I am sometimes amazed at how badly doctors reason when I encounter them in an attempt to reason about a subject I know about—and so it struck me today that the old suspicion that doctors are all quacks is about as true today as it ever was.
The mistake is to think “they reason badly about this subject, because they don’t know about it”—and yet it’s the whole approach that seems suspect. So they don’t reason about medicine, either? Well, that’s the mistake—you just think “he said something stupid here, reasoned in a stupid way, but, of course, when it’s medicine it’s different.”
Except it isn’t. Quack is going to quack.
Doctors today owe their reputation to penicillin—and penicillin was discovered by chance. Fleming wasn’t even searching for it (he just happened to leave one mould culture with the lid off over the summer). Hence:
“For the effect on the cultures of staphylococci that Fleming observed, the mould had to be growing before the bacteria began to grow, because penicillin is only effective on bacteria when they are reproducing. Fortuitously, the temperature in the laboratory during that August was optimum first for the growth of the mould, below 20 °C, and later in the month for the bacteria, when it reached 25 °C. Had Fleming not left the cultures on his laboratory bench and put them in an incubator, the phenomenon would not have occurred.”
Well, today I’d say the “accident” that caused it to be discovered was Providence (a gift from a god—after all, Fleming did have an assistant whose middle name was “Merlin”); and, as it happens, the ancient Egyptians knew about penicillin—they used to put mouldy bread on wounds, an act that for centuries seemed foolish and superstitious, except that, once penicillin was discovered, it became obvious that the mouldy bread contained penicillin, hence its medicinal properties. Yes—that’s not the same as when you extract the “broth”, the essence, of the mould and put it in tablets; but it’s pretty close.
Anyway, without penicillin you just wouldn’t think very much of doctors at all. As Céline observed, penicillin took all the romance out of medicine—for him, the doctor was a quasi-mystical figure who appeared at a door and uttered incantations (just as for Somerset Maugham the doctor could venture into the worst slum, always protected by his black bag—and so, as with Chekhov or the fictional Doctor Zhivago, he could “see life”). The fact is that before penicillin there just wasn’t a lot you could do for many conditions, except some very speculative treatments—hence medicine had this romantic air about it.
The doctors who were just romantics (clueless) are the same as they ever were but have been bailed out by penicillin. Because a whole range of illnesses that used to be fatal aren’t anymore, the doctor has grown in stature (he’s become almost god-like). Yet his status doesn’t rely on some “application of the scientific method” or a multi-billion-dollar “war on cancer” (per Nixon), but rather on what appears to be “dumb luck” (actual Providence, divine intervention) in an experiment that in no way sought to discover a reliable way to kill bacteria.
In fact, I rather think the gods like it that way—and that the gods do not like huge multi-billion-dollar “wars on cancer”; if there’s to be a cure “for cancer”, it will come about as it did with penicillin—through serendipity (and perhaps, as with the mouldy Egyptian bread, it will have an ancient analogue).
So you shouldn’t trust doctors, you shouldn’t have anything to do with them—they’re basically living off “stolen valour”; if they didn’t have penicillin, you’d run a million miles from them in most circumstances—or treat them with a certain circumspection and scepticism, anyway. I have copies of the Oxford Handbook of Clinical Medicine and the Oxford Handbook of Psychiatry and I glance at them from time-to-time but when I do so I’m always struck by how woozy the thought process in the handbooks is.
It’s something to do with the bedside manner, I think. There’s always a somewhat encouraging tone, “Don’t despair—chronic stomach haemorrhages may look tricky, but there are several modalities in the clinician’s toolkit.” Obviously, psychology is important—the doctor does need to present both authority and also a certain softness that encourages his patient lest said patient should fall into despair. There’s a balance to be struck between treating a person as “a thing” and as an individual who wants to live and needs encouragement to live, often in quite severe circumstances.
Yet somehow this whole medical persona seems to convey wooziness to me—kind of a confident wooziness, derived from both the advances in medical science over the last century and a sense that the doctor is arbiter of life and death.
There’s a certain smugness and complacency to a doctor that derives from the fact people are grateful to have pain relieved (just think how grateful you are to a dentist to have a toothache terminated) and that he knows a lot about medical science and is known to be intelligent (high-status) and that he can take and preserve life (god-like). It’s quite a heady brew that is bottled at medical school, which, so far as I can tell, is as much an inculcation as an army bootcamp.
That’s to say, the doctor leaves there with his manner-mask firmly in place—and I think doctors “think through the mask” more than any other profession except, perhaps, soldiers (who are also concerned with the taking of life—and, collaterally, the preservation of their nation’s life). Well, that’s all very well—but I think what amounts to a medical priesthood occludes both clear thought and perception. I think the mask is so fixed—with the quack being a stock character from the likes of Racine—that the doctor sometimes doesn’t see the obvious; and that’s why it’s best to avoid doctors.