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Lively provocative account of medicine
on 6 December 2001
Other pundits have proposed the misanthropic ideas of the end of history, of politics, of industry and of class. Now James Le Fanu, the Daily Telegraph's medical columnist, pronounces the end of medicine.
He claims that medicine's golden age from 1945 to 1980 was due to the chance discovery of drugs, advances in clinical science and innovative technology. He believes that medical progress is now exhausted, and laments that the vacuum is being filled by what he thinks are the dead ends of New Genetics, epidemiology and social medicine.
However, it is perhaps bad timing to write off genetics when the Human Genome Project offers such exciting possibilities, and when epidemiology and social medicine have proven the social determinants of so many diseases. He rejects all social and economic explanations of illness. But lifestyle changes - losing weight, improving diet and exercising more - do, for instance, prevent diabetes and promote health and well being (British Medical Journal, 14 July 2001, page 63.)
But he usefully calls for more research into the causes of disease, and rightly rejects idealist explanations. He recounts how doctors used to blame peptic ulcers on 'stress' or 'personality factors', but in 1984, Barry Marshall, a young Australian doctor, identified the bacterium that triggered them. A seven-day course of antibiotics could cure them. The same organism caused two-thirds of stomach cancer cases. In 1986, Thomas Grayston discovered that the bacterium chlamydia caused heart disease. Le Fanu speculates that bacteria as yet undiscovered may cause arthritis, schizophrenia, leukaemia, MS, diabetes and ME.
Le Fanu shows that doctors' seclusion of tuberculosis patients in sanatoria dramatically reduced the infection's incidence, proving that the influential historian of medicine, Thomas McKeown, was wrong to deny doctors the credit for its decline.
He has a brilliant chapter on how the use of new drugs refuted Freudianism and psychoanalysis, as chlorpromazine effectively relieved schizophrenia's symptoms, lithium mania's, prozac depression's and Valium anxiety's.
This is a provocative and infuriating book, full of ideas and prejudices. All who work on improving people's health will naturally make their own judgements about the continuing value of their work.