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on 22 February 2005
In this lively and hard-hitting book, Raymond Tallis, Professor of Geriatrics at Manchester University, surveys the current state of British medicine.
He points out how much we all gain from the NHS. Britain is top of nine Western countries in years of life expectancy added for each 1% of GDP spent on health; the USA is ninth. We get 2.5 more years of good health than Americans do. Since 1950, we have gained five extra years of life due to improved medical care under the NHS, and infant mortality has fallen by 80%.
Yet, as Tallis reminds us, much of the media relishes only bad news about health care, fostering a culture of contempt focused on scandal and personalities, and scaremongering to attack the NHS. He cites shoddy reporting by Jeremy Laurance, Melanie Phillips, Anthony Browne, Will Hutton and Simon Heffer.
Tallis analyses the assault on MMR vaccination, started by Dr Andrew Wakefield's article. This was a preliminary study of just twelve children, with no control group, so it could not prove a link with autism, let alone a cause. But Wakefield immediately called a press conference to urge abandoning the triple vaccine. Tallis rightly calls this utterly irresponsible.
The media highlighted Wakefield's claim and ignored further research - two British studies, a Danish study of half a million children, and a Finnish study of 1.8 million children - which proved that there was no more autism among vaccinated children than among non-vaccinated children. The Danish study also found no link between the development of autism and age at vaccination or time since vaccination.
Tallis also criticises Peter Duesberg, who irresponsibly claimed that AIDS was not due to a virus. The South African government has relied on this oft-refuted claim to justify its opposition to sex education, to condom use and to providing anti-retroviral drugs. This stupid policy has caused hundreds of thousands of unnecessary deaths.
Among many other good things in this book, Tallis details the Labour-Tory abuse of the NHS through 'permanent revolution', concealing under-investment by over-organisation, and he exposes Labour's attack on the medical profession.
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on 14 June 2005
As a student nurse, I approached this book with interest.
Ray Tallis supplies a spirited and well-argued reposte to those who seek to portray doctors as aloof, over-empowered and arrogant. Instead Tallis argues that doctors are often disempowered and assailed by ill-informed pressure groups, a hysterical media and meddling politicians.
In places this leads Tallis to come across as something of a medicalised Grumpy Old Man, but it must be conceded that his points are valid and well-argued. Tallis' account of the recent hysteria over the MMR vaccine is excellent in particular. He relates how a single piece of dubious research led to a major panic, with some shockingly irresponsible and uninformed behaviour by campaigners, journalists and politicians that continued well after any link between the MMR vaccine and autism had been discredited by research.
Having read Hippocratic Oaths, I think I may have to be nicer to my doctor colleagues in future. :)
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on 16 July 2012
First, a minor gripe to get off my chest: the book is a tad over-written. Sometimes to the point that while you begin by mentally applauding the erudition of Tallis' points and research in the first few paragraphs, you are exasperated as he spends a further 30 passages elaborating, re-elaborating and rephrasing the points already made. The middle part of the book, in particular the chapter "Enemies of Progress" which details the endless changes in the NHS governance and management in the last 5 decades, sags heavily by his relief-stricken polemical prose style (although by design, it accentuates the futility of the ceaseless superficial organisation-morphing and makes you see Tallis' point).

But look beyond the non-existent editing and this is one of the most intelligent summaries of medicine's current state in the UK that functions as a veritable intellectual anchor for those working in a cash and resource strapped, in-process-of-being-privatised NHS and need some background into its current state of affairs.

It delivers on its exploration of "contemporary discontents" with utmost conviction: from the newfound professional neurosis of communication skills to the culture of contempt and sensationalism bred by present day media, from hostility to research to misrepresentation of doctors: every word of his essays rings true as he takes us on a journey into the unfolding and aftermath of key medical scandals in the decade leading on to 2002. While published in 2004, this should not deter readers to go out and give this book a read, as the interminable reorganisation of the NHS continues, and the media's tone and approach to reporting that Tallis bemoans, has not surprisingly, remained the same. It is another thing that general public and professional indifference courtesy the information overload has seemingly increased, but the key contemporary discontents remain. And Tallis knows how to articulate these like no other.

Being a recently qualified doctor who started medschool 6 years back, I can vouch for a few changes since 2004: the curriculum delivery seems to be reverting back to more "old-school" ways, i.e. the resources and time invested in teaching touchy-feely communication skills are being reduced to give more credence to anatomy and physiology in pre-clinical years-a move welcomed fraternity-wide; thanks to a severe lack of jobs at registrar and consultant levels, there is a rampant de-incentivisation for aspiring specialist/core trainees (to the point that on mentioning nowadays that one plans to be a hospital medic or surgeon, you are chided for your naivete and told to go the GP way) and finally it is appalling to see my immediate seniors getting totally disillusioned during their foundation years by being shuttled around teams and working as paper-shifting clerks on unforgiving shifts. There is no continuous narrative to their practice; they remain uncertain of what they have learnt, finding themselves thrown unsupervised in the deep-end and the endless evaluations on increasingly IT-dependent check-boxes and portfolios further dragging them down.

Other than articulating wonderfully the contemporary discontents, the book's strengths are the thought experiments it indulges its readers in, especially in the First Part (Origins) and Third Part (Destinations) of the book where you get to contemplate everything from inception and development of modern medicine in the way its practiced to its probable demise as a caring, continuously innovating, conscientious vocation as it becomes a bullet-point ridden, governance and guideline overloaded supermarket with robotic doctors/vendors rehearsing rote-learnt gestures and phrases. The cherry on the cake is when Tallis dons his philosopher and geriatrician hats together and gives a splendid essay on how the current attitudes of ageism must change drastically if the prolonged lifespan and delayed disease incidence gifted by modern medicine is to be benefited from.

I recommend this (justifiably) holier-than-thou collection of essays highly to all prospective and practicing medics as it equips you with perspective and direction to maneuver through the everyday information barrage from media, politicians and managers who are forever defining the duties and boundaries of a doctor (when they have no business doing so) and not lose sight of your key duties. It is also a resounding corroboration for the unassailable authority of the core values and clinical priorities of every clinician and the respect overdue to these in today's times.
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on 3 February 2014
Dear Dr Tallis - this is in my opinion the best commentary written on modern medicine and the NHS. Part of my duties are acting as a 'clinical supervisor' to ST1s and ST3s. I recommend your book to all of them and keep copies on hand to encourage them. I have also recently taken to showing them some of your other commentaries, in the seemingly futile endeavour to politicise them. May I be so bold as to suggest updating 'Hippocratic Oaths'. It is still the best. Patrick
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on 12 April 2006
reasoned thoughtful overview of the politics of medicine, essential reading for todays health professionals,puts the stresses of the job in a rational context, and certainly helped me to make sense of the rapidly changing environment we work in.
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on 20 March 2015
Insightful analysis, carefully argued, about man's place in medicine today, as a patient and as a physician. Such lessons are learned very slowly and reluctantly by the majority of Doctors.
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on 18 October 2004
Tallis potrays the current state of the NHS very well in this book with a great philisophical angle. As someone applying to study medicine, it illustrates very well what I'm going to deal with in the future and also has opened up perspectives of medicine that I haven't perceived before. I would recommend this book to all people who have had, do have or will have ties with the NHS (other than being a patient of it) especially prospective medical students, people associated with the governing bodies of the NHS and also people who side with the tabloids against doctors. A well earnt 4*'s.
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on 17 February 2016
Good experience
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on 12 January 2013
Recommended by a medical colleague, certainly thoughtful, but a little heavy going and very few laughs in it. May improve on rereading.
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