Customer Reviews

The Rise and Fall of Modern Medicine (CARROLL & GRAF)

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3 star:		(2)
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Very rarely, I come across a book so enjoyable that I have to put everything else on hold until I finish reading it. This is one of those books. It combines fanscinating information, intriguing analysis, and a thoroughly enjoyable writing style.

The book is divided into two major sections: an extended prologue, and the book proper. The prologue is nearly half of the book, and it describes twelve definitive moments in medicine in the past 50 years. This section is informative and enjoyable, and the book is worth reading for this part alone.

The second section is even better. Le Fanu believes that medicine experienced its Golden Age during the fifties and sixties, and is now in decline. He provides compelling evidence in support of this claim, and his discussions on the false hopes brought about by genetics, and the falsity of the Social Theory (the theory that most of our health problems are caused by environmental factors) are great, and probably largely correct.

This is a book that I would recommend to anyone. It is easy enough for the layman to understand, and I think that those in the medical profession will get a lot out of it, whether they agree with the author or not. READ THIS BOOK!!!

Le Fanu writes extremely well, as long as he's not ranting. His coverage of the history of western medicine is informative and highly readable, if debatable on small points. His talent is creating a real story out of a collection of facts, and delivering it in a punchy and amusing way.

Le Fanu successfully communicates his main thesis - that the history of medical progress consists mainly of accidental or fortuitous discoveries, and that it is therefore not the rational machine that many people imagine it to be. We know much less about human health than you might think, and even less about how to go about improving it. Since many otherwise intelligent and well-informed people place blind faith in doctors, medicine, and in press stories about health issues, Le Fanu is performing an important public service.

The book is marred by his rants against modern medical research. While this industry undoubtedly deserves criticism, he makes a poor job of it. He ceases to support the points he makes, and since many of them are debatable, it is difficult to take this part of the book seriously. For example, he suggests shutting down all departments of epidemiology in all medical educational and research institutions. While I hold no torch for epidemiology, this strikes me as excessive, and he fails to win me over with any rational explanation as to how this would help.

Despite my reservations about the final chapters, I would highly recommend this book. Anyone who already harbours doubts or concerns about western medicine will find the book interesting. Anyone who does not really needs to read this.

This is an original and provocative view of the failings of modern medicine that I would recommend to anyone in the profession. I found parts of the book uneven. Specifically, the historical aspects were outstanding and obviously thoroughly researched. In contrast, the sections devoted to genetics and epidemiology came across as superficial. This book is essentially a long editorial, and as such, should be read with a large grain of salt. Nonetheless, it offers a unique perspective.

This is a brilliant book and I am amazed that this is the first review. It is a 'tour de force'. It brings together many threads of the great advances of modern medicine post war and chronicles how the golden age petered out eg the pharmacological revolution slowed rapidly particularly post thalidimide. It explores the fallacies and cheating which gave us the Social Theory ie ill health is all our own fault because of what we eat - we shouldn't eat so many lamb chops or choccie bikkies - and the unfulfilled expectations of genetics and its possible limited application in medicine. It is both scholarly and readable as well as becoming quite compelling. Even if the bloke is a journalist this is stunning stuff. I am still searching for an effective contrary view.

The historical review (about the first two-thirds) in Rise & Fall is generally excellent. It is marred by a confused date for the first successful human renal transplant and the consistent misspelling of the name of the pioneer cardiac surgeon, C. Walton Lillehei (as "Lillehai"). Even if the author had these wrong, the editors should have picked them up and corrected them. However, the amount of scholarship and detail in the histories is impressive and the stories are fascinating. The last third (The Fall)comments on why the "golden age" is over. He's wrong, but we won't know for another 20 years or more. Some points seem valid (e.g., our plasma cholesterols are controlled by millenia of evolution, and the drugs can't change them much, and then only with really uncertain side effects & results). If deterioration of modern medicine occurs, it is more likely to be from financial & social limits than scientific limits. He underestimates the promise and power of knowing the human genome and its proteomics. The book is well worth a careful reading for anybody interested in medicine, its history and possible futures.

This book (written by J. Le Fanu, a medical journalist) attempts to synthetise the history of modern medicine as well as takes a critical look at present-day medical care. Titled "The Rise & Fall...", it appropriately begins with the Rise. Le Fanu has selected twelve discoveries that have allowed significant improvement in medicine in the past 50 years (of course, that leaves other important breakthroughs unaccounted). The description of the people involved in these discoveries - often medical practitioners or others busy with their everyday work, not laboratory-confined geniuses - is excellent. I loved in particular the account of the polio epidemic and the first use of positive-pressure mechanical ventilation on a large scale - using medical students as "pump power"!.

After this self-titled "lenghty prologue", however, my enthusiasm cooled down a little. Le Fanu sets out to answer four paradoxes of modern medical care: Why are so many medical practitioners disappointed with their job? Why are people so worried about their health while the health of the population at large never has been better? Why has alternative medicine become so popular? How can we cope with the rising costs of medical care? In "The Fall", Le Fanu takes aim at two domains of present-day medicine (what we could call "Epidemiology of modifiable risk factors" and "Genetic basis of disease") that are probably over-emphasized currently, but that hold lots of promise for the future. His condemning genetic therapy, in particular, is untimely: this technique is still at its birth.

Nevertheless, this book is worth having for the excellent historical insights it gives about medicine in the last half-century.

A must read for anyone blinded by medicine's apparent glory and victories over human disease. This book exposes the past in which medicine's landmark discoveries/ events are shown to be mostly a combination of chance, persistance, mindless trial and error or even freak accident. From modern medicines illustrious history '10 definitive moments' have been selected by the author to illustrate the events that have led to the glorified status that medicine holds in our western society. Beginning with Penicillin in 1941 and ending with the discovery of Helicobacter, the cause of peptic ulcers, in 1984. These accounts make any reader wide-eyed at the simplicity of some of the research designs and truck loads of luck involved in the discoveries. This portion of the novel is full of interesting facts concerning the '10 definitive moments' written in rich narrative rather than a more conventional dry historical account to keep any reader glued to his lazy chair.

The next portion of the book is an elaborate argument for his hypothesis; that medicine has long ago reached it epiphany and is currently in the decent phase, "The Fall". He gives convincing arguments for his opinion which makes a reader think about it even if one isn't totally convinced.

The Title, "The Rise and Fall of Modern Medicine" caught my attention and once I opened the book the words trapped me until the last page was turned. Even after closing the book I considered his hypothesis and reflected on it, which has spawned me to follow up on some of his references and read some of them. In my opinion any book that causes such a fury of reading, thought, and reference checking and further reading is worth a look by any casually interested reader.

The Telegraph's medical columnist claims that medicine's golden age was from 1945 to 1980, due to the chance discovery of drugs, advances in clinical science and innovative technology. He believes that it is now exhausted, and laments that the vacuum is being filled by what he thinks are the dead ends of New Genetics, epidemiology and social medicine. It is untimely to write off genetics when the Human Genome Project offers such exciting possibilities.

He calls for more research into the causes of disease, and rightly rejects idealist explanations. Doctors used to think that peptic ulcers were due to `stress' or `personality', but in 1984, Barry Marshall, a young Australian doctor, identified a type of bacterium that triggered them. A seven-day course of antibiotics was the cure. The same organism caused two-thirds of stomach cancer cases. In 1986, Thomas Grayston discovered that the bacterium chlamydia caused heart disease. Perhaps as yet undiscovered bacteria cause arthritis, schizophrenia, leukaemia, MS, diabetes and ME.

He has a brilliant chapter on how the use of new drugs refuted Freudianism, as chlorpromazine effectively relieved schizophrenia's symptoms, lithium mania's, prozac depression's and valium anxiety's.

Le Fanu shows that the influential historian of medicine Thomas McKeown wrongly denied doctors the credit for tuberculosis's decline. Doctors' seclusion of TB patients in sanatoria dramatically reduced the infection's incidence.

He argues against social medicine, rejecting all social and economic explanations of illness. But lifestyle changes - losing weight, improving diet and exercising more - do prevent diabetes and promote health and well-being (British Medical Journal, 14 July 2001, page 63.)

He claims that medicine has run its course. We have seen the misanthropic idea of the end of history, of politics, of industry and of class. Now Le Fanu pronounces the end of medicine. This is a provocative and infuriating book, full of ideas and prejudices. We need the tests of practice to see what he has got right.

Rise and Fall of Modern Medicine provides an important survey of the major breakthroughs in modern medicine from 1945 to the 1970s, outlining medical process and barriers to achieving goals. From major battles won against illness and treatments of chronic diseases to medicine's battle against political and social barriers to research, this provides an essential history important for any serious medical collection.

Like several other reviewers I found the first 2/3 of this book which focused on the past 70 years of major medical breakthroughs to be a generally well researched and dispassionate historical account. The last third however, in strong contrast is nothing more than a rather poorly written polemic against what Le Fanu terms the New Genetics and the Social theory, in which accurate historical accounting is replaced by strongly biased editorial rhetoric.
This can be seen in his polemical pronouncements, such as on p.288 where Le Fanu writes: "When the slightest breath of skepticism is sufficient to undermine McKeown's argument, perhaps a similar attitude will prove just as damaging to the Social Theory he instigated". Or p.330 when he writes, "The Social theory... is in error in its entirety" and is in violation of the "inescapable laws of biology". Such sweeping pronouncements seem greatly at odds with the well researched and documented passages that make up the bulk of this book.