BOOK OF THE DAY: DAVIS COAKLEYreviews Taking the Medicine: A Short History of Medicine's Beautiful Idea, and Our Difficulty Swallowing Itby Druin Burch Chatto Windus 330pp, £20
THE USE of drugs to treat illness has evolved over many years and is still evolving. Significant advances have been made, often by chance observation in earlier times but more recently by an active search for compounds of possible therapeutic value. The greatest advances by far were made in the 20th century.
However, some drugs which were developed as new therapies were later found to have serious side effects, for example, thalidomide, which was marketed as a sleeping tablet. Often in response to catastrophes such as the thalidomide scandal, governments have had to introduce legislation to monitor and control the development of new compounds.
In earlier centuries, treatments were not subject to control and we know now that many of the "treatments" were harmful and could cause death. Most historians of medicine seek to understand these treatments by setting them in the context of the culture and knowledge of the period. However, Druin Burch, a doctor and the author of Taking the Medicine: A Short History of Medicine's Beautiful Idea, and Our Difficulty Swallowing It, argues with passion that this leaves generations of doctors off the hook. "Doctors," he writes, "for most of human history, have killed their patients far more often than they have saved them. Their drugs and their advice have been poisonous. They have been sincere, well-meaning and murderous."
Burch approaches his task with vigour and pace, exploring the therapeutic failures of “doctors” over the ages. Nothing is statute barred and no quarter is given. He starts with the ancient Sumerians, who lived in what is now Iraq 6,000 years ago, and he turns a critical eye on their treatments. He then proceeds to do the same through subsequent centuries. However, the repeated condemnation of doctors, chapter after chapter, becomes tiresome and almost polemical.
The author is a keen supporter of evidence-based medicine but he does not seem to require similar standards when forming his own opinions and judgments about his predecessors in the medical profession.
Polemic aside, there is much of interest as the story unfolds. He writes about the introduction of new therapies that have stood the test of time such as aspirin, quinine and morphine. He also describes how discoveries are often linked to advances in other spheres of activity. For example, the development of dyes and stains in the latter half of the 19th century led directly to the discovery of micro-organisms which cause disease.
The author discusses the significance of the modern random controlled trial and the great contribution it has made in assessing the efficiency and safety of new drugs. Scottish doctor Archie Cochrane emerges as one of the heroes in Burch’s book. He became one of the great advocates of what is now known as evidence-based medicine, challenging doctors to produce evidence to support their therapies. His pioneering work has had a major impact on the practice of medicine today.
The author adopts a more reflective approach in the concluding chapters when he discusses the potentially stifling effects of over-regulation on medical researchers, the dangers of the growing power of global pharmaceutical companies, and the potential misuse of evidence-based medicine by governments to control doctors’ prescribing. This is already happening to a significant extent in the UK, where inroads have been made on the freedom of consultants to prescribe what they consider best for their patients as they must apply to a committee for approval to use certain medications, particularly those that are expensive. Such restrictive policies have resulted in unseemly situations where seriously ill patients have had to appeal to the courts in the UK.
Davis Coakley is professor of medical gerontology at Trinity College Dublin and a physician at St James's Hospital. He has written a number of books on medical history, including The Irish School of Medicine