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The Human Nature Review 2002 Volume 2: 130-131 ( 5 April )
URL of this document http://human-nature.com/nibbs/02/gfim.html
Great Feuds in Medicine
by Hal Hellman
New York: Wiley, 2001
Reviewed by Duncan Double, Consultant Psychiatrist, Norfolk Mental Health Care NHS Trust.
Hal Hellman is the author of several popular science books, and this book is a follow-up to his previous book Great Feuds in Science. He tells the stories of ten famous and not so well known clashes in the history of medicine from the 17th century to the present day. The focus is on medical research, rather than clinical controversies. Application of scientific knowledge to therapeutics creates powerful ideological forces, not always grounded in reality and evidence.
A common theme of the book is the high emotional cost paid for initiating new ideas and sustaining new beliefs and theories. Conflict creates tensions and unpleasantness. Rather than open debate and encouragement, personal relationships tend to be invaded by jealousy, animosity and threats.
Peer pressure can lead to social isolation, lack of recognition and marginalization. To take an example from the book, Sabin promoted the weakened virus method for developing a polio vaccine, whereas Salk championed the killer-virus method. Sabin was the medical statesman and researcher with a reputation, and his attacks on Salk were on the front page of every important newspaper. The damnation of Salk meant that his fundamental advance in human health was not recognised as a scientific contribution in his lifetime by the medical scientific community, although he received many honours from the public and the US government.
Perhaps the best example from the book of the power of the medical establishment is that of Semmelweis. He recognised that the cause of puerperal sepsis was lack of cleanliness through failure to wash hands before internal examination of a woman. Understandably, professional shame creates much defensiveness and resistance, however unconsciously. Semmelweis himself attempted to cope with his guilt about having killed many women. Moreover, he had to persuade others of his case before the later work of Koch and Pasteur that showed conclusively that infections, including childbed fever, were caused by germs. Semmelweis met much resistance and left Vienna for his home in Hungary after his position at the hospital clinic was not renewed and restrictions were placed on his professional practice. A prominent medical journal urged an end to his chlorine treatment. Over the years he became less moderate in the tone of his argument. For example, he denounced respected obstetric teachers as murderers before God. He suffered a mental breakdown aged 47 and was committed to an asylum, where he died soon after.
As Hal Hellman writes:-
Was it [the mental breakdown] an obvious result of the reception this highly emotional personality received at the hands of his peers? Was it a response to the constant struggle and rejection? It seems very likely.
Hellman deals sensitively with the historical evidence and considers opposing views. He is not afraid to give his own perspective. For example, as far as Semmelweis is concerned, he suggests that if he had not "flailed with wildness and venom … the field might have taken even longer to progress than it did". Hellman does have a sense of historical accuracy and the tales are well researched. His primary motivation, though, is to tell a story and the medical conflicts he describes are both informative and engaging. The dramas of medical innovation and advance are important and their personal nature should not be discounted. I found this book enjoyable. It is not a weighty historical and critical analysis of medicine. It is an intelligent, enlightening account of disputes, narrating the advance and progress of medicine.
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© Duncan Double.
Double, D. (2002). Review of Great Feuds in Medicine by Hal Hellman. Human Nature Review. 2: 130-131.