Suffering and healing in America: an American doctor’s view from outside. Raymond Downing. Oxford: Radcliffe Publishing, 2007 (xii + 126 pp). ISBN 978 1 84619 130 5.

In an age of increasing disparity between the health systems of rich and poor countries, Suffering and healing in America offers an analysis of how America’s health system can learn from the achievements of those in more poorly funded settings. The author argues that health care in America risks the charge of hubris as it increasingly fails to address the needs of poorer members of the community. Furthermore, Western medicine has so raised the expectations of cure that it has contributed to the loss of capacity to cope with suffering when cure is not possible. He discusses the comparative notions of cure and healing and the evolving role of family medicine within the health care system.

While many of the questions the author raises are undoubtedly serious challenges facing health care and therefore worthy of discussion, his subjective analysis rarely penetrates far below the surface of the more complex issues. The author makes heavy going of his cure versus healing discussion but never really mounts a clear argument. The way he uses anecdotes to illustrate certain points is reminiscent of parables, and too often they shed little light on the labyrinthine world of modern health care. The chapter on culture offers perhaps the most pertinent example of this, leaving the reader frustrated by the simplicity of the analysis.

The title of the book is itself a curious example of the false trails the author follows: he spends more of the book discussing his experiences as a medical practitioner in Africa than America, and not all the comparisons he makes are relevant given the cultural, social and economic disparities between the two worlds. The repeated pattern of raising topical issues but then not really addressing them undermines the value of the book as anything more than a mildly interesting narrative.