Book Review

Can Medicine be Cured?

by reestheskin on 29/01/2021

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I am probably biased as my mother was Irish, one of a large O’Mahony clan who were born in or around Cork. She moved to Dublin in her early teens, crossed the water in 1941, and, a few years later, after meeting a Welshman from Neath, set up home together in Cardiff. Cardiff had a long-established Irish community, one that was good at replenishing itself with fresh blood from the motherland, in tune with the rhythms of economic cycles. I was sent to a Christian Brothers’ school where many of the brothers were Irish exports. In junior school, at least, I can remember having some green plant pinned to my lapels on March 17. I didn’t stand out, many of the other kids were similarly tattooed. If I count my extended family — including my brother — they mainly reside across the water.

Without any grand theory at hand I have always thought there must be something special about schooling in Ireland, even if the supposed benefits are not intentional, nor shared equally. Historically, there are many bad things; this is well known. But if I cast an eye over medics who I judge to write deeply about medicine, there is a disproportionate number of Irish doctors.

Anthony Clare was the first example I came across. I was a wannabe psychiatrist when I was a medical student in Newcastle, and I spent undoubtedly the most enjoyable three months of my undergraduate medical course, in Edinburgh, on an elective on the unit headed by Prof Bob Kendell. For most of this time, since it was summer, there were no Edinburgh students, and so I was viewed by the staff as useful. One of the tragedies of being a medical student nowadays is that you don’t feel useful simply because for most of the time you are not useful. The thousand-year-old laws that guide apprenticeship learning have not so much been forgotten but well and truly trashed.

Clare wrote a wonderful book Psychiatry in Dissent when he was still a Senior Registrar at the Maudsley. Despite the title, it was a calm and measured critique of medicine and psychiatry. Reading it felt dangerous, but more than that, it was the voice of quiet reason and a call to arms. It stands as an example of the difference between a medical education and a medical training. The GMC don’t do the former, nor does the NHS.

Another Irish psychiatrist whose writings I have admired is David Healy. Healy is now in Canada and, as far as I can see, has been blackballed by the UK medical and psychiatric establishment. His three-volume history of Psychopharmacology (The Psychopharmacologists) is a masterpiece. Sam Shuster was the first person to introduce me — over coffee— to how many of the revolutionary drugs that changed medicine in the middle of the last century were developed, but Healy’s scholarship cast it in a larger and richer framework. Healy has done lots of other things, too, and possesses a well of moral courage that puts to shame most of the so-called leaders of the profession.

James McCormick was a professor of general practice at Trinity, in Dublin. I first came across him when he contributed a chapter to Bruce Charlton’s and Robert Downie’s book on Medical Education (The Making of a Doctor: Medical Education in Theory and Practice). I have only recently returned to this book, but reading his chapter is disturbing because it makes you shocked that you can ever have been taken in by the pabulum of the modern world of ‘primary care’ and its apologists. The late and singular Petr Skrabenek found his academic home with McCormick in Trinity. Petr was on holiday in Ireland when the Russian tanks rolled into his hometown of Prague n 1968. Yes, not Irish, but if you read his writings about medicine (check out Wikipedia), and have dipped into Havel and Flann O’Brien, you see he is of that place.

Seamus O’Mahony, a ‘Cork-man’, who used to work in Edinburgh before returning to Ireland, has published two books about medicine. The first — which I haven’t read — is named The Way We Die Now. His more recent book, published in 2019, is titled Can Medicine Be Cured? The full title is Can Medicine Be Cured?: The Corruption of a Profession. You get the message, and the jury didn’t take long to realise which clause required an affirmative verdict.

The book covers a lot of ground, yet the pages fly by. There are chapters on how much medical research is dysfunctional — when it is not criminal; on the corruption of the academy; and the oft hidden problems of combining the practice of science and medicine. He talks about pharma (of course), the invention of disease (there isn’t enough money in treating the sick, we need to treat the non-sick), the McNamara fallacy (data, just data, dear boy), and the never-ending bloody ‘War on Cancer’. He picks apart the lazy confusion between needs, wants, and consumerism, and highlights the fact that the directionless NHS is run by politicians who want to do everything— except politics: they just want to be loved. Meanwhile, the medics tired of the ever faddish evidence-based medicine turned to sentimentality-based medicine allowing ‘empathy’ and superstition to ride roughshod over the ability to reason about the natural world, and their patients. Among doctors and medical students, a facile sense of feeling good about yourself has overtaken technical mastery, allowing all to wallow in kumbaya around the campfire they now pretend to share with their charges. Not so. If doctors were once labelled as priests with a stethoscope, we have cast our tool away.

O’Mahony writes well. I particularly liked his metaphors that are familiar to anybody brought up in Catholicism even if they left the bus before it (and they) returned to the terminus. A few examples:

The decadence of contemporary biomedical science has a historic parallel in the mediaeval pre-Reformation papacy. Both began with high ideals. Both were taken over by careerists who corrupted these ideals, while simultaneously paid lip-service to them. Both saw the trappings of worldly success as more important than the original ideal. Both created a self-serving high priesthood. The agenda for the profession is set by an academic elite (the hierarchy of bishops and cardinals), all the day-to-day work is done by low status GPs and hospital doctors (curates, monks). This elite, despite having little to do with actual patient care, is immensely powerful in the appointment of doctors.”

The Czech polymath and contrarian Peter Skrabanek (1940–94) taught these skills at Trinity College Dublin medical school during the 1980s and early 1990s, and lamented that “my course on the critical appraisal evidence for medical students can be compared to a course on miracles by a Humean sceptic for prospective priests in a theological seminary”.

And on attending a consensus conference of medical experts in Salerno (you only have a consensus when there bloody-well isn’t any…).

I found a picture online of the experts gathered at Salermo, and was reminded of a fresco in the Sistine chapel depicting the first Council of Nicea in A.D. 325. The council was convened by the Emperor Constantine to establish doctrinal orthodoxy within the early Christian Church. The industry-sponsored get-together in Salerno had similar aims.… The aim is expansionist: the establishment of a new disease by consensus statement, the Big Science equivalent of a papal bull. Non-coeliac gluten sensitivity has been decreed by this edict, just as papal infallibility was decreed by the first Vatican Council in 1870.

As for the sick and needy

Meanwhile, the sick languish. The population are subjected to more and more screening programs (for breast cancer, cervical cancer, colon cancer, high blood pressure, cholesterol levels etc.), but if they become acutely ill and need to go to hospital, it is likely that they will spend hours on a trolley in an emergency department. When they are finally admitted to a ward, it is often chaotic, squalid and understaffed. Hospices have to rely on charity just to keep going, and have so few beds that ten times as many people die in general hospitals than hospices.

And, as for David Cameron (lol!) and his plans to fund cancer drugs that were rejected by NICE, well, he was a nice (not NICE) guy, and he was on the side of the people. O’Mahony points out that this money alone would have funded all UK hospices for over a year.

Populism doesn’t cure cancer, but it trumps justice, evidence and fairness every time.

Along with Henry Marsh’s Do No Harm, O’Mahony’s book deserves to become a classic. Buy it and read it. Just don’t turn it into a multiple-choice exam. A brave medical school might even add it to the freshers’ pack — well, I can still dream.


The photo, facing towards Kerry, is from Penglas, a mainly Welsh hamlet in West Cork.

Machiavelli on study habits (and passion).

by reestheskin on 12/10/2020

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After he had been dismissed from government, and implicated in the anti-Medici conspiracy, Machiavelli was imprisoned, tortured, before returning to the family farm. But his passions ran deep.

…Machiavelli was unable to turn his mind from politics. ‘I could not help but fill your head with castles in the air,’ he wrote to Vettori in 1513, ‘because since Fortune has seen to it that I do not know how to talk about either the silk or wool trade, profits or losses, I have to talk about politics.’ He spent the days chewing the fat with woodcutters on the farm and playing cricca in the tavern. But in the evening, he told Vettori,

I return home and enter my study; on the threshold I take off my workday clothes, covered with mud and dirt, and put on the garments of court and palace. Fitted out appropriately, I step inside the venerable court of the ancients, where, solicitously received by them, I nourish myself on that food that alone is mine and for which I was born; where I am unashamed to converse with them … and they, out of their human kindness, answer me. And for four hours at a time I feel no boredom, I forget all my troubles, I do not dread poverty, and I am not terrified by death. I absorb myself into them completely. And because Dante says that: no one understands anything unless he retains [it], I have jotted down what I have profited from in their conversation and composed a short study, De principatibus. [emphasis added]

Erin Maglaque · Free from Humbug: The Murdrous Machiavel · LRB 16 July 2020

As light as a bag of wind

by reestheskin on 25/09/2020

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In my ignorance I had always assumed that the ‘Haldane’ of the Haldane Principle1 referred to the great and singular geneticist and physiologist JBS Haldane. Not true. JBS once remarked that God must have been inordinately fond of beetles because there are so many species of beetles, so with the Haldanes; (good) fortune is, it appears, inordinately fond of the Haldane clan. A relative of JBS, Richard Burdon Haldane — who did indeed come up with the Haldane principle — is the subject of a new biography by Philip Campbell, and a witty and sharp review in the FT by Philip Stephens.

Watching today’s politicians fall over their own mistakes as they fumble with the Covid-19 pandemic, it is easy to forget that securing high office once required more than a few years of dashing off political columns for a national newspaper. So the life and political times of Richard Haldane, the subject of John Campbell’s engaging biography, offers a fitting rebuke to the trivial mendacity and downright incompetence of the nation’s present administration.

Exaggeration, it is not. Haldane…

…an Edinburgh lawyer and philosopher-politician before becoming a minister in Herbert Asquith’s Liberal administrations, was an important champion of universal education and one of the founding fathers of the UK university system. He also found time to create the Territorial Army, and to have a hand in the foundation of the London School of Economics, the Medical Research Council and the Secret Intelligence Service…

As Asquith’s minister for war, he created the expeditionary force that saved Britain from defeat in the opening stages of the first world war. As Lord Chancellor, his judgments did much to set in place the federalist tilt of the Canadian constitution.

And if there is any doubt about his intellectual gravitas, the review is headed by an image of Haldane with Albert Einstein whom he hosted on the latter’s first visit to the UK in the 1920s. Just conjure up BoJo or Patel or Hancock when you read the above, or when you step on something unpleasant and slimy.

It also seems that Haldane might have performed slightly better across the dispatch box than some of the current irregulars. Clark McGinn writes

He [Haldane] is also one of the few men to have beaten Winston Churchill by riposte. Haldane was a portly figure and Churchill remarked on his girth by asking when the baby was due and what it would be called. Haldane retorted: “If it’s a boy it will be George after the King, a girl will be Mary after the Queen. But if it is just wind I shall call it Winston.”

  1. The Haldane Principle is the idea that decisions about what to spend research funds on should be made by researchers instead of politicians. It is named after Richard Burdon Haldane. For a recent take on the Haldane Principle see David Edgerton, The ‘Haldane Principle’ and other invented traditions in science policy here.