Why is all this important? Well, it shows us that health and disease, are to a large extent value judgements, based on what people are currently prepared, or not prepared to accept as a cost of living. The “hard science” of medicine is, in large part, illusionary. Science is not value free, and medicine much less so. Values change, often with alarming rapidity. When this happens, accepted “truth” also changes.

This illusion allows us to think that both doctors and patients have the same expectations about conduct (they don’t), behaviour (rarely) and outcomes (almost never). It has been said that “In reality, there are no diseases, only sick patients”.