A maverick's passing
April 23rd 2018, 15:30
We need our nay-sayers if medicine is ever to improve
The death of a maverick is always worth a moment's reflection. They often put their own personal ambitions and career on the back burner as they strive for something that's more important, such as changing the system they're a part of.
One such maverick was Professor Alan Maynard, whose recent death brought back memories of another member of the awkward squad, Dr Bob Mendelsohn, who was one of the inspirations for What Doctors Don't Tell You.
Both had cast a critical eye over medicine and found their profession wanting. Their insights and suggestions were met with a spectrum of responses that ranged from indifference and dismissiveness to ridicule. Mendelsohn expected nothing less—after all, he had likened medicine to a religion, and a dogmatic one at that, which requires the absolute obedience of its high priests.
Maynard believed something similar. "It is curious," he once wrote, "that the debates about the design of healthcare systems worldwide are dominated by assertions and almost religious beliefs to the exclusion of construction of hypotheses and their testing by careful collection of data."
All of which is academic-speak for saying something like: Look, you're throwing tons of money at medicine (with annual spending on healthcare topping $3 trillion in the US alone) when you haven't properly tested it to make sure it's working, or even doing any good.
He suggested that medicine adopt the model created with the 1854 Lunacy Act in the UK, which checked to see just how many patients the doctors were actually helping to get better (as opposed to those who were being killed by the treatment).
Surprisingly, such a simple and obvious measure was never implemented, and Maynard suspected this was because of a powerful triumvirate whose fortress could never be breached: the clinicians who didn't want their effectiveness measured; politicians who took a fashionably romantic view of the existing healthcare system (and didn't want to lose votes); and a pharmaceutical industry that was making a mint (and who strenuously lobbied the politicians to ensure they continued cashing in).
He estimated that nearly half of all medical treatments had absolutely no evidence of working (and even the conservative British Medical Association has accepted that around one-third of drugs and treatments are unproven). His contribution to the celebrations for the 50th anniversary of the UK's National Health Service was the observation that "successive governments clearly did not wish to be confused by facts. ... We know relatively little about the figures concerning patients' treatments, and so doctors fly by the seat of their pants and the scientific basis for their choices is really quite poor." Talk about a party pooper.
Maynard, who was based at the University of York, wasn't very complimentary about our much-loved family doctors either. In fact, he described them as "a marauding bunch of shopkeepers who wish to preserve the inefficient provision of care." Ouch.
Bob Mendelsohn wasn't a great one for taking prisoners either. The title of one of his books, How to Raise a Healthy Child in Spite of Your Doctor, pretty much sums up his position. Although he died nearly 30 years ago, he was already seeing the first signs of a society that was becoming over-medicalized.
He believed that most drugs and treatments were unnecessary because diseases tend to self-correct, especially when supported by a healthy diet and a loving family. But perhaps most controversially, he was opposed to the growing litany of vaccinations that toddlers were supposed to have. And this from one of America's leading pediatricians—see if you can spot any today who would dare to question the party line like this.
He even went on national television to tell American parents that they probably didn't need to get their babies immunized (as good hygiene, diet and sanitation make most childhood diseases relatively benign). Horrified industry observers made sure that a medical heretic (as Mendelsohn liked to describe himself) would never again be given free rein on a major TV show, and, of course, it hasn't happened since.
Bob's one legacy, in an age before the internet and social media, was to get the publishers of the Physicians' Desk Reference (PDR) to make this reference book available to the public. The PDR lists every side-effect and adverse reaction to all drugs—but it was distributed only to doctors.
So you see, we need our mavericks and nay-sayers. They are our change agents, whose courage helps make the world a better place. RIP, Alan and Bob.