Thelma Lovell applauds an attack on NHS bean counters
Can Medicine Be Cured?
By Seamus O’Mahony,
Head of Zeus, 256pp, £20/$22
Even Jeff Bezos is going to die some time. So are we all, actually. And when that day comes, it sure as hell won’t be an algorithm that we turn to. All of us – the need for a priest aside – will want a good doctor. Even if, like Bezos, we are worth $100 billion.
What does that mean? In this humane, knowledgeable and scathing book (subtitled The Corruption of a Profession) about the dislocation of medical priorities from the basics of human need, Seamus O’Mahony gives us some pointers.
On the principle that we know a thing by what it is not, O’Mahony takes us on a tour of the multiple ways in which the practice of medicine has strayed from its core functions. He makes a strong case that the profession has too willingly succumbed to numerous fads of our time.
As a senior hospital doctor and medical researcher, he’s seen it all: the fake doctrines of managerialism and protocols; the siphoning of megabucks to a medical-industrial complex that feeds off its own glamour; the orchestrated public sentiment around certain tragic cases where doctors are abused for their lack of magic wands; and the paucity of financial support for the care of humdrum suffering.
It’s not that O’Mahony has any time for the anti-vaxxers. He knows all too well from his own background how much we owe to the last century’s golden age of drug discoveries. His mother, born in rural Cork in 1932, lived through premature family bereavements unthinkable nowadays for those who have access to medical care.
What the book does take issue with is what it sees as an underlying false premise: that, with enough money thrown at the problem, we can defeat death itself.
O’Mahony’s view of Big Science (large-scale projects often publicly funded) is hard-hitting and sceptical. Devouring the lion’s share of medical research funding, it appears prone to moral hazard: research findings are too often not repeated to check that they are valid. If global research output doubles every nine years, this is a testament not to genuine innovation so much as to the energy of self-promoters who compete in the merry-go-round of mutual citations – a sort of incestuous whirl to the top of the heap.
Eloquent and lucid, this powerful account confronts some of the most important questions of our time: practical, philosophical and moral. How, for example, does funding Britain’s National Health Service sit with the dominant consumerist ethos of our world? That partly depends on how we define health, and whether we are prepared to match our expectations with our resources – the discussion of which is generally shirked by politicians and public.
O’Mahony is critical of “awareness” campaigns, which merely pit one type of illness against another (while, of course, paying the salaries of those who run pressure groups). Who is to be more deserving this week: stroke or cancer patients? Then again, the fashionable mission creep of mental health risks pathologising “the societal intolerance of distress” at the expense of the needs of those with profound, chronic conditions.
Far from being a hatchet job on the rationale of the NHS, Can Medicine be Cured? is a plea for a return to first principles. Aneurin Bevan’s concept of such a communally funded social benefit rested on the assumption of a contract between state and a user able to exercise a degree of personal responsibility. (Sometimes one might, for instance, have to let another person go to the front of the queue.) The heart of the problem, however, for O’Mahony is something that has been allowed to put its pawprints in all sorts of places where they have no business to be. It is the controlling urge that wants to codify everything in sight, to reduce the human and the personal to a bundle of data.
There is a time and a place for quantifying – and empathy training (“let me hold your hand while I misdiagnose you”) is no substitute for professional observation and knowledge. But the care of the sick, and especially the dying, is both an art and a benediction.
O’Mahony says of himself: “Temperamentally, I was made for the cloister … I have lived instead in a world of pain, sickness and death, but also in a world of intimacy, humour and life”. This is medicine as vocation: a practical calling, to be sure, but with the care of others at its heart. At any rate, a lot more valuable than making a hundred billion dollars.