Books and Arts

Nature 443, 275-276 (21 September 2006) | doi:10.1038/443275a; Published online 20 September 2006

Failing the ailing

Andrew Scull1

BOOK REVIEWEDBad Medicine: Doctors Doing Harm Since Hippocrates

by David Wootton

Oxford University Press: 2006. 320 pp. £16.99, $25

David Wootton has made a truly remarkable discovery that he can't wait to share with the rest of us: medicine didn't work very well for millennia. Indeed, it almost certainly didn't work at all. For most of recorded history, it seems, doctors secretly did little except harm their patients while pretending to cure them. "Before 1865 all medicine was bad medicine," he writes in his book, appropriately called Bad Medicine. But then came Joseph Lister and antisepsis, Louis Pasteur and germ theory, and Alexander Fleming (or was it Howard Florey?) and penicillin. And from that point on, science was in place, medicine worked, and we entered an era of continuing progress and enlightenment.

Unfortunately, Wootton laments, benighted medical historians have somehow overlooked this state of affairs. Instead they have either constructed narratives of progress when medicine wasn't progressing, or (in a perverse reversal extending over three decades now) have decided that it's wrong to write tales of heroes and villains that describe an onwards-and-upwards march to scientific nirvana.

Failing the ailing

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A saw point? Some medical practices may have done more harm than good.

The sources of this historiographic perversity are never clearly articulated, nor are many of the offending historians identified by name, for Wootton's is a blanket condemnation. He alone has been privileged to see the true state of affairs, and henceforth the history of disease and its treatment will have to be radically recast in the light of his fundamental new insight. For the notion that there is any sort of continuity in the medical enterprise is fundamentally mistaken, he declares: we need to develop a history of error, albeit often honest error, followed by a new history of triumph. This latter alone constitutes "the modern history of medicine, grounded in constantly developing scientific understanding".

A small fraction of the book is devoted to medicine's successes: Lister's development of antiseptic surgery, John Snow's work on cholera in the mid-nineteenth century, and the advent of antibiotics, especially penicillin. For the most part, however, Wootton's eye falls on medicine's failures and missteps. For two thousand years, the galenic and hippocratic approaches dominated Western medicine. The remedies they proffered, Wootton reminds us, were painful and actively harmful, except to the degree that they produced placebo effects. Of course, there were developments in the understanding of human biology and in medical technology in these years: Andreas Vesalius produced his stunning work on human anatomy; William Harvey discovered the circulation of the blood; Antonie van Leeuwenhoek and others used microscopes to reveal the world of the infinitely small; René Laennec invented the stethoscope; and François Magendie, Claude Bernard and others used unspeakably cruel vivisections to explore the physiology of the body. But none of these developments led to therapeutic progress, and those that might have done so (such as the ability to see germs) went unexploited for decades, even centuries.

The brief sketches Wootton provides of these and other episodes in the long reign of error are rendered deftly and vividly. When he attempts to address larger themes, however, things do not always go so well. Frequently he points to missed opportunities to exploit the implications of technical advances and key discoveries. He cites as examples the long hiatus between the discovery of bacteria and the link to infectious disease, and the shorter but still significant gap between the first observations of the antibacterial effects of Penicillium moulds in the 1870s and Florey's development of a therapy that worked in the 1940s.

But Wootton's attempts to blame these failures on the blinkered self-interest of medical men — "doctors were determined no scientific discovery would alter their traditional therapies of bleeding, purging, and vomiting" — are crude and unsatisfying. He claims that medical historians have glorified the link between the laboratory and advances in basic science but overlooked the fact that these discoveries led to no immediate therapeutic advance. But this is simply false, as would be made clear by a quick perusal of such sources as William Bynum's Science and the Practice of Medicine in the Nineteenth Century (Cambridge University Press, 1994) or John Harley Warner's The Therapeutic Perspective (Harvard University Press, 1986). His global characterization of the state of medical history strikes me as woefully wide of the mark — the subtle relationship between science and medicine requires a far deeper understanding than anything on offer here. And his assertion that the history of modern medicine can be reduced to a paean to scientific progress is a recipe for bad scholarship, of which there is already far too much in the world.

  1. Andrew Scull is in the Department of Sociology, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093-0533, USA.

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