May 19, 1993

Healing the Schism: Epidemiology, Medicine, and the Public's Health

Author Affiliations

University of Washington Seattle


by Kerr L. White (Frontiers of Primary Care, M. Lipkin, Jr, ed), 278 pp, $49, ISBN 0-387-97574-8, New York, NY, Springer-Verlag, 1991.

JAMA. 1993;269(19):2560-2561. doi:10.1001/jama.1993.03500190104050

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This engaging memoir begins with an extended and familiar lamentation about two intertwined problems: the "inability of the public health enterprise to attract and retain its essential share of the best minds in medicine" and the "failure by most physicians to understand or appreciate the population (or public health) perspective." Dr White names four root causes: failure to establish public health as a separate profession; failure to establish epidemiology as the entire health establishment's fundamental science; failure to teach epidemiological and social science concepts in medicine; and failure of medicine and public health to cooperate.

Readers may be surprised to learn that the glory days of medicine were before Flexner or Pasteur—before the germ theory of disease! White claims that physicians in many countries had a broad view of their mission and worried about unacceptable environmental and social conditions that endangered the public's health. Indeed, alert clinicians had discovered environmental