J. W., et al. (1985). The nationwide nosocomial infection rate: a new need for vital statistics. American Journal of Epidemiology, 121, 159–167.PubMedGoogle Scholar
  23. Hampton, J. R., Harrison, M. J. G., Mitchell, J. R. A., et al. (1975, May 31). Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients. British Medical Journal, i, 486–489.CrossRefGoogle Scholar
  24. Hart, J. T. (1983). A new type of general practitioner. Lancet, ii, 27–29.CrossRefGoogle Scholar
  25. Hippocrates. Airs, Waters, Places (1973). (pp. 71–72). Translated by W.H.S. Jones. Cambridge: Harvard University Press.Google Scholar
  26. Kellerman, G., Shaw, C. R., & Luyten-Kellerman, M. (1973). Aryl hydrocarbon hydroxylase inducibility and bronchogenic carcinoma. New England Journal of Medicine, 289, 934–937.CrossRefGoogle Scholar
  27. Landesman, S. H., Ginzburg, H. M. & Weiss, S. H. (1985). The AIDS epidemic. New England Journal of Medicine, 312, 521–525.PubMedCrossRefGoogle Scholar
  28. Levy, R. I., & Moskowitz, J. (1985). Cardiovascular research: decades of progress, a decade of promise. Science, 217, 121–129.CrossRefGoogle Scholar
  29. Lindenbaum, S. (1983). The influence of maternal education on infant and child mortality in Bangladesh. Bangladesh: International Center of Diarrheal Disease Research.Google Scholar
  30. Marx, J. L. (1985). The cytochrome P 450’s and their genes. Science, 228, 975–976.PubMedCrossRefGoogle Scholar
  31. McCarthy, E. G., & Finkel, M. L. (1978). Second opinion elective surgery programs: outcome status over time. Medical Care, 16, 984–994.PubMedCrossRefGoogle Scholar
  32. McKeown, T. (1976). The Role of Medicine: Dream, Mirage or Nemesis?. London: Nuffield Hospitals Trust.Google Scholar
  33. McKusick, L., Horstman, W., & Coates, T. J. (1985). AIDS and homosexual behaviour reported by gay men in San Francisco. American Journal of Public Health, 75, 493–496.PubMedCrossRefGoogle Scholar
  34. McPherson, K., Wennberg, J., Hovind, O., & Glifford, P. (1982). Small area variations in the use of common surgical procedures: An international comparison of New England, England and Norway. New England Journal of Medicine, 307, 1310–1314.PubMedCrossRefGoogle Scholar
  35. Nebert, E. W. (1980). The Ah locus, a gene with possible importance in cancer predictability. Archives of Toxicology. (Suppl. 3), 195–207.PubMedCrossRefGoogle Scholar
  36. Newmark, P. (1985). Trailing AIDS in Central Africa. Nature, 315, 273.PubMedCrossRefGoogle Scholar
  37. Osterhold, M. T., Bowman, R. J., Chopek, M. W., et al. (1985). Screening donated blood and plasma for HLTV-III antibody. New England Journal of Medicine, 312, 1185–1189.CrossRefGoogle Scholar
  38. Peabody, F. W. (1927). The care of the patient. Journal of the American Medical Association, 88, 877–882.CrossRefGoogle Scholar
  39. Peabody, F. W. (1930). Doctor and Patient. New York: Macmillan Company.Google Scholar
  40. Phibbs, B. (1979). The abuse of coronary arteriography. New England Journal of Medicine, 301, 1394–1396.PubMedCrossRefGoogle Scholar
  41. Rahman, M., Chen, L. C., Chakraborty, J., et al. (1982). Tetanus toxoid I: Reduction of neonatal mortality by immunization of non-pregnant women and women during pregnancy in rural Bangladesh. Bulletin of the World Health Organization, 60, 261–267.PubMedGoogle Scholar
  42. Rahman, M., Chen, L. C., Chakraborty, J., et al. (1982). Tetanus toxoid II: Factors related to immunization acceptance among pregnant women in a maternal-child health program in rural Bangladesh. Bulletin of the World Health Organization, 60, 269–277.PubMedGoogle Scholar
  43. Ravenholt, R. T. (1984). Addition mortality in the United States, 1980: Tobacco, alcohol and other substances. Population and Development Review, 10, 697–724.CrossRefGoogle Scholar
  44. Richmond, J. B., & Waisman, H. A. (1955). Psychologic aspects of management of children with malignant diseases. American Journal of Diseases of Children, 89, 42–47.PubMedGoogle Scholar
  45. Salahuddin, S. Z., Groopman, J. E., Markham, P. D., et al. (1984). HTLV-III in symptom-free seronegative persons. Lancet, 2, 1418–1420.PubMedCrossRefGoogle Scholar
  46. Sarngadharan, M. G., Popovic, M., Bruch, L. Schupbach, J., & Gallo, R. C. (1984). Antibodies reactive with human T-lymphotropic retrovirus (HTLV III) in the serum of patients with AIDS. Science, 224, 506–508.PubMedCrossRefGoogle Scholar
  47. Smithson, W. A., Gilchrist, G. S. & Burgert, E. O. (1980). Childhood acute lymphocytic leukemia. Cancer, 30, 158–181.Google Scholar
  48. Spiro, H. M. (1974). My kingdom for a camera -some comments on medical technology. New England Journal of Medicine, 291, 1070–1072.PubMedCrossRefGoogle Scholar
  49. Steel, K., Gertman, P. M., Crescenzi, C., & Anderson, J. (1981). Iatrogenic illness on a general medical service at a university hospital. New England Journal of Medicine, 304, 638–642.PubMedCrossRefGoogle Scholar
  50. Surgeon General. (1982). The Health Consequences of Smoking: Cancer. Rockville: Office on Smoking and Health, Public Health Service.Google Scholar
  51. Terhost, C., van Agthoven, A., Reinherz, E., & Scholossman, S. (1980). Biochemical analysis of human T lymphocyte differentiation antigens T4 and T5. Science, 209, 520–521.CrossRefGoogle Scholar
  52. Thomas, L. (1984, December 5). Whitehead Institute Inaugural Address.Google Scholar
  53. Vayda, E., & Mindell, W. R. (1982). Variations in operative rates. Surgical Clinics of North America, 62, 627–639.PubMedGoogle Scholar
  54. Vayda, E., Mindell, W. R. & Rutkow, I. M. (1982). A decade of surgery in Canada, England and Wales and the United States. Archives of Surgery, 117, 846–853.PubMedCrossRefGoogle Scholar
  55. Virchow, R. (1947). Cited in Rosen, G. What is social medicine? Bulletin of the History of Medicine, 21, 674–733.Google Scholar
  56. Wennberg, J. E., Blowers, L., Parker, R., & Gittelsohn, A. M. (1977). Changes in tonsillectomy rates associated with feedback and review. Pediatrics, 59, 821–826.PubMedGoogle Scholar
  57. Wennberg, J. E., Bunker, J. P. & Barnes, B. A. (1980). The need for assessing outcomes of common medical practices. Annual Review of Public Health, 1, 277–295.PubMedCrossRefGoogle Scholar
  58. Wennberg, J. E., & Gittelson, A. (1982). Variations in medical care among small areas. Scientific American, 126, 120–134.CrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1986

Authors and Affiliations

  • Leon Eisenberg
    • 1
  1. 1.Department of Social Medicine and Health PolicyHarvard Medical SchoolUSA

Personalised recommendations