About book The Rise And Fall Of Modern Medicine (2002)
Excellent read – part history book, part analysis and part critique Le Fanu traces out the rise and fall of modern medicine, starting with analysis of the factors that have contributed to the extra-ordinary success of medicine in the 30 years following 2nd world war and following through to the identifications of the factors that have contributed and are still contributing to subsequent stagnation. The first half of the book is mostly uncontroversial – Le Fanu outlines a few now-famous examples of post-war medicine success stories including but not limited to discoveries of penicillin, cortisone, streptomycin, chlorpromazine and covering such breakthroughs as open heart surgery and kidney transplants. Two major themes recur in various forms throughout the success stories – serendipity and emphasis on practice over theory. Most of drug discoveries were indeed accidental and in fact the exact mechanism of their curing ability was not known at the time and for many is still not known today. But they do work. As such it is a classic example of bottom-up empirical approach where the main goal is to find something that works rather than attempt to explain why it does. The second half of the book is more controversial – Le Fanu explains how the combination of our exhausting of chance discoveries and reframing of bottom-up medical practice into top-down medical theory have resulted in the stagnation of significant medical progress. Broadly the argument stipulates that once we’ve exhausted serendipitous “gifts of nature” (e.g. penicillin, cortisone etc) and have addressed single-cause diseases we’ve started running out of ammunition at which point top-down grand theories such as New Genetics and Social Theory of disease have swooped in. Here the specific analysis becomes more speculative and uneven – he does an excellent job of destroying the Social Theory via the examples of search of environmental causes of heart disease (brilliant expose on the subject btw) and cancer (remember Nixon’s war on cancer?) and a pretty good job of criticizing the shortcomings of genetic engineering, but some of his other critiques (e.g. gene therapy) are more questionable. Overall when it comes to technical details of evolution and molecular biology Le Fanu’s reasoning becomes less lucid. That said he nicely demonstrates the massive gap between the promises of New Genetics and its accomplishments and he also correctly calls Social Theory for what it is – yet another example of utopian social engineering. Finally, Le Fanu is certainly correct in lamenting the transition from practice-based approach aim at finding cures to theory-based approach aimed at finding explanations. Frankly I was only marginally interested in the subject matter but once I picked up the book I couldn’t put it down – despite some of its flaws I can’t recommend it enough.
An inspirational and eye opening piece of writing. The first part of the book, 'The Rise', documents 12 definitive moments in the 'golden age' of medicine from the end of the second world war to the mid 80s. These chapters are exciting and engaging accounts of such marvels as open-heart surgery, intensive care and the discovery of penicillin. It is often the case in these chapters that the discovery being chronicled was the offspring of tireless scientific effort and a healthy slice of good fortune. In fact this part was so awe inspiring that I couldn't bring myself to read the second part of the book: 'The Fall' for a year or so for fear that it would take the shine off what I had just experienced. However, the tale of the fall of modern medicine was equally exciting, if not sobering. The main point addressed here I believe, is the paradox that even as life expectancy and general good health continues to rise, there is more concern than ever about the health of the population. I particularly enjoyed the use of the word 'disease-mongering' to describe the sensationalist attitude taken by the media and big pharma in their efforts to convince us that, for example 'mobile phones cause brain cancer' or 'genetically engineered insulin is a new hope for diabetics'. Le Fanu goes on to lucidly explain that the amount of radiation emitted by mobiles is a fraction of what we are exposed to from that of the earth's static magnetic field, and also that pig and cow insulin is not only more effective than the GM counterpart, but also considerably cheaper! He goes on to debunk many more myths of good health (including the fabled 'low cholesterol diet'). This book is essential reading for any social scientist or medic and anyone who needs reminding that when it comes to science we should all have our feet planted firmly on the ground.
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Read this a few years ago, so the details are fuzzy. I'd have given 5 stars for the first half - a rundown of twelve pivotal discoveries/inventions in medicine. Le Fanu brings these events, involving chance findings and big personalities, to life with skillful story-telling. The second half, about the 'fall' of modern medicine, includes some questionable analyses of the epidemilogical evidence regarding heart disease among other issues, which I would have liked to have seen better argued. Still, some interesting points made in the second half gets it 3 stars, so the book gets 4 overall.
—Kenzo
This was a provocative read and I liked the fact that the author was taking such a fresh perspective on our whole medical research enterprise. From the emphasis in the pharmaceutical industry on developing "lifestyle drugs" or slightly tweaked variations of existing treatments, to the lack of funding for basic science there's a lot of unorthodox thinking to absorb. I was interested to read LeFanu's call for a return to "first principles" which I hear echoed sometimes at this research institution where I work.
—Julie Whelan
