The Rise and Fall of Modern Medicine by James Le Fanu. Abacus, 2000.
This intriguingly titled book makes fascinating reading. Le Fanu argues that in the forty or so years following the end of the Second World War the achievements of medicine were prodigious, but that by the beginning of the 1980s “the age of optimism had ended”. The first half of the book, which charts the rise of modern medicine, Le Fanu associates with a series of spectacular discoveries and developments, and particularly with “twelve defining moments”—including the discovery of penicillin and cortisone, smoking being identified as the cause of lung cancer, tuberculosis being cured with streptomycin etc, the development of intensive care, open-heart surgery, hip replacement, the prevention of strokes, the cure of childhood cancer. The second half, the fall, he associates with the “blind alleys” of “Social Theory” and “The New Genetics”.
It is instructive to note that most of the favourable reviews which are quoted at the beginning of the paperback edition, are especially generous when writing about the first part of the book. And it is easy to see why. Le Fanu juggles his story marvellously, mixing medical history, reflections about the scientific method and enthralling anecdote, skilfully and entertainingly. The first part of the story is essentially descriptive—discussing the combined impact of drug therapy and technological developments in combating disease. In contrast the second part is more polemical, and this more contentious, and reviewers in, for example, the Daily Telegraph and the Financial Times, are generally much happier with exposition than argument. This is especially the case when the argument reveals that the public can be persuaded to believe the most fanciful nonsense, if it is offered by supposedly credible authority figures.
But why the fall? Why did the great advances of the years following 1945 come to an end? First, says Le Fanu, because the rate of introduction of new drugs fell in the 1970s, as the discovery of new biologically important chemicals ended. And, second, because new technological innovations seemed only able “needlessly to prolong the process of dying”.
Into the vacuum two new specialities have emerged: genetics and epidemiology. However, says Le Fanu, since genetics is not a particularly significant factor in human disease its impact is limited. But if the author has little faith in the efficacy of genetics, he reserves his most devastating criticisms for epidemiology and the Social Theory that it spawned.
Social Theory seeks to provide not only an explanation for disease, but also to suggest ways of engineering its prevention. For example, if smoking can be shown to be associated with lung cancer, causing people not to smoke will reduce the incidence of the disease. Health promotion (or what Le Fanu calls social engineering) thus becomes associated with changes in lifestyle and diet, and can be seen as the modern-day equivalent of the great sanitary reforms of the late 19th century, which were based on massive civil engineering projects.
Unfortunately much of the so-called evidence which informs current Social Theory is specious. Le Fanu has much fun setting out the way in which eminent scientists, health administrators and politicians have become involved in some of the fictions of the last 20 years, especially those associated with supposed “Diseases of Affluence”—various cancers, strokes, heart disease etc. Thus it turns out that there is no evidence to sustain the supposed link between eating large quantities of meat and dairy products and cancer, even though in the last five years the population of the USA has been spending $3 billion a year on cholesterol-lowering drugs, on the basis of just such a connection. “Together the drug companies and Social Theorists had triumphed.”
And there is more, much more. Le Fanu offers convincingly evidence to show that most of the claims that associate diet with disease are at best tendentious half-truths. And whilst he doesn’t suggest a conspiracy uniting the leaders of the medical profession, with drug manufacturers and politicians, there is no doubt that the nostrums which underpin Social Theory are consistent with the interests of all three groups, if clearly not with the public-at-large. Socialists will find this unsurprising. Professionals with reputations to preserve frequently find themselves allied to capitalists who want to make money, and politicians anxious to save it. Every politicians knows that prevention is cheaper than cure, especially when the former is paid for by the individual and the latter by the state.
On reviewer reports that “this excellent book” has changed his opinions about modern medicine. It has certainly changed mine.
Michael Gill
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