The Writings of Ivor Browne: Steps along the road-the evolution of a slow learner

40. Turning Medicine Upside Down

Medicine at present is functioning upside-down. What do I mean by this? Traditionally, the medical profession is organized on a hierarchical basis. The elite at the top are the specialist physicians and surgeons. They work in our hospitals and private clinics and expect to be treated with the greatest deference and respect. In a recent paper, David Healy referred to the ‘Cardinals of Psychiatry’. With his indulgence, I feel it is appropriate to extend this metaphor to cover all the ‘Cardinals of Medicine’. We have exposed the feet of clay of the church authorities. Since then, elite developers and our politicians have also been exposed for what they are: addicted to greed; corrupt and dishonest. They are now regarded with the same distrust as the bishops and cardinals of the Church. Only the legal authorities, senior councils and judges, and the medical specialists are still regarded with any respect by society, although the former are already under scrutiny for the fortunes they have made from the tribunals and the exorbitant fees they have been charging. One can only wonder how long it will be before people feel the same way about the elitist medical 40. Turning Medicine Upside Down 518 specialists who are showing the same tendencies. In attempting to understand how medicine has come to be organized on the present hierarchical basis, controlled by an elite group of medical and surgical specialists, we need to ask what is the prevailing view of most doctors in terms of their understanding of the nature of health and disease? In order to do this, I would like to look at the way medicine has developed over the past 200 years. There is an historical perspective to all this, about which I feel it is important to remind ourselves. Prior to the emergence of germ theory, surgery was conducted without gloves, masks or antiseptic. Surgeon’s gowns and smocks were only used to keep blood from staining their clothing and these were not changed between operations. Infections were so common that more than half of the patients for some procedures died afterwards as a direct result of them. Germ theory was to change all that. During the nineteenth century, Louis Pasteur demonstrated that fermentation is caused by micro-organisms and that the emergent growth of bacteria was due to biogenesis, not spontaneous generation. Thus the germ theory of disease was born. He was not, in fact, the first person to propose this idea but he demonstrated it beyond contradiction and, as so often happens, its time had come. Three of Pasteur’s five children had died from typhoid and this personal tragedy inspired him to try to a find a cure for diseases such as this. 519 Turning Medicine Upside-Down Fig. 40.2. Louis Pasteur (1822–1895) By coincidence – if there is any such thing as coincidence – another Frenchman, Claude Bernard, made an equally significant contribution to our understanding of health and disease. He was a celebrated physiologist and a contemporary of Louis Pasteur. Pasteur was born in 1822 and Claude Bernard in 1813, so their work was carried out during the same period of the nineteenth century, but Bernard approached the question of the management of our health from the opposite direction. He was fascinated by, and emphasized, our inner ability to manage our health and to resist disease. He was the first to define the term milieu intérieur; of this major insight he wrote: La fixité du milieu intérieur est la condition d’une vie libre et indépendante (the constancy of the internal environment is the condition for a free and independent life). This is still the underlying principle of ‘homeostasis’, a term that was coined by Walter Cannon in 1928. It is the term used more recently to describe the way we maintain our physiology in a balanced state and manage our immune responses in general. In this sense, Bernard could be said to be the father of the whole concept of immunity. A historian of science, 520 The Writings of Ivor Browne Fig. 40.3. Claude Bernard (1813–1878) Bernard Cohen of Harvard University described Claude Bernard as ‘one of the greatest of all men of science’. I remember reading somewhere, I think it was in G.K. Chesterton, that a heresy is not something which is untrue or false but rather the emphasis on one aspect of truth at the expense...