Medicine & Culture: Varieties of Treatment in the United States, England, West Germany, and France

In a highly illuminating comparative study of medicine in the U.S., England, West Germany and France, medical journalist Payer (How to Avoid a Hysterectomy) speculates that to a large extent medical care is determined by value judgments rooted in national character and priorities rather than on scientific criteria. The four countries have equivalent life expectancies, she notes, despite widely differing approaches to medical treatment. She charges that American physicians favor technology and aggressive intervention over reflection, and she links German concern for the heart to a lingering romanticism. Despite the economy-conscious English system, extensive geriatric programs cater to the revered aged, while, she claims, French medicine, especially psychiatry, reflects the country's Cartesian habit of thought as opposed to empiricism. Types and rates of gynecological and cosmetic surgery, radiology and anesthesiology vary greatly among the countries, as do their use of contraceptives and drugsespecially antibioticsand alternate or holistic medicine. The author therefore urges patients to consider medical biases and range of treatment options. (April)