Bad Medicine: Doctors Doing Harm Since Hippocrates

Abstract

Historian David Wootton seeks to restore the concept of progress to medical historiography. Contrary to the postmodernist fashion, Wootton argues that, in terms of alleviating pain, shortening illness and prolonging life, practitioners of modern medical science have made major advances on their predecessors. Yet Wootton's embrace of medical progress is heavily qualified by his strictures on the ambivalent role of the medical profession in the advance of medical science. Thus, he emphasizes that medicine's positive contribution to humanity began scarcely a century ago. In the 2500 previous years of medical practice, with their ‘bleeding, purging and vomiting’, doctors were more likely to do harm than good. Furthermore, he believes that his readers will be ‘surprised to discover just how limited the achievements of modern medicine are’. Bad Medicine is not so much a celebration of medical progress as a study of the ways in which progress has been frustrated by the psychology and culture of the medical profession. Wootton shows, for example, how the main elements of the germ theory were in place by the early 18th century. Yet it was not until a century later that the germ theory of putrefaction was established (1837) and another 30 years before Lister's application of the theory to surgery (1865). But if Lister gets the credit, several generations of his colleagues must take the blame for the long delay. Debunking the doom-mongers, Wootton recognizes the contribution of modern medicine to increased life expectancy. Citing John Bunker's important study, he suggests that two of the 23 years increase in longevity between 1900 and 1950 were attributable to medicine, and three of the 7 years increase between 1950 and 2000. He concludes that medicine has contributed less than 20% of the overall 20th century increase in life expectancy (five out of 30 years), ‘not nearly as much as most of us believe’. After emphasizing 2500 years of failure, this seems a somewhat grudging acknowledgement of this dramatic reversal in medical fortunes. Not only did bad medicine turn good in the 20th century, it got better all the time: whereas medicine contributed less than 10% of the longer life expectancy in the first half of the century, in the second half it accounted for more than 40% of the improvement. While Wootton challenges convention in recognising medical progress, he is strikingly conventional in his distaste for the spirit of experimentation in medical science. Thus he disparages early medical researchers' involvement in dissection and vivisection as ‘mangling the dead, torturing the living’. He condemns studies carried out by Claude Bernard on animals as ‘gruesome and grotesque’. But the price of progress in science—today as in the past—is that scientists are obliged to challenge popular prejudices to extend the frontiers of knowledge. No doubt the doctors of old pursued many mistaken theories and inadvertently harmed many patients. But the good medicine of today and the better medicine of the future are inextricably the legacy of the bad medicine of the past.

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