Time for a cure for medicine?

Title:       Can Medicine be Cured? The Corruption of a Profession

Author:   Prof Seamus O’Mahony

Publisher: Head of Zeus

Reviewer:     Prof Brendan Kelly

We live in a golden age of medical writing. In the US, Atul Gawande, Jerome Groopman and Danielle Ofri are busy producing book after book, pushing the boundaries of medical writing in new and enlightened directions. In the UK, Gavin Francis and Adam Kay (the latter no longer practising medicine) are both making substantial contributions (in different ways) to medical literature and thought, re-shaping public perceptions of our profession.

In Ireland, too, a growing number of medical writers are exploring different aspects of clinical care, and these now include Prof Seamus O’Mahony, a consultant physician in Cork and author of Can Medicine Be Cured? The Corruption of a Profession. O’Mahony’s previous book, The Way We Die Now (2016), concerned death and our (in)ability to deal with it, and was widely acclaimed. His new book is even more ambitious and looks set to generate yet more discussion.

In Can Medicine Be Cured?, O’Mahony, a regular contributor to these pages (whom I do not know at all), takes issue with a great many accepted tenets and sacred cows of modern medicine. But O’Mahony’s book is not so much a take-down as a searing reappraisal of some of the fundamental directions taken by clinical medicine and research over the past few decades. It is well worth reading.

O’Mahony finds a lot to worry about. He cites opinions and evidence to support the views that 85 per cent of medical research is useless (wasting £170 billion annually); the new genetics and molecular medicine have yielded treatments of marginal benefit at huge cost; people increasingly confuse needs and wants; patients and doctors are both unhappy; and medicine now does more harm than good. Clinical practice, he argues, has become a vast industry, concerned chiefly with old age, degenerative disease, and making everyone into patients though awareness-raising, screening, disease-mongering and preventive prescribing.

All told, there is a great deal to admire in O’Mahony’s book: Intellectual honesty, scientific integrity, and a logical tone that makes his arguments even more impactful. Some readers will object to some of his critiques. This is precisely as it should be. O’Mahony’s book is written in a spirit of enquiry that prompts and arguably requires engagement from people with other views. Ironically, it is this spirit of enquiry and open debate, so evident in O’Mahony’s book, that is precisely what’s lacking in much medical research and scientific discourse at present: Cool, logical and fearless examinations of where we are going, what we are doing, and who (if anyone) is likely to benefit.

Ireland, as it happens, has a significant history of critical medical writing. Petr Skrabanek (1940-94), for example, was a doctor, academic and author of Follies and Fallacies in Medicine (with James MacCormick, in 1989) and The Death of Humane Medicine (1994). Skrabanek, to whom O’Mahony refers, was another broad thinker and a relentless critic of lazy thought, pomposity and humbug. Like O’Mahony, Skrabanek was unafraid to express his views with candour, regardless of how much they seemed to contradict mainstream thought.

In truth, though, most clinicians will find themselves nodding in agreement with much of what O’Mahony says. It is a regrettable fact that modern clinical practice often involves navigating organisational, intellectual and academic landscapes that appear weirdly antithetical to good medicine in order to snatch small victories for patients wherever we can. O’Mahony is right to call time on much of this and to point out that, in order to do better, we need to stop doing many things that we are doing now, re-direct research in more pragmatic directions, and place greater emphasis on good old-fashioned doctoring.

That said, I am not quite as pessimistic as O’Mahony is about the future. In my experience, good doctoring is still evident in many hospitals, clinics and GP surgeries. I agree with O’Mahony that compassion needs to lie at the heart of good care but I find that it often still does (although undoubtedly more needs to be done). And while it might be challenging to actually teach good communication, having it on the medical curriculum prompts students to pay close attention to communication styles, which are important.

Overall, though, I agree with O’Mahony that much has been lost in medicine over recent decades and that it is time, yet again, for medicine to re-find its soul. The history of medicine is, however, a history of repeatedly going astray (in small ways and large) and then self-correcting. The correction happens differently every time — but every time, it happens.

So, can medicine be cured? Yes, it can. And part of the credit for this lies with honest, rigorous doctors like O’Mahony, whose searing critiques are vital for the evolution of our profession.

Prof Brendan Kelly is Professor of Psychiatry at Trinity College Dublin and author of  ‘The Doctor Who Sat For A Year’ (Gill, 2019)