The Rise and Fall of Modern Medicine

Cicero, before his head and hands were unceremoniously dismembered from his body and displayed before the Roman Senate, said that gratitude is the greatest of all virtues and that, in fact, it is the father of all virtues, upon which all virtues are based. As I enter the third decade of my private practice of medicine, I realize how Plutarch’s Moralia (or Lives and Essays) and George Santayana’s admonitions to study history can indeed suffuse my sometimes disaffected heart with gratitude as I listen to Longfellow’s call to virtue:

The biggest hindrance for psychiatrists in private practice is not only the fear of what Pascal referred to as “the eternal silence of these infinite spaces” but an epidemic disease that has insidiously infected us all in these litigious times: eisoptrophobia, a morbid fear of mirrors.

As with Plutarch’s desire to jump-start the flagging spirits of his fellow Romans, Dr. Le Fanu, an evocative raconteur, weaves a riveting tapestry of stories spanning the years 1935 to 1998 and highlights in bold, colorful—sometimes brash—brush-strokes 10 of 46 definitive moments of modern medicine. Le Fanu succeeds in keeping the reader’s interest throughout with an uncanny fiction-author-like manipulation of story, character, plot, and action. He “shows” rather than “tells.” He dexterously uses “hooks” and “leads” that leave those among us old enough to have met or known the many protagonists of his play walking away shaking our heads saying, “I’ll be damned if I saw that one coming!” and marveling at some description or insight.

Le Fanu, a Londoner, is a medical columnist for both The Daily Telegraph and The Sunday Telegraph and a writer for the Times, The Spectator, and GQ magazine. His writing is bold and his wit biting. For example, he says,

He calls the cholesterol studies of Ancel Keys and Jeremiah Stamler “the great cholesterol deception.” I asked my cardiologists their reactions to Le Fanu’s ideas. Their responses are not fit to be printed in this publication.

In 1928 Alexander Fleming did not take the matter of discovering penicillin farther because he did not think it worth pursuing, a good example of how preconceived ideas in medicine can stifle the imagination and impede progress. It was not until February 12, 1941, that a 43-year-old British policeman (Albert Alexander) became the first person treated with penicillin, thanks to the combined efforts of Florey and Chain in Oxford (1935).

The same thing seems to have happened in psychiatry. Although Freud died in 1939 at age 82, his oppressive, phantasmagorical influence on the therapeutic nihilism of psychiatrists worldwide was still felt in 1960–1972, when I was in medical school and postgraduate training for adult and child psychiatry. Psychiatric psychoanalysts still ruled over academia and specialty boards. So it was no small miracle that, according to Le Fanu, a French naval surgeon named Henri Laborit, while laboring in a maritime hospital in Tunisia in 1949, by sheer inquisitiveness

Laborit noted that promethazine produced a “euphoric quietude”—a “calm, with a restful and relaxed face.” In 1950, the drug company Rhone-Poulenc, picking up on the hunch that it might be useful for psychiatric patients, initiated a major research into phenothiazines, the group of drugs promethazine belongs to. In 1952, when health maintenance organizations and pharmacopoeia oversight boards, which would have vetoed such an “unproven venture,” were unheard of, two Parisian psychiatrists, Jean Delay and Pierre Deniker, treated a 57-year-old laborer, Giovanni A., who was diagnosed as having schizophrenia. After 3 weeks of treatment with chlorpromazine, a phenothiazine, Giovanni was discharged “able to have a normal conversation.”

It was not until 1963 that chlorpromazine was shown to interfere with the action of the neurotransmitter dopamine. Le Fanu says, “This goes to show that to treat a problem does not necessarily require absolute knowledge of the causation or the mechanism or the explanation of what is wrong in a particular illness.”

And so, on and on, Le Fanu goes in a pace that never lets your interest wane or wander, recounting how 10 definitive moments in medicine—including the discovery of penicillin, open-heart surgery, in vitro fertilization, kidney transplantation, the cure of childhood cancer, the discovery of Helicobacter pylori by Barry Marshall—brought on watershed, sometimes tsunami-like changes in the way medicine began to conceptualize and deliver its services. As in the dispirited days of Rome, when Plutarch’s Moralia fanned the hopes of the spent Romans by reintroducing them to the unheeded advice on gratitude by the beheaded Cicero, Le Fanu fans the dying embers of growing disillusionment among medical professionals.

In The 1001 Arabian Nights of Scheherazade, there is a story of three princes from Serendip who were so learned, astute, and intrepid that when ordinary people saw an accidental occurrence or an event of no significance, these three found opportunity and fortune. It is no coincidence that the Chinese words for “crisis” are “way” (risk or danger) and “gee” (opportunity). The medical pioneers whom Le Fanu describes follow a consistent pattern, which mirrors the studies on resiliency and “Emotional Intelligence” by Daniel Goleman (1): zeal, impulse control, persistence, perseverance, self-awareness, self-motivation, empathy, and social deftness.