At the birth of medicine, millennia ago, diagnosis (the identification of the patient's disease) and prognosis (the understanding of the disease's likely course and outcome) were the most effective tools a doctor brought to the patient's bedside. But beyond that, little could be done to either confirm a diagnosis or alter the course of the disease. (A)Because of this impotence in the face of illness, the consequences of an incorrect diagnosis were-minimal. The true cause of the illness was often buried with the patient.

In more recent history, medicine has developed technologies that have transformed our ability to identify and then treat disease. $\fbox{B}$ Blood tests have exploded in number and accuracy, providing doctors with tools to help them make definitive diagnoses in (C)an entire alphabet of diseases from AIDS to zoonosis*.

Better diagnosis led to better therapies. (D)For centuries, physicians had little more than compassion with which to help patients through their illnesses. The development of the randomized controlled trial and other statistical tools made it possible to distinguish between therapies that worked and those that had little to offer beyond the body's own recuperative powers*. Medicine entered the twenty-first century with a wide range of potent and effective tools available to treat disease.

Much of the research of the past 40 or 50 years has examined which therapies to use and how to use them. Which medication is appropriate, and for how long and at what dosage should it be administered? Which procedure is suitable for this patient? What is the benefit of this procedure over that? These are all questions commonly asked and that can now be regularly and reliably answered. Treatment guidelines for many diseases are published, available, and regularly used. And despite concerns and lamentations about “cookbook medicine,” these guidelines, which are based on an ever-growing foundation of evidence, have been amply demonstrated to save lives. Such evidence-based medicine allows individual patients to benefit from the thoughtful application of what has been shown to be the most effective therapy for their particular condition.

But effective therapy depends on accurate diagnosis. We now have at our disposal a far wider range of tools, both new and old, with which we can make a timely and accurate diagnosis. And as treatment becomes more standardized, the most complex and important decision-making will take place at the level of the diagnosis.

Usually, the diagnosis is routine. The patient's story and exam suggest a likely suspect, and the technology of diagnosis rapidly confirms the suspicion. A doctor with an elderly patient complaining of a fever and cough might well suspect pneumonia, and this suspicion can be quickly checked with an X-ray. A man in his fifties has chest pain that radiates down his left arm and up to his jaw, and electrocardiography* or a blood test bears out the suspicion that he is having a heart attack. This is the bread and butter of medical diagnosis - cases where cause and effect tie neatly together and the doctor can almost immediately explain to the patient and his/her family what the problem is and, usually, how it arose.

But then there are (E) the other cases: patients with complicated stories or medical histories; cases where the symptoms are less suggestive, the physical exam unrevealing, and the test results misleading; and cases in which the narrative of disease strays off the expected path, where the usual suspects all seem to have alibis, and the diagnosis is elusive. For these, the doctor must put on his or her deerstalker* and unravel the mystery. It is in these instances that medicine can rise once again to the level of an art and the doctor-detective must pick apart the tangled threads of illness, understand which questions to ask, recognize the subtle physical findings, and identify which tests might lead, finally, to the right diagnosis.

• 1 下線部分(A) をthis impotenceの内容を明らかにして、日本語に訳しなさい。
• 2 (B)の部分に入れるのにふさわしいように次の英文を並び替えて、解答欄に番号を書き入れなさい。
  • 1 The indirect evidence provided by touching, listening to, and seeing the body hinted at the disease hidden under the skin.
  • 2 The physical exam, invented primarily in the nineteenth century, was the starting point.
  • 3 That first look through the skin at the inner structures of the living body laid the groundwork for the computerized axial tomography (CT) scan in the 1970s and magnetic resonance imaging (MRI) in the 1990s.
  • 4 Then the X-ray, developed at the start of the twentieth century, gave doctors the power to see what they had previously only imagined.
• 3 下線部分(C)を10字程度の日本語で説明しなさい。
• 4 下線部分(D)を日本語に訳しなさい。
• 5 According to the fourth paragraph of the passage, are the following statements true or false? On the answer sheet, indicate those you consider to be true with an A, and those you think are false with a B. If you think it is impossible to tell from the paragraph whether a particular statement is true or false, indicate this with a C.
  • ア The selection of treatments appropriate to the needs of individual patients is a widely studied area.
  • イ Researchers have been trying unsuccessfully for many years to answer the commonly asked questions cited in this paragraph.
  • ウ The treatment guidelines compiled so far are widely applied in clinical practice.
  • エ The efficacy of “cookbook medicine”is questionable.
  • オ “Cookbook medicine” is an example of evidence-based medicine.
  • カ Evidence-based medicine protects against the development of disease.
• 6 According to the fifth paragraph, which of the following statements is not true?
  • (A) Treatment will not work unless it is aimed at the right disease.
  • (B) Making a correct diagnosis is easier now than it used to be.
  • (C) It is important to dispose of old diagnostic tools as new ones become available.
  • (D) The trend toward uniform treatment for each specific disease will put relatively more weight on the judgments made during the diagnostic process.
• 7 According to the sixth paragraph, which of the following statements is not true?
  • (A) The process of reaching a diagnosis is generally not particularly complicated.
  • (B) A preliminary diagnosis can usually be quickly confirmed with technology.
  • (C) Certain signs in certain patients clearly point to specific medical conditions.
  • (D) Although doctors can usually identify illnesses, they cannot normally tell what caused them.
• 8 下線部分(E)について、医師は具体的にどのように対処すべきであると筆者は言っているか、70字程度の日本語でまとめなさい。