Deviance, equivalence, renaissance.

Abstract

The rationale for The Economist magazine is that everything relates to economics. Is it possible to make the same argument for medicine and health? This issue of JRSM, while not necessarily proving that case, tests the hypothesis. Russia's involvement in Ukraine is dominating news headlines, but you might have missed the significance of recent statements by President Vladimir Putin on homosexuality. Robert Bartholomew argues that Russia is edging towards medicalising deviance, in echoes of the way Nazi Germany manipulated ‘science’ to classify Jews as physically and mentally inferior.1 The former Soviet Union, to take another example, attempted to ‘rehabilitate’ political dissidents using psychiatric treatments. Putin's stance on homosexuality, says Bartholomew, poses a challenge to Russian health professionals. In an essay, Alex Till et al.2 discuss the provision of prison health services, and argue that health services for prisoners should be equivalent to those available to the rest of the population. Equivalence, propose the authors, is a minimum acceptable standard, since the needs of the prison population may be greater and more complex. Dinesh Bhugra,3 in the second article in his series on medicine and society, explains why medicine cannot exist in a social vacuum, an argument that provides a broader context for any call for better prison health services. Finally, public health specialists review conditions in Iraq 10 years after the US-led invasion, which was meant to consider the post-war rehabilitation of the country.4 Inevitably, data are far from perfect, and some indicators for Iraq are better than other countries in the region, but the authors conclude unsurprisingly that Iraq's health and social system is yet to recover to pre-war levels and requires ongoing support from other countries. The consequences of war are not easily erased, and here's an example of where better health, the renaissance of Iraq, clearly requires more economic aid. Sexual discrimination, prisoner health, the interplay between medicine and society, and a war in Iraq might be different from the routine matter of a teaching hospital grand round but the practice of medicine touches these themes and more. Doctors may not be economists just yet, despite the best efforts of politicians, but the rights of our fellow humans and a greater empathy with the trials of humanity are often prime motivations for people to embark upon a career in medicine. In the whirlwind of medical practice, these noble inspirations are too easily forgotten.