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by Caitlin Burke

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Written by a physician and a journalist (described as an "obituarist"), this lurid little book is full of chilling stories from the annals of medicine. A tour through centuries of charlatanism, cruelty, and incompetence, it promises, "You won't hear these stories from your family doctor!" It certainly has a number of interesting stories -- dangerous doctors, the harrowing history of lobotomy, and detours in the development of medicine. It also has a number of flaws, including a willingness to indict practitioners that had good ideas that were ahead of their time, some confusion about the purpose of the practice of medicine, and a breadth of scope that leaves inadequate space for complex issues.

Among the neat and lurid stories of doctors gone terribly wrong -- from drug addiction to senility to just plain craziness -- there are numerous less-satisfying vignettes. Is it necessary to take to task doctors who attempted sound procedures that overreached the science of the time? Blood transfusion, for example, is now a proven and routinely useful treatment, and yet the authors remark of the first attempt (in the 1880s, before blood groups were discovered), "...all four patients died. There were no ethical research committees, and no question of litigation against him arose." A satisfyingly hypocritical view in a book that later smirks at the American passion for lawsuits. The authors also frankly misstate the clinical priorities of medicine. "Treating symptoms is bad medicine," states one vignette, but this is nonsense. Sometimes treating symptoms is the only medicine worth practicing, as with a terminal patient or a patient with a benign or healing condition that just happens to have irritating symptoms.

Of course, no discussion of the development of medicine is complete without a veneration of the placebo effect, but in this book this is almost completely undermined in the -- also obligatory -- denigration of Sigmund Freud. Freud was not a "scientist" as "we" use the term. Psychoanalysis remains popular with "millions of people who are more interested in talking about themselves or in obtaining some kind of psychological support than in the strictly scientific merits of the procedure." In conclusion, "what we need to combat psychological problems is more science and less pseudo-scientific dogma of the psychoanalytical variety."

The authors define psychoanalysis (and, it seems, psychotherapy in general) by strict and literal adherence to Freud's writings. Maybe Freud was a "blunderer" for ascribing men's fears to lust for their mothers, but where is the measured approach to these issues? Psychoanalysis has developed over the past century, and it's perfectly valid for therapy seekers to wish to talk about themselves or obtain some kind of psychological support. Even if psychotherapy doesn't have the "cachet" of drug-based medicine, the placebo effect, particularly when combined with the ill understood -- but obviously very powerful -- effect of social relationships, can hardly be discounted as a part of mental health. Sum the authors, "There is no point in arguing with the proponents of psychoanalysis because they do not speak the same language as scientists so there is little common ground for discussion." This elevation of the ideology of science, which neatly segregates and systematically devalues the literary, the emotional, and the unconfirmed, is tedious and pompous in a book that seeks to put a powerful Establishment group into perspective.

Such unevenness is perhaps to be expected in a book that sets itself as large a task as does Medical Blunders. Nearly 400 pages long, the book seems to wish to present a comprehensive catalogue of medical crimes, from early and misguided medical beliefs to unethical human experimentation. Racing through more than 60 subjects, with almost three dozen boxes detailing particularly gruesome examples, the book cannot help but give cursory and sometimes misleading attention to some very complex issues, ironic in an exposť.

Among the awkward treatments are those of eugenics, better handled by Marouf Hasian in The Rhetoric of Eugenics in Anglo-American Thought, or the Tuskegee experiment, dramatically better handled by James Jones in Bad Blood: The Tuskegee Syphilis Experiment. The authors discuss British eugenic fervor and policies but give somewhat more attention to American and German eugenics policies, particularly when it is time to give shocking examples, and the treatment of Tuskegee in Medical Blunders is particularly misleading, basically ascribing the existence of the Tuskegee experiment to racist denial of Black people the right of informed consent. While it is certainly the case that Tuskegee exemplifies the need for informed consent and that the experiment was utterly racist, their view, like many others in the book, holds one era's practice to another's standards and omits too many facts to retain much use. These are big, complex topics, and they deserve the unflinching attention to racism and historical context given in longer treatments.

Medical Blunders has a peevishly broad sweep that undercuts the reader's ability to enjoy the stories suggested by its title. Part of the book's conceit seems to be that medicine is truly science-based, safe, and objective when practiced properly, and while that may seem like a tautology (unless it seems completely content-free), it's only part of the story. Although seduced by the comforting objectivity of the body's physiology, the authors are aware of the substantial power of evidence-based medicine, but they still seem to have failed to notice what a subjective and complex creature clinical medicine is. Is the history of medicine filled with quacks and worse? Indeed it is. And one hopes to enjoy their exposure in a slightly more balanced and more focused way.

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