Can Porter's contrasting views of health be reconciled? Does this mean that increasing economic inequality will degrade the medical advances of the last centuries?
The ending to Porter's work does render a sense of skepticism. The collusion of both the medicalization of society as well as the looming colossus of the medical industrial complex are realities that Porter feels will come to define medicine. At the same time, Porter speaks to the consumerism that has filtered into the field today, one that has permanently changed everything within it. The intimacy of contact between doctor and patient has become filtered through the lens of health- management organizations, litigation concerns, as well as political interest advocacy.
As with all excessive consumerism, Porter does not see much in way of potential for overall joy. Yet, he is passionate about the progressive trend in medicine. For example, he points to how the diseases of the last century are no longer threats to public safety. Medical science has moved past tuberculosis, syphilis, or polio. Diseases that used to wipe out millions have themselves been wiped out. Porter does feel that this progressive trend can continue. However, he also suggests that the growing consumerism that has become intrinsic to medicine could impact the overall distribution of such trends. The egalitarianism and public safety that once was such a part of medicine is something Porter sees a potential victim to organizations, pharmaceutical companies, and proprietorship.
Such an ending is not necessarily the most reaffirming. However, there might be some reconciliation present. Throughout Porter's account, one of the dominant trends has been to display how medical science has the capacity to break through the challenges and barriers that seem to prevent its progression. New forms of scientific research such as bacteriology emerge in order to advance the discipline: "Modern medicine began when the physicians retreated from time to time to the laboratory in order to search for solutions to problems they encountered at the bedside; it grew through the cultivation of knowledge that was not immediately useful, until eventually it became an entity and built itself into an establishment." Throughout medicine's ascension, there have been challenges that have been faced. Porter is not shy about detailing these conditions, for the story of "the greatest benefit" has been one filled with challenges and adversity: "The history of medicine tells us something of far greater importance: namely, that medicine's long path has not been a smooth trajectory." In order for the narrative to continue, perhaps it makes sense that this recent spate of challenges must also be faced. The history of medicine would not have it any other way. In the final analysis, this is where some reconciliation can be offered. The history of medicine is reflective of challenges faced and navigated. "The greatest benefit" might be medicine's spirit of confronting and appropriating such looming obstacles. It is here where some reconciliation might be present in Porter's account. He suggests that "medicine's finest hour is the dawn of its dilemmas." Speaking to the spirit that has continually defined it, Porter suggests that its crucible will force it to "redefine its limits even as it extends its capacity." In such a challenge, one can find where Porter sees a sense of reconciliation and potential restoration in the medicine's modern landscape.