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Can medicine be cured?

Medicine Balls

Phil Hammond

Monday, 18 February 2019

AdobeStock_220120304_phblog.jpgEvery now and then we need a book that questions the established wisdom of medicine, tells us what we secretly believe but dare not say in public and pushes us back from the brink. In my gap year, I stumbled across a copy of The Doctor’s Dilemma by George Bernard Shaw in a second-hand bookshop. The play was first performed in London in 1906, and the preface brilliantly captures the dangers of treating health as a commodity, and incentivising doctors to do unpleasant things to us. ‘That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg is enough to make one despair of political humanity… And the more appalling the mutilation, the more the mutilator is paid. He who corrects the in-growing toe-nail receives a few shillings: he who cuts your insides out receives hundreds of guineas, except when he does it to a poor person for practice.’

The NHS momentarily took away the vested interest of market forces with Nye Bevan’s argument that rich and poor be treated identically, according to need not profit. But his concession to contrary consultants that they be allowed to practice privately alongside their NHS work, and for GPs to be self-employed but incentivised, has meant that some doctors have corrupted their profession in the pursuit of money and professional status. Indeed, in his latest book, ‘Can Medicine Be Cured? The Corruption of a Profession.’, Seamus O’Mahony argues that the whole of medicine has been corrupted.

Much of what doctors do, O’Mahony argues, is driven by myriad vested interests of profit, professional ambition, patient expectation and political control, leading to a ludicrous situation where doctors are as likely to make patients, and themselves, anxious and ill by the practice of their craft as to help or heal them. Rarely do we have time to check if a medical intervention made a life sweeter, or if we have addressed what matters most to our patients.

This particular pill may be hard for us to swallow but is sweetened by the fact that O’Mahony is a doctor, rather than a mischievous playwright or – in the case of Ivan Illich - an Austrian priest and philosopher. Illich caused a storm in 1975 with Medical Nemesis, opening with the famous line ‘The medical establishment has become a major threat to health.’ Illich believed most advances in health came from improved living conditions and  viewed institutionalised modern medicine as a quasi-religion, with its own rituals and dogma, and the medical profession as a new priesthood. He railed against the monopoly and dominance of doctors: ‘Modern medicine is a negation of health. It isn’t organised to serve human health, but only itself… It makes more people sick than it heals.’

O’Mahony’s arguments aren’t new, but he writes beautifully in what is both a history and a celebration of medical scepticism, with the occasional foray into cynicism. In exposing the futility of much medical research, he quotes a colleague who defines a mouse as ‘an animal which if killed in sufficient numbers produces a PhD’. The problem of corruption in research is neatly summarised by Richard Horton, the editor of the Lancet, who observed ‘no one is incentivised to be right.’ If drug companies are paying for your research, you’re more likely to get the results the drug company demands. If your research is purely for career advancement, it’s unlikely to advance the lot of patients.

O’Mahony caught the tail end of ‘the golden age of medicine’, when its achievements were truly spectacular. Like James Le Fanu in The Rise and Fall of Modern Medicine, he is sceptical that the claims of genomics and digitalisation will bear fruit. Rather than needing a tweak of our genes or a lifestyle App to sort us out, O’Mahony observes that many patients are suffering from ‘shit life syndrome.’ The determinants of illness are largely social, and yet doctors are expected to have a magic answer for everything, usually in under ten minutes. Hence the massive over-reliance on prescriptions and sick notes, a subtle way of saying ‘now f*** off.’ The underlying problem is that we spend trillions on health globally but, like Brexit, nobody can agree what it means. The World Health Organisation set a ludicrously high bar in 1946 – ‘health is not merely the absence of disease or infirmity, but a state of complete physical, mental and social well-being.’ No-one has ever achieved this, except perhaps fleetingly through opium or orgasm. The NHS compounded the problem by promising this mirage of health to each citizen. So every physical, mental and social problem conveniently becomes the doctor’s problem, and we all tot up needless repeat prescriptions.

In O’Mahony’s view, whether society can be cured of its medical dependence depends on whether physicians can heal themselves. Doctors helped create a culture of omnipotence, self-interest and barbaric workaholism, and turned a blind eye to the appalling scandals that resulted. This allowed politicians and managers to control, regulate and incentivise them as human robots. ‘Doctors need to proclaim that professionalism and clinical judgement are still – and will always be – the core of what we do. We need to stop hiding behind protocols, edicts and fear of sanction.’ O’Mahony is not optimistic doctors can rise up and free us all from the shackles of the medico-industrial complex. And it is left to his mother to remind us of the progress we have made. ‘People say how bad the health service is now, but they should go back to the 1940s and they would see what bad care was really like. All the problems we have are because people live so long now.’ Medicine has become a victim of its own success.

Phil Hammond is an NHS doctor, author and comedian. He will perform ‘The Great Health Con’ at the 2019 Edinburgh fringe.

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Phil Hammond

Phil Hammond is an NHS doctor, journalist, author, broadcaster, speaker and comedian. He qualified in 1987 and worked part time in general practice for over 20 years. For the past seven years he has worked in a specialist NHS team for young people with chronic fatigue. He presented five series of Trust Me, I’m a Doctor on BBC2, encouraging patients to be more involved, assertive and questioning. Phil is Private Eye’s medical correspondent; in 2012, he was shortlisted with Andrew Bousfield for the Martha Gellhorn Prize for Journalism for ‘Shoot the Messenger’, an investigation into the shocking treatment of NHS whistleblowers. In 2013 and 2014, he was judged to be one of the top 100 clinical leaders in the NHS by the Health Service Journal. As a comedian, Phil was half of the award-winning double-act Struck Off and Die, with Tony Gardner. He has done five solo UK tours, appeared on several TV shows, and has written five books.
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