A solitary statistic is a dreary thing; but when combined, statistics can reveal questions that previously remained hidden. Thus it is only of passing interest to learn that more than two thirds of doctors qualifying ten years ago have “regrets” about their chosen career. We all have spasms of self-doubt; doctors are no exception. But when the same “regrets” were expressed by only 28 per cent of doctors qualifying 20 years ago, and 16 per cent 30 years ago, then a pattern is clearly emerging.

This is not the only sign that medicine is in trouble. Surveys reveal that the proportion of the population claiming to be “concerned about their health” has increased from one in ten in 1968, to one in two last year. And the most curious aspect of this new phenomenon of the “worried well” is that it is medically inspired. The well are worried because repeatedly and systematically they have been told by experts that their health is threatened by hidden hazards. The commonsense advice of the past-”don’t smoke and eat sensibly”-has metamorphosed into an all-embracing condemnation of every sensuous pleasure: food, alcohol, sunbathing and sex. And every week brings yet another danger. Who would have thought until a few weeks ago that night lights which have reassured generations of children should be damaging to their eyesight?

The paradox of modern medicine that requires explanation is why its spectacular success over the past 50 years has had such perverse consequences-leaving doctors less fulfilled and the public more neurotic about their health. These are, of course, complex matters with any number of explanations. But consider a list of significant medical advances in the past 60 years-starting in 1937 with blood transfusion, and moving through penicillin, kidney dialysis, radiotherapy, cortisone, polio vaccination, the oral contraceptive pill, hip replacement operations, kidney transplants, coronary bypass, the cure of childhood cancer, CAT scanners, test-tube babies and concluding with Viagra. Several themes are easy to identify: the assault on infectious disease (penicillin and childhood immunisation); major developments in the treatment of mental illness, cancer and heart disease; the widening scope of surgery (hip replacements and transplantation); and improvements in diagnostic techniques (the CAT scanner). But what is most noticeable about the list is the concentration of the important breakthroughs in a 30-year period from the mid-1940s to the mid-1970s. Since then, there has been a marked decline in the rate of therapeutic innovation. This “rise and fall” runs counter to the common view of an upward and onward march of medical progress-but it provides the key to understanding current medical discontents.

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