Bad Medicine by David Wootton

This is a book of two halves. On the one hand it's an exciting and uncomfortable exploration of just how new medical science is and how precariously it rests on just a couple of foundations. It lays out just how much harm vested interests (in this case a medical community immune for accountability) have done to us and just how difficult it has been to introduce scientific method to what typically trumpets itself as a bastion of free thinking and clear mindedness. In this it is a triumph and a must read, especially for doctors.

On the other hand it's a none too subtle attempt to present medical history as one of progress...It tries to suggest that current historians of medicine have missed the point - that the story of modern medicine is one of heroes and villains, good guys and bad. However, in this it baffles and, ultimately, fails. I'm not interested in whether the history of science is presented as progressive or otherwise - the story Wootton tells is compelling without his editorial preferences. At the same time, if one's aim is to make this accessible as possible, then spending any time on discussing an argument that's only really of interest to academics is off putting and pretty indulgent. And by indulgent I mean boring and elitist.

I do think Bad Medicine is a great read. It transformed my thinking about just how useful tools like homoeopathy have been when one compares them to non-stop purging or a medical community that stood in the face of evidence and STOPPED the practice of taking lemons on ships to combat scurvy and thereby resulting in the deaths of hundreds and thousands all because reality didn't match theory and they allowed theory to drive out reality. In the history of medicine then Homoeopathy has provided a much more benign alternative to most of medicine exactly because it has no active components and only works within patients' minds. At worst it hasn't done harm. Don't get me wrong - it's a placebo at best and an unethical con at worst - particularly now when technical medicine has gone a long way from when it was a worse alternative than 'made up' remedies but that's just the thing, medicine eventually changed and helped defer death. Homoeopathy hasn't changed and is just as inert a remedy as it always was. Now it is the damaging remedy.

Yet Wootton points out that if anti-biotics fail us then almost all the progress we've made will evaporate. It's not a one way journey to ever better health. That's frightening because it highlights that modern medicine is based on the assumption that we can stave off the most basic deadly threats such as bacteria and concentrate on what goes wrong with people. That's pretty precarious and the fact that we're fragile creatures has perhaps been something we're too confident of ignoring in our quest for glossy hair, dogs that can fit in handbags and the appearance of eternal youth.

I neither agree with Wootton's argument for a progressive interpretation of medical history but nor do I think his view of the world damages the story he's telling about what actually happened. This is a great book.