Shakespeare, Health Care and the Limits of Medicine

Whom worse than a physician Would this report become? But I consider, By medicine life may be prolong’d, yet death Will seize the doctor too.Whom worse than a physician
Would this report become? But I consider,
By medicine life may be prolong’d, yet death
Will seize the doctor too.

Cymbeline, act 5, sc. 5

For ordinary citizens it is difficult to understand the issues surrounding the so-called Obamacare plan, legislation or reform, however we may want to call it.

To date its most visible effect has been the partial shutdown of government. It is a  measure that (probably) leaves most people baffled and maybe even more baffled if the event had not occurred before.

One thought that comes to mind is that if the government shuts down so should all activities that directly depend on the government, such as the military. But that only shows the deep naiveté of the thought.

However, since the source of the political controversy has to do with medicine, I take the occasion of reviewing a book I picked up during a visit to the Publisher Felice Scipioni in Italy. The author is a respected medical doctor and the title is “Useless Doctors, Insane Medicines”.

It is not the only publication that, more or less, deals with the same theme. It  started, I believe with Ivan Illich’s book, “Limits of Medicine” where he says, “…   Until recently medicine attempted to enhance what occurs in nature. It fostered the tendency of wounds to heal, of blood to clot, and of bacteria to be overcome by natural immunity. Now medicine tries to engineer the dreams of reason…     Medicine undermines health not only through direct aggression against individuals but also through the impact of its social organization on the total milieu. When medical damage to individual health is produced by a sociopolitical mode of transmission, I will speak of “social iatrogenesis,” a term designating all impairments to health that are due precisely to those socio-economic transformations which have been made attractive, possible, or necessary by the institutional shape health care has taken…”

Another instructive text is “The Rise and Fall of Western Medicine” by Dr. James LeFanu. One thesis of the book is the very limited number of key medicines that have been found to be effective against certain pathologies. Hundreds of others are but variations on the theme, a medical equivalent of jazz’ improvisations on the same tune.

In turn, “Useless Doctors, Insane Medicine” reflects the candid views of a physician in his daily practice. The book starts with a quotations from the 12th Century Salernitan School of Medicine, “Si tibi deficient medici, medici tibi fiant haec tria: mens laeta, requies, moderata dieta” (If you do not have physicians, let your doctors be a serene mind, rest and a moderate diet). A plan that, for many, may be more difficult to apply than resorting to medical help (Obamacare or otherwise).

In the introduction, the author explains his dilemma. On one hand he would like his book to be popular, on the other he would prefer that the exposure be limited to the selected few. This, to prevent the rage of other doctors. Because, even if a minority of them were to make a small contribution, it would be sufficient to hire a killer to do away with the author.

No room here for a summary that does justice to the book. I will just mention the business of the “check-up” that – he says – was invented by the Americans. It became known in Italy in the 1950s when sailors in Genova (where the doctor had his practice) told of the medical innovation.  “There were check-ups (cecappe in the Italian rendering) for 10,20,50 dollars. “Depending on the thickness of his wallet, the patient could know the illnesses he had and those that may affect him later.  This produced an interesting effect – the poor often was found healthy while the rich was affected by a full range of diseases. The familiar social injustice….”

Equally sharp barbs are directed at compulsive jogging, “the American who invented was taken ill while he was experimenting with it…. A martyr for science….”

To conclude, this article’s opening quotation by the queen’s physician in Cymbeline should be considered as a reminder. Besides, as Warwick says in King Henry VI, part 3, “….And, live we how we can, yet die we must.”

In the play. Cornelius the physician comes in to announce that the (evil) queen is dead.

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