- Bad Medicine: Doctors Doing Harm Since Hippocrates
Moving jerkily from the ancient Greeks to the present day, Bad Medicine offers a farrago of mostly standard medical history written to deliver this message: before Joseph Lister applied the germ theory to clinical practice in 1865, physicians using “bad medicine” did their patients more harm than good. Moreover, medical historians have obfuscated this long legacy of ineffectual and dangerous medical practice because they don’t like to write about “progress” or to make retrospective judgments. This book’s author has no such hesitation, labeling past therapies that we now see as wrong as being “not remotely rational,” even “entirely arbitrary” (p. 4). He bemoans needless and harmful delays in adopting seemingly obvious (from our twenty-first-century perspective) medical advances and lays the blame for those delays on physicians’ resistance based on psychological and cultural adherence to traditions.
Heroes and villains are clearly marked. For example, James Lind “deserves to be left in obscurity” (p. 166), and John Haygarth has previously failed to receive the historical credit he deserves for his work on the placebo effect on account of medical historians’ “blinkered vision” (p. 170). Those historians have been “mesmerized” by Pasteur to the extent that they have been “quite incapable of hearing what Lister says” (p. 237). This book is out to set the historical record straight. There are few shades of gray; conclusions are rendered in starkly contrasting black and white.
This slim volume presents an unusually dense target-rich environment for reviews; indeed, it almost seems to invite criticism from historians. But the author appears to revel in the controversy. Reviews and the author’s commentaries thereon are posted at www.badmedicine.co.uk , along with a postscript to the soon-to-be-published paperback edition.
What does the book have to offer historians? They could mine it for previously underappreciated historical actors. Although the author elected not to burden the text with footnotes, a more detailed bibliography is promised at the Web site. The book could also spark lively discussion in a class on historiography.
Is this a book for physicians? The author has generalized on his Web site that “Broadly speaking, doctors (who take progress seriously) love it . . .”1 Perhaps they do, but if doctors (and I am one) were to share the book’s understanding of “progress,” they would be more likely to practice “bad medicine.” That is because of the single, profoundly ahistorical lesion in the book’s reasoning: the supposition that someone can contemporaneously differentiate clinical practice based on “legitimate reasoning” from clinical practice based on “arbitrary assumptions.” The author praises the recent rise of what is called “evidence-based medicine” as a corrective to past missteps. However, physicians of the past were no less confident of their superiority over previous generations or comfortable with their ability [End Page 766] to use available evidence to make rational choices. Rather than using history to enhance a sense of superiority over past practices, today’s physicians will be better healers if they appreciate that their most deeply held beliefs about health and disease may well be overturned.
Yes, medical practice has changed. I use the fruits of contemporary medical research every day in clinical practice. When I become ill, I wish to be treated not with nineteenth-century but with twenty-first-century medicine. We all hope that our physicians will consider carefully the latest sets of new ideas and techniques. However, pace the author’s assertions, if we want to understand the past or to create history that can improve current policy or practice, we cannot dismiss actions as “not remotely rational” or “entirely arbitrary.” We must instead understand why ideas come into existence and how they persist as long as they do. We need to ask these questions both for ideas that we now think are true and for ideas that we now think are wrong. This task requires that we take seriously belief systems with which we may now disagree, and that is a...