Physician, reveal thyself

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Doctors and Discoveries: Lives that Created Today's Medicine

Houghton Mifflin: 2002. 480 pp. $24

Encores can be tricky. Do you provide more of the same, or show your versatility by doing something completely different? John Simmons' The Scientific 100 (reviewed in Nature 385, 215; 199710.1038/385215a0) audaciously but successfully offered a biographical ranking of the top scientists of all time. The encore, Doctors and Discoveries, which attempts something similar for the medical profession, is geared to the author's strengths: an empathy for individuals and their contributions, and an outstanding ability to explain complex scientific and medical ideas simply yet accurately. There are differences, too. There are 15 fewer doses, only 85 entries, and the absolute ranking has been abandoned. Entries for individuals who appear in both volumes have been completely rewritten.

Happily, Simmons has not entirely given up the subjective dimension, which was part of the fun of the earlier volume. Instead, in six gatherings, he has stamped his judgement on the history of medicine. Rather than a simple chronological ordering, the result is a game in which the company of one's peers becomes significant.

The first part establishes the parameters of medical modernity, through two ancient thinkers, Hippocrates and Galen, and six nineteenth-century giants, with Charles Darwin occupying pride of place. Darwin's role as head of the class is both amusing (he was, after all, a would-be doctor who couldn't stand the sight of blood) and appropriate. Evolutionary biology underpins much of our knowledge of organisms in health and disease, and ought to have been more intertwined with biomedical thought from the start. The piece on Darwin takes account of recent developments in “evolutionary medicine”, which promise much.

This pantheon is followed by a section on the highly commended, including several who were too clinical to make the first volume. DNA is nicely pinned on Oswald Avery, who showed that DNA is responsible for heredity, instead of James Watson and Francis Crick, who were in the earlier volume. Besides, they will get plenty of exposure next year, the fiftieth anniversary of their famous Nature communication.

The third section, on historical also-worthies, records important characters such as Ambrois Paré, who discovered in the sixteenth century that it was better to treat wounds with a gentle salve rather than boiling oil; Pierre Fauchard, an eighteenth-century pioneer of dentistry; and psychoanalyst Sigmund Freud.

The next part spans the period from William Osler in the late nineteenth century to Macfarlane Burnet in the twentieth. This section has a Nobel prize count of about 75%, giving scant encouragement to those who might wish to improve diagnosis, medical education or treatment if their goal in life is the Ultimate Reward. Osler and the educationalist Abraham Flexner would not have expected one. Archibald Garrod died before the fundamental significance of his work on inborn errors of metabolism was adequately appreciated. Walter Cannon probably deserved one for his work on homeostasis and on the functions of the autonomic nervous system; neurosurgeons Harvey Cushing and Wilder Penfield would have liked one. It is not too late to consider Willem Kolff, who invented the kidney dialysis machine 60 years ago, because Peyton Rous, also included here, received his at the age of 87 for work on tumour-inducing viruses that he had done long before.

The Nobel count in the next, more recent, section is about the same, but it also includes mavericks such as the paediatrician Benjamin Spock, sex physician William Masters and, curiously, Melanie Klein — curiously because psychoanalysis no longer has the psychiatric cogency that it once did. There is no mention of psychiatrist Emil Kraepelin, who could have been interestingly paired with his almost exact contemporary Freud. British readers might favour Richard Doll and Austin Bradford Hill ahead of Ernst Wynder on the smoking and health issue, especially as the rigour of Doll and Hill underpins epidemiological surveillance, double-blind clinical trials and, indirectly, evidence-based medicine. But Wynder was an influential figure in contemporary lifestyle medicine.

That fewer than half of the “creators” of modern medicine worked in the United States, whereas two-thirds of the contemporary ones did (or do), is historically tenable. The only coupled entry is for HIV's inextricably linked Robert Gallo and Luc Montagnier; Simmons' exposition of their rivalry is both lucid and balanced.

I doubt that Simmons frequents either homoeopaths or chiropractors, but in his final section he discusses dispassionately some creators of modern medicine, if not exactly modern medical science. He points out that Avicenna, who died over a thousand years ago, is still studied widely, and that Samuel Hahnemann and D. D. Palmer, creators of homoeopathy and chiropractic, respectively, have many followers. Lydia Pinkham, a nineteenth-century American nostrum pioneer, represents that happy band of entrepreneurs; Paul de Kruif, author of Microbe Hunters and other popular books, exemplifies an earlier heroic depiction of medicine; and Henri Dunant, founder of the Red Cross, provides a humanitarian face.

Medical schools have more difficulty recruiting than they did a generation ago. It is one of the many virtues of this book that it can be read and understood by someone thinking about a career in medicine. This young reader would be apprised of many of the difficulties facing anyone making such a career choice, but might still be encouraged to follow that path.

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Bynum, W. Physician, reveal thyself. Nature 419, 115–116 (2002) doi:10.1038/419115a

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