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May 9, 1977

The Role of Medicine: Dream, Mirage, or Nemesis?

JAMA. 1977;237(19):2125. doi:10.1001/jama.1977.03270460115035

McKeown's monograph assembles and amplifies, in one text, ideas he has long held about the importance of "the preservative" as compared to "the mechanistic" approach to human health. The preservative approach includes all measures that promote the public health, such as population control, provision of adequate nutrition, and protection from environmental hazards, including exposure to infective organisms. The mechanistic approach, on which much of medical practice and research is based, favors the view that human health depends on understanding the structure and function of the body and the diseases that affect it. Although McKeown does not denigrate the value of the latter approach to the person, his thesis emphasizes the greater importance of "preservation" to mankind.

Following an introduction, part 1 of the book examines the determinants of health. The first chapter of this section classifies diseases into conditions determined at fertilization (genetic diseases, other diseases determined at fertilization) and