Abstract
Are you a god from the machine of medicine? Are you able to rapidly resolve once-insoluble problems? Does the government expect you to possess powers beyond your abilities? Do patients and other doctors expect the same? Do you, in turn, demand that colleagues are gods of all they survey, providing a difficult diagnosis or managing impending death? God from the machine, deus ex machina, allows us to appease our anxiety, argues Anthony Cohn, to take credit for success and abdicate responsibility for failure. 1
We worship different gods, of course. The god of Osama Bin Laden failed to protect him from an attack by US forces. The trail to Bin Laden, in his retreat in Pakistan’s northern hill town of Abbottabad, was confirmed by taking DNA samples from children during a Hepatitis B campaign ‘entirely designed for intelligence purposes’, say Bowsher et al. 2 They continue: ‘Clearly, the boundaries between disease securitisation and intelligence activity were blurred, and the global health community has raised grave concerns about the damage caused by the programme.’
Readers may be familiar with global health security, which demands action to protect the vulnerability of people around the word from our inability to control ‘new, acute, or rapidly spreading risks to health, particularly those threatening to cross international borders’. Medical intelligence, by contrast, is driven by national security concerns and uses health as a vehicle of foreign policy, as in the CIA’s hunt for Bin Laden. Bowsher et al. untangle the differences between the two approaches and propose how they might be best combined. Their conclusion, that it will be necessary ‘to accept a blurring’ of the two agendas, will appeal to pragmatists but displease idealists.
Both pragmatism and idealism inspired Guy Scadding and the Medical Research Council’s planning committee to agree on using randomisation for treatment allocation in the historic trial of streptomycin in pulmonary tuberculosis. 3 The decision was not driven by statistical theory. Successful concealment of the allocation schedule, not deus ex machina, was the primary driver behind this landmark use of randomisation in a controlled trial.