I PRESENTED a paper at a scientific meeting in Basel, Switzerland, last July. Walking around the city, I was struck forcibly by the significant number of homeopathic remedy shops, all well patronised. In Ireland and the UK homeopathic medicine is of interest only to a tiny minority. I also recall my experience with dentistry in America, where I lived for three years in the 1970s. I visited the dentist on three occasions, and each time he took a dental X ray, for no particular reason that I could divine. I have attended my dentist on very many occasions in Ireland, and I can only recall having one or two X rays, ever.
Although it might be thought that medicine is practised in a very much standardised way throughout western Europe and the USA, there are, in fact, pronounced regional differences in practice between for example, Germany, France, the UK and the US. These interesting differences are discussed in Medicine and Culture by Lynn Payer, published by Gollancz, 1990.
Different medical treatments are popular in different regions. For example, homeopathic treatments are widely prescribed in Germany and France but would not even be considered to lie within the boundaries of scientific medicine in the US. Also, visits to natural health spas are covered under national health insurance in Europe.
There are also regional differences in patterns of consumption of prescription drugs. For example, Germans use six times more heart stimulants (cardiac glycoside) per individual than the French and the English. On the other hand, the German per capita consumption of antibiotics is only half the rate in France and England.
The popularity of specific medical procedures also varies from region to region. For example, coronary by pass surgery is performed six times more frequently in the US than in England. Even setting aside cost considerations, American physicians are three times as likely to perform this procedure as their English counterparts.
Neither is medical diagnosis exempt from regional variation. A study by the World Health Organisation in 1967 showed that doctors from several countries, presented with identical information from the same death certificates, diagnosed different causes of death. Diagnosis of psychiatric patients can also vary significantly between the US, England and France.
German medicine is very preoccupied with the heart. The organ is viewed not merely as a mechanical pump, but as a complex seat of emotions. Fatigue is often diagnosed as herzinsuffizienz roughly meaning weak heart. Herzinsuffiziencz is probably the most common ailment treated by German GPs and largely explains why, heart stimulants are so widely prescribed. Herzinsuffizienz would not be defined as a disease, in England, France or the US.
On the other hand, German medicine is very sparing in its prosecution of antibiotics. There is a marked reluctance to prescribe antibiotics not only for colds, but even for conditions as severe as bronchitis. Even when bacteria bare found in inflamed tissue, there is a reluctance to use antibiotics unless it is judged that the bacteria are causing the infection.
It is hypothesised that the German concern for the heart is a remnant of the romanticism of several great German literary figures, e.g. Johann Wolfgang von Goethe. The reluctance to prescribe antibiotics may be a continuation of the tradition started by the 19th century German medical scientist Rudolph Virchow, who felt that illness is a reflection of internal imbalances, not external invaders.
The French, like the Germans, also regard disease as a failure of the internal defences. The French have a well developed concept of the internal terrain which roughly translates as the constitution. A vigorous terrain will repel disease, a weakened terrain will allow disease to gain a foothold. French medicine is therefore preoccupied with measures to bolster the terrain by prescribing vitamins, tonics and drugs.
Spa treatments are also very popular, and about one in 200 prescriptions is for a three week visit to a specialised spa. Traditionally the individual organ that preoccupies the French is not the heart but the liver. A "fragile liver" can be blamed for many ailments ranging from headache to dandruff.
English medicine is very different to German and French, and concentrates on external causes of disease. Homeopathy, spa treatment, tonics and vitamins play little role in English medicine, but antibiotics are widely prescribed. On the other hand, English medicine is parsimonious, and interventions are made much less frequently than in the US or in continental Europe. The English prescribe only half as many drugs as the French and Germans, and take only half as many X rays as, the Americans.
The conservatism of English medicine is largely determined by economics. In continental Europe, and America, physicians are paid on a fee per service basis, whereas English doctors are either paid on a fee per patient basis or on a flat salary. In one system therefore the ideal patient, (from the doctor's point of view), seeks frequent medical help, and, in the English system, rarely seeks the doctor's advice.
American medicine is characterised by an aggressive approach. An American doctor will always prefer to do something rather than nothing. Surgery is much more common in America than elsewhere. For example, hysterectomy and caesarean section are more than twice as common in America than in most European countries.
Cardiac by pass is even more common. Americans view themselves as naturally healthy and disease is always ascribed to an external cause. Americans have an obsessive fear of germs, and prescription rates for antibiotics are very high.
The preoccupation with germs largely explains the American obsession with cleanliness, for example the frequency of taking a shower. That most awkward practice of drinking directly from the "bottle of beer in a bar is really fuelled by fear that the bartender's stock of glasses is contaminated with dangerous germs.
Irish medicine is quite similar to UK practice. There is some what more emphasis on private practice in Ireland than in UK, largely because the UK system of public health is so well established. Also, in Irish medicine litigation rates, where patients sue doctors, have soared in recent years, and are much higher than in the UK.