I recently finished Seamus O’Mahony’s book Can Medicine Be Cured? He poses the title as a question and it is tempting to apply the principle that one should, as a matter of course, answer these kind of questions as ‘No’. And, indeed, O’Mahony offers little comfort that it can be answered positively. As a result, there may be some risk of despair in reading it.
Jane Rosamund Moore provided an excellent review for us at the BJGP.° O’Mahony takes a hammer to the medico-industrial machinery – the endless biomedical research and Human Genome Project, generally all regarded as A Good Thing, are all duly bashed. Like Moore I was particularly intrigued by O’Mahony’s account of the Mid-Staffs scandal and the contentious use of statistics.
In her review, Moore notes that O’Mahony comes across as a bit ranty. That feels like more of a problem in the back end of the book. For instance, I’m quite prepared to look critically at the evidence for bare-below-the-elbows infection control policies but there is a whiff of the old-school consultant when complaining about the abolition of white coats. The chapter on empathy and compassion wasn’t as compellingn and felt a little under-cooked. Worryingly, O’Mahony offers little in the way of solutions and we’re left with the end-of-career cry that it ‘was better in the old days’. Except O’Mahony wasn’t that impressed then either. How do we find another way? We get a few words at the end about readjusting our aims for people who are suffering but it’s cold comfort.
Overall, though, it’s an excellent book and one that challenges. And O’Mahony offers plenty of avenues for further exploration. We need contrarians. Perhaps one of the best in recent years is the redoubtable Richard Smith. Smith gets to a fundamental problem at the heart of the doctor-patient-system dynamic. O’Mahony writes:
Richard Smith, then editor of the British Medical Journal, wrote about the ‘bogus contract’ in 2001. This contract is based on patients believing that modern medicine can do remarkable things; the doctors can easily diagnose what is wrong, know everything it’s necessary to know, and can solve all problems, even social ones. Doctors know that these beliefs are childish, and that the contract is bogus.