Irrationality, without which life cannot be lived, is profoundly irritating, especially in others. It is at its worst when those who are guilty of it try to sue those who, like Simon Singh, try to expose it. Singh was sued by the British Chiropractic Association after he wrote a book debunking several alternative ‘therapies’. A few weeks ago, thankfully, he was given leave to appeal but the affair nearly spelled victory for irrationality. Irrationality is also very bad when displayed by someone close to you.
My late mother suddenly suffered from a non-life-threatening but disfiguring skin condition of her scalp that naturally enough caused her great distress. Old ladies in their eighties, worried about their appearance, are not high on the National Health Service’s list of priorities; and this, combined with a severe shortage of dermatologists in this country, meant that she could not be seen on the NHS for 18 months. In dermatology, at any rate, the Grim Reaper is used as an auxiliary in the government’s Waiting Time Initiative.
She went private, as my patients used to put it. Even the private dermatologist had a waiting list of nine months, however, so she chose another. He prescribed something that made her condition much worse. She consulted another, with the same unhappy result. Finally, in desperation, she sought out a homeopath and, to both my pleasure and my chagrin, his ministrations cured her. At least, she got better after them.
It was difficult in the circumstances to persuade her that homeopathy had no rational basis, quite the reverse, and that properly conducted scientific trials had demonstrated its inefficacy. She had personally undertaken the only trial that really interested her, namely on herself, and it was successful. What more could a patient ask?
There is more in heaven and earth than is dreamed of in anyone’s philosophy, of course. Every doctor knows of patients who didn’t get better when, according to science, they should have done so, and patients who, according to the same criteria, shouldn’t. I recall a patient in Africa to whom, in desperation, I gave steroids when trials had conclusively demonstrated their uselessness in his condition. He was cured in a trice; from which I concluded that the world is too fine-grained to be caught in its entirety in the coarse net of our knowledge, and that a dogmatic doctor is probably as dangerous as an ignorant one.
This being the case, what is the role of rationality in medicine? Must we regress to the era of a pink pill for pale people, when every quack remedy came with testimonials from grateful people who (if they actually existed) had all fallen into the fallacy of post hoc ergo propter hoc?
Rationality might be a blunt and insufficient instrument sometimes, but it is often the best that we have. No one believes in the healing power of crystals for appendicitis. Irrationality, then, is best left to medically marginal situations, to the worried well and to those whom rational medicine has failed.
Of course, irrational medicine should preferably be, at worst, harmless: many a consultation with an Indian traditional healer, for example, has ended in lead poisoning, and the widespread belief that natural herbs are harmless because they are natural is, alas, a manifestation of the modern paganism of people who have never lived where there is no street lighting.
Irrational medicine has certain attractions, and efficacy is not prominently one of them. Indeed, if scientific trials were to demonstrate that a particular magical therapy had, shall we say, the tendency to reduce the pain and disability of osteoarthritis by 6.3 per cent by comparison with placebo, the belief in it would suffer a mortal blow. It would become a rational medicine like any other, useful in some cases; it would have lost its magic.
Everyone likes to question authority — especially nowadays when our inflamed egotism demands it in order to establish our individuality in a mass society. What better way to do so than to reject the vast, impersonal apparatus of modern scientific medicine, which consumes more and more of our economic product with diminishing returns, and resort to some pseudo-ancient hocus-pocus propagated by modern witches and wizards.
It is also extremely gratifying to know that one’s condition is beyond the reach of the most sophisticated treatment that science can offer, but is susceptible to something more in harmony with the spiritual vibrations of the universe. This suggests that one’s body and soul is a refined one, not like that of the common herd, whose grossness responds to such crudities as surgery and pharmacology.
In my more rationalist days — not rational, of course, that is another matter entirely — I was much annoyed by irrational medicine. It offended me personally that people attended faith-healing meetings, for example. The healers were to me so obviously crooks who preyed on the credulity of those whom I suppose we must nowadays call their clients. And it is indeed a very sad thing to see a paralytic’s disappointment at his continued paralysis, especially when the corollary of the omnipotence of faith to heal is that failure to heal is attributable to a lack of faith.
But as one grows older one grows more tolerant, or more aware that no one conducts his life as if it were an algorithm, at each branch of which he decides which way to go on strict evidence of what is best. A doctor becomes aware that a considerable part of his own beneficial effect depends upon his almost shamanistic authority; even a patient’s consent to treatment depends upon faith and trust.
Here there is something of a paradox. Partly because of the increased coverage of matters medical in the press and in broadcasting, in which stories swing, pendulum-like, between the miracle-working and the murderous doctor, trust in the profession has declined (much greater as it remains by comparison with that in, say, politicians). So the doctor increasingly is seen either as denying his patient the best treatment, or as maliciously maltreating him. The patient’s defence against this is the internet, information on which is often treated with all the credulity worthy of, or attaching to, a miracle-working virgin.
The sceptical, it turns out, are certainly not immune from the siren song of credulity. It is as if, exhausted by the mental effort of taking nothing on trust, they suddenly throw in the sponge and believe the most implausible nonsense that would not take in someone half as educated as they.
Every day for many years, on my way to work in hospital, I passed an establishment offering high colonic lavages to the public, by way of panacea. Whether this was a front for other services, I never discovered; but my grandmother, who believed implicitly in a weekly clearout by means of castor oil, would have approved.
At first I used to experience irritation every time I passed the establishment. But when I reflected that it was appealing to the same nonsense that my grandmother had believed in a hundred years earlier, I calmed down and was much comforted.