Medicine: the good, the bad and the ugly

Between April and July this year, spiked and Wellcome Collection worked together to generate a major public debate about a key contemporary issue: what’s good and bad in the world of healthcare. The result – The Best and Worst of Medicine, a live and online series of debates – featured a variety of thought-provoking diagnoses on the success stories and failures of medical practice, and how medicine has improved and possibly worsened human health, life and liberty.

The debate series was designed to stimulate public discussion and argument about the best and worst ideas, phenomena, developments and practice in the world of medicine. For the online debate, spiked commissioned a total of 13 experts and commentators to give their nominations for the best and worst of medicine – and more than 230 readers chipped in with their views.

The online debate was an accompaniment to two live debates that took place at Wellcome Collection in central London. The first live debate on 26 June – The Best of Medicine – featured Michael Worboys, director of the Centre for the History of Science, Technology and Medicine at the University of Manchester, who argued for vaccination; Raymond Tallis, emeritus professor of geriatric medicine at the University of Manchester, who argued for evidence-based medicine; Sara Eames, GP and president of the Faculty of Homeopathy, who argued for homeopathy; and Zoe Williams, columnist for the Guardian, who argued for family planning.

The second live debate on 17 July – The Worst of Medicine – featured Michael Fitzpatrick, GP and author of The Tyranny of Health, who nominated the obsession with healthy living; William Schabas, director of the Irish Centre for Human Rights at the National University of Ireland, Galway, who nominated the global migration of health professionals; David Wooton, professor of history at the University of York, who nominated the idea of a single, worldwide medical profession derived from Hippocrates; and Richard Halvorsen, GP and director of Babyjabs, who nominated vaccination.

In the first live debate, vaccination, as nominated by Michael Worboys, was voted by the audience as the ‘best of medicine’. In the second debate, the audience chose Dr Michael Fitzpatrick’s nomination of the contemporary obsession with healthy living as the ‘worst of medicine’.

The range of responses to this important discussion – both online and in the real-world debates – shows how health concerns have become central to our lives. The commissioned expert responses for spiked’s online debate featured ‘best of’ contributions on vaccination, abortion, the Pill, the toilet and sanitation, genetic testing, and the treatment of mental health. And the expert ‘worst of’ responses discussed ‘healthy living’, homeopathy, epidemiology, body mass index, fears about chemicals, nutritional supplements, and the recruitment of developing world healthcare professionals by well-off countries.

The reader responses covered an even wider range of topics. Often unpredictable and frequently passionate, the 230 responses from around the world covered topics as diverse as antibiotics, hip replacements, free healthcare, smoking bans and care for the elderly. In particular, there were two very hotly disputed topics in the online and offline debates: vaccination and homeopathy.

Vaccination

To get the online debate underway, Michael Worboys of Manchester University nominated vaccination as the best of medicine. Vaccines have ‘saved hundreds of millions of lives by preventing infections, and they have spared people the suffering and long-term consequences of terrible diseases’, he argued. He pointed to the eradication of smallpox in 1977 and the decline of tuberculosis as two major improvements brought about by vaccination.

Yet others vehemently disagreed. Many readers argued that vaccination was in fact the worst medical development. Driven by the anti-vaccination movement that grew out of claims that the measles, mumps and rubella (MMR) vaccine caused autism, spiked’s online debate had clearly been doing the rounds of anti-vaccination campaigners, many of whom wrote in to challenge Michael Worboys’ view on vaccines.

One typical reader response argued that vaccination ‘has damaged so many children by suppressing their immune systems and injected neurotoxins into them leading to learning difficulties and many other problems’.

This theme was taken up by a London doctor, Richard Halvorsen, who runs a private clinic offering single vaccinations as an alternative to the MMR jab. In the second of the two live events held at the Wellcome Collection in London on 17 July – on the worst of medicine – Halvorsen argued that vaccinations were not all they were cracked up to be. He claimed that the major part of the fall in death rates from disesases like measles and pertussis (whooping cough) took place before vaccination was introduced, as a result of better general health, nutrition and treatment of the sick.

Unlike some campaigners, Halvorsen is clearly not anti-vaccination – he wouldn’t run his clinic if he was. Rather, he believes that some vaccines may be dangerous and that the benefits of vaccination have been overstated.

However, vaccination won out in the first public debate, on ‘the best of medicine’. Michael Worboys’ passionate defence of immunising people against common diseases led audience members to choose vaccination as the greatest medical breakthrough. Not only has the ‘miracle’ of vaccination saved millions of lives, argued Worboys, but the development of vaccines also greatly assisted the rise of ‘public medicine’: ‘The world’s first human vaccine, Pasteur’s anti-rabies vaccine, prompted the establishment of the world’s first purpose-built, medical research institution – a model that was rapidly emulated across the world. These laboratories brought large-scale private, public and voluntary funding into research and prompted the growth of research across medicine.’

‘Indeed’, argued Worboys, ‘without the development of organised medical research, most of the breakthroughs of the past hundred years would never happened or would have been delayed’.

Homeopathy

Alongside the controversy over vaccination, there was a raging debate about homeopathy in The Best and Worst of Medicine. In fact, many reader responses combined nominations for homeopathy as the best of medicine with vaccination as the worst.

In the online debate, two distinguished professors, Edzard Ernst and Michael Baum, argued eloquently and passionately that homeopathy was the worst of medicine. If ‘homeopathy is correct, much of physics, chemistry and pharmacology must be incorrect’, they said. And in conclusion: ‘Homeopathy and similarly irrational treatments cannot work, and, until proven otherwise, any positive evidence simply reflects publication bias or design flaws.’

This provoked a storm of angry responses, many of them from homeopathic practitioners. Gabriela Rieberer, writing from Germany, said: ‘Homeopathy is a safe and effective treatment. Clinical results and thousands of patients treated in a host of countries in the past 200 years are evidence enough. As the German saying goes “the one who heals is right”.’

Readers pointed to randomised controlled trials which, they claimed, demonstrated that homeopathy was effective. Others argued that homeopathy could not simply be a placebo effect because it was successful in treating animals. Others agreed with Ernst and Baum, calling homeopathy a ‘sham’ and arguing that its effective endorsement by sections of the NHS was a dangerous denigration of the principles of medical research and scientific fact. As a result of the numerous reader responses that took up Ernst and Baum by nominating homeopathy as the best of medicine, Sara Eames, president of the Faculty of Homeopathy, was invited to put the case for homeopathy as the best at the first live debate on 26 June. However, despite defending herself well against some impassioned interrogation from the audience, she lost to Michael Worboys.

Fertility and infertility

Another major theme in the debate was the way in which medical developments have had a significant impact on women’s reproductive choices and, therefore, on women’s liberation and their standing in society. On this issue, in particular, experts, readers and the live debaters got to explore the impact that medical breakthroughs can have on society and history as well as human health.

In the online debate, Stuart Derbyshire of the University of Birmingham described abortion as ‘an extraordinary medical breakthrough’, adding: ‘In the modern era it is normal for women to be sexually active outside marriage, to lead independent lives, and to follow careers. Without the possibility to terminate an unwanted pregnancy these freedoms might never have been possible.’

A similar theme was taken up by the doctor and freelance science writer Rob Johnston, who put the case for the oral contraceptive pill as the best of medicine in the online debate. ‘More than any piece of legislation, control of fertility opened the doors to female liberation. The Pill is more than just a contraceptive and even women who never use it experience the benefits’, he argued. He had his critics, however. Some readers challenged Johnston by arguing that the Pill had had a negative impact on their health.

The wonder of women’s increased reproductive choices was championed by Zoe Williams, a columnist for the Guardian, at the live ‘best of’ debate on 26 June. Williams argued that the Pill liberated women from the burden of having more children than they wanted, which means that we value and care for children – born through choice – more now than we did in the past.

Just as the choice to prevent a pregnancy has benefited women, so the ability to have children where once it was impossible is a great breakthrough, too. Cheryl Hudson, an Oxford historian and a beneficiary of in-vitro fertilisation (IVF), argued in her expert contribution to the online debate: ‘Since Louise Brown, the first “test-tube baby”, was born in 1978, in-vitro fertilisation has added exponentially to the sum of human happiness. By 2006, three million babies had been born worldwide as a result of IVF and other assisted reproduction techniques (ART).’

IVF also opens up the possibility of allowing control over whether or not to have a child on health grounds, as John Gillott discussed in his nomination of pre-implantation genetic diagnosis (PGD) as the best of medicine in the online debate. PGD ‘allows parents the chance to have healthy children through a relatively simple, definitive, test’, argued Gillott. Yet both Gillott and Derbyshire argued that the benefits of their respective nominations have been unnecessarily limited by restrictive, anti-experimental legislation.

Modern health fears

One of the ironies of modern medicine is that we seem increasingly obsessed with health just as we are living much longer and healthier lives.

As broadcaster Adam Hart-Davis argued in his contribution to the online debate, the general health of the population was far, far worse in the past, before the introduction of the toilet and proper sanitation: ‘In British cities until the middle of the nineteenth century, the infant mortality rate was 50 per cent: half the babies who were born did not live to be five years old.’ And it was (and in the developing world, still is) bad water that was principally to blame, said Hart-Davis, since it allows the spread of diarrhoea, dysentery, typhoid and cholera. Now the infant mortality rate in the UK is less than one per cent – a breakthrough definitely worth celebrating.

For London-based GP and author Michael Fitzpatrick, the obsession with healthy living is now the worst of medicine. Dr Fitzpatrick wrote in his online contribution: ‘For Aristotle a true state of health meant a “flourishing life”, not merely in terms of prolonging our bodily existence, but in terms of personal achievement.’ Today, the modern obsession with self-preservation means that ‘security and safety have become the highest values and the goal of preserving health has become the zenith of human aspirations’, said Dr Fitzpatrick. And in the second live debate on the worst of medicine, Dr Fitzpatrick won the audience’s backing.

These days, apparently, health risks are all around us. Often, as I noted in my contribution to the online debate, health fears are started by dubious studies based on the sometimes flawed tools of epidemiology. Todd Seavey, editor of the US website Health Facts and Fears, nominated the obsession with chemicals in the environment as his worst of medicine: ‘Despite near-constant claims in the media that “chemicals in the environment are making people sick”, there is no good evidence that trace amounts of environmental chemicals cause human illness’, he argued. Yet he pointed out that the obsession with the alleged chemical threat has led to the banning of many useful chemicals, most notably the pesticide DDT, leading to millions of deaths from malaria that could have been prevented.

Our diets are another area of constant concern. For Patrick Basham and John Luik, co-authors of Diet Nation, fears about obesity – driven by what they describe as the inaccurate and arbitrary yardstick of body mass index (BMI), which was their nomination for the worst of medicine – have led to an unnecessary ‘war on fat’. Tom Sanders, professor of nutrition at King’s College London, took aim at the pointless and potentially dangerous craze for nutritional supplements, encouraged by ‘self-appointed experts’ who ‘hoodwink the public’.

Other nominations

One of the most rewarding features of the spiked/Wellcome Collection debate was the way that contributors made us think again about some lesser-known innovations and problems. For example, Ken McLaughlin and Chris Yianni, both from Manchester Metropolitian University, drew attention to two much-maligned developments in mental health as actually being highly positive: ‘care in the community’, a great step forward from the old asylums; and anti-psychotic drugs, which allow many mentally ill patients to lead much more satisfactory and normal lives.

William Schabas, director of the Irish Centre for Human Rights, argued that one of the worst aspects of modern medicine has been the draining of healthcare professionals from the developing world by richer countries. ‘Global health is a global responsibility. By draining Africa of its best and brightest, people in the North enhance the quality of their own healthcare but by damaging that of those who live in the South’, he argued.

spiked readers provided an enormous range of the good, the bad and the ugly-sounding in the world of medicine. The simple benefits of clinical hygiene – hand-washing in particular – were celebrated. Antibiotics, a notable exception to the list of lead contributions, were also praised. ‘Evidence-based medicine’ had both fans and critics; the development of institutions like the UK National Health Service – providing free care at the point of need – received plaudits, too.

Perhaps the most unusual and eye-watering reader nominations for the worst of medicine was for the Lord anal stretch, which ‘involved placing (gloved) fingers in the anal canal and literally stretching it, then stuffing a large sponge in it to keep it stretched until the patient recovered. Done ostensibly to treat piles, and indeed it did improve them. But it also tore the anal sphincter muscles resulting in faecal incontinence in later life!’

This debate proved that the world of medicine is a hugely varied and important aspect of modern life – and it demonstrated that while discussion of health is everywhere today, it really pays to take a step back and analyse medical breakthroughs in detail and with some passion and wit. Showing us how medical developments have saved lives, improved health, transformed society and raised people’s aspirations – but also how they have on occasion backfired and proved damaging – the online and live debates on the best and worst of medicine engaged both experts and the public in a much-needed discussion about the historical standing of medicine, and where it might go in the future.

Rob Lyons is deputy editor of spiked.