Medicine

How much would your family stump up for your ransom?

‘I can’t quite believe I’m here, having a steak dinner with a killer,’ writes Jenny Kleeman, as she sits with a hitman for the big opening to her book about the price we put on life. Someone paid to take lives is about to spill the beans on his dark trade. There should be tension. There should be jeopardy. We should be worried about Kleeman’s safety. So why does it feel a bit flat? It is difficult to find a hired gun, obviously. This one is John Alite, who was ‘a hitman for the Gambino dynasty’. However, he is now ‘a motivational speaker’ and ‘host of several podcasts’, and seems

Not everything in the garden is lovely

While I was reading Most Delicious Poison, I visited a herbal garden in Spain which features the plants grown by the Nasrid rulers of Granada hundreds of years ago. They cultivated myrtle for its medicinal uses and jasmine for its fragrance. How did they know of myrtle’s properties? Some ancient ancestor must have figured it out. And that ancestor might be more ancient than we realise. Noah Whiteman explains that DNA from plants found in Neanderthals’ teeth tartar suggests even they were self-medicating with herbs. We have been entangled with the chemicals around us for as long as we have been human. The author of this book, a professor of

Are surgical museums such as the Hunterian doomed?

I have a soft spot for specimen jars and skeletal remains. Museums of natural history, surgical pioneering or anthropological oddities have always struck me as equally suitable for lunch breaks and first dates as for serious study and research. As far as public and casually accessible encounters with mortality go, these kinds of museums are the most straightforward way of confronting the realities of human nature. But whether we should have this kind of casual access is now increasingly being questioned. Telling history through displays of human remains presents a challenge for curators. They are responsible for contextualising exhibitions to ensure that the remains don’t become a dehumanised spectacle, while

The mystery of chronic Lyme disease

I struggled to pull myself out of bed in the morning. I slept for hours at lunch breaks and was having a hard time focusing. I was working six days a week as an editor at one of the world’s largest newspapers. I needed to concentrate. It was my first year there on a fixed-term contract. I didn’t have the security of knowing I would be hired afterwards; I had limited scope to make mistakes. Articles that required extensive fact-checking, style correction and careful proofreading felt like an insurmountable obstacle. What was wrong with me? I booked a doctor’s appointment to check my vitamin levels. I’m anaemic, so thought that could

The deathly malaise that’s crippling Russia

Now is a difficult time to empathise with Russians – which is why we need Maxim Osipov. We need him to bring alive to us what it means to live in Putin’s Russia – how the system finds ways to crush all but a very few. Even more, we need him to remind us of the kaleidoscope of qualities that a country like Russia inevitably contains – the humanity and generosity as well as the stupidity and cruelty. An author of great subtlety, Osipov would no doubt wince at such grandiose claims for his writing. Yet when the world is deciding how to deal with the aftermath of Putin’s (eventual,

How the ancients treated gout

Medical problems come and go in the media, and at the moment the flavour of the month appears to be gout (from Latin gutta, a ‘drop’, seeping into a joint). For the Greek doctor Hippocrates, gout (Greek podagra, ‘foot-trap’) was the ‘fiercest, longest and most tenacious of all joint diseases’. But since the ancients did not know that excess uric acid, a natural product of the body, was its cause, their remedies were futile. Pliny the Elder claimed that wet seaweed was the answer. Scribonius Largus was at least original, the first to suggest electrification for medical purposes: he backed torpedo fish (an electric ray) for curing gout (some types

How we fell for antidepressants

The French novelist, Michel Houellebecq, with his accustomed acuity about modern culture, titled his last novel but one Serotonin. By then, of course, this famous neurochemical had become the key to a perfect human existence, too little or too much of it resulting in all the little problems that continue to plague mankind. If only we could get the chemical balance in our brains right, all would be well, life would return to its normal bliss! After the commercialisation of Prozac, people started talking about the chemical balance in their brains in much the same way as they talked about the ingredients of a recipe. As Peter D. Kramer put

The treatment of mental illness continues to be a scandal

There is much more desperation in this searching and enlightening history than there are remedies. Andrew Scull is a distinguished sociologist and scholar of psychiatry. He comes across as wise, sanguine and unsurprised by his findings in this survey of how American – for which also read British – psychiatry has understood and treated the insane, distressed and traumatised from 1820 to the present. His book, however, will leave readers who are unfamiliar with the story horrified and aghast. Since my own breakdown and sectioning in early 2019 I have been working with sufferers, social workers and psychiatrists on improving the understanding and treatment of mental distress. Members of the

The danger of learning too much from Covid

When Ray Bradbury was asked if his dystopian vision in Fahrenheit 451 would become a reality, he replied: ‘I don’t try to predict the future. All I want to do is prevent it.’ In the hot embers of the Covid-19 pandemic, it may not be enough to foresee infectious disease threats if we lack the ability to forestall them. After all, predictions were made about 2019. In a Ted talk four years earlier, Bill Gates warned about what he later called ‘Disease X’, a respiratory disease that would cause millions of fatalities. Devi Sridhar, a professor of public health at the University of Edinburgh, addressed the Hay Festival in 2018

TB is back with a vengeance

If you were a teenager before 2005, one reminder of tuberculosis in British life is that small circular scar on your bicep. Maybe you’ve explained to your children why it’s there, if you ever knew. The BCG is no longer a routine vaccination in the UK, a revision which signalled to many that TB was over. What used to be known as consumption became treatable, preventable and ostensibly consigned to medical history as a threat of the past. We tell stories about diseases as if they are constant things. ‘It’s no worse than flu’ has become a familiar phrase; but flu is not all that common, it varies wildly in

Eugenics will never work – thankfully

In his most recent book, How to Argue With a Racist, the geneticist Adam Rutherford set out a lucid account of how the basis for many widely held and apparently commonsensical ideas about race are pseudoscientific; and he lightly sketched, along the way, the historical context in which they arose and the ideological prejudices that nourished them. We might have some half-baked ideas about how evolution works — and have unthinkingly accepted racial categories invented by 18th-century imperialists — but, he assured us in perhaps the standout line of the book, the underlying genetics is ‘wickedly complicated’. Control is a companion piece to that one. It again looks at the

Why has medicine been so slow to improve over the centuries?

Medicine was founded by Hippocrates in the 5th century BC. Doctors continued to study the Hippocratic texts into the 19th century, and many of the therapies, such as bleeding, purgatives and enemas, continued to be practised into the 20th. The standard Hippocratic account of disease was that it resulted from an imbalance of humours within the body. But this failed to explain how some diseases spread through populations at particular times. Among the earliest Hippocratic texts, Epidemics and On Airs, Waters, Places sought to explain this phenomenon. In 1850 the London Epidemiological Society was formed. The governing assumption of most of its members was exactly the same as those of

Why cocktails are superior to wine

I often argue that, in theory at least, well-made cocktails are indisputably better than wines costing 20 times more. My argument runs as follows. In making a cocktail, you can mix, in any combination you wish, any of the liquids known to humanity. In making a wine, you are stuck with using grape juice harvested by grumpy Frenchmen from scrubland east of the Gironde. Mathematically, the odds that the best drink you can generate derives only from a few bunches of such grapes is so small as to be infinitesimal. Besides, almost no one drinks grape juice, and nobody has ever seriously tried to sell non-alcoholic wine. If it really

What did the Romans ever do for us?

The mayor of London, Sadiq Khan, is planning to install a statue of John Chilembwe in Trafalgar Square. Mr Chilembwe was a Malawian Baptist famous for, among other things, leading an uprising where the head of a Scottish farmer was chopped off and put on a pole. He is much revered in his home country for all this and his face has appeared on banknotes. In truth, Mr Chilembwe didn’t incite the murder of many people, in the great scheme of things. If the mayor is searching for a murderer who did punch his weight, he could do worse than hoist up a statue of Francisco Macías Nguema, the former

How the Lancet lost our trust

Right from its first issue in 1823, the Lancet was more than just an ordinary medical journal. Its founding editor, the dyspeptic surgeon and coroner Thomas Wakley, purposefully gave the journal the name of a sharp scalpel that could cut away useless, diseased tissue: he used it as a campaigning organ, to push back against injustice, bad ideas and bad practice. What bothered Wakley most was the establishment. Not only did the Royal College of Surgeons care little about quacks and snake-oil salesmen, but its members were also engaged in corruption and nepotism, ensuring that their cronies got the best positions and filling their pockets with lecture fees. Wakley wrote

The hidden death toll of lockdown

The last patient I treated was 105 years old. She has lived through two world wars, a depression and at least five pandemics. It’s a real honour to treat centenarians. They teach me much about life: how it is and how it ends. I can also lighten the mood with my 80-year-old patients by telling them that they’re still young. It’s common to hear talk about an ‘ageing society’ being some kind of disaster befalling the country. Yes, people are leading longer, healthier lives now than ever before. Is this really a ‘demographic timebomb’? I’d call it the greatest achievement of our time. When my patient was born in 1915,

In an age of science, why are face masks a matter of opinion?

In 1846 Vienna, as across much of the world, a relatively new disease called puerperal (or ‘childbed’) fever had reached epidemic proportions in the local maternity hospital. Death rates of mothers and babies after childbirth were averaging 10 per cent, sometimes twice that. Across the western world millions were dying, the rate reaching 40 per cent in some hospitals. A Hungarian doctor in Vienna’s hospital, Dr Ignaz Semmelweis, began to wonder whether the problem might be something on the hands of doctors who’d been conducting post mortem examinations on the fever’s victims. He suggested handwashing with a chlorine solution. It worked. Deaths plummeted. But Vienna’s medical community would have none

Let’s bring back Britain’s fever hospitals

Could the future of pandemic planning lie in our past? A century ago, there were hundreds of so-called ‘fever hospitals’ dotted across Britain. These small institutions were built for diseases of a bygone age – smallpox, scarlet fever and typhus – but were designed for precisely the same problems we face today.  They contained isolation wards, separate accommodation for different infections, laboratories, operating theatres and convalescent wards with activities for recovering patients. Given the current problems of the Covid-19 outbreak, we need to re-establish these medical relics.  The lessons that led to the fever hospitals’ formation were paid for with the lives and suffering of our fellow human beings Fever hospitals were often built so

The truth behind ‘do not resuscitate’ orders

Coronavirus is revealing many good things about our society: the number of people willing to volunteer to help tackle the outbreak and help the isolated, the number of former doctors and nurses keen to return to the front line, and the number of businesses that have switched to making equipment and protective clothing for those healthcare workers. But it has also revealed our ignorance about many matters that are still important outside of a pandemic. Today’s example comes, inevitably, from our general reluctance to think about what old age and end-of-life care look like. Care homes have expressed concern that residents and their families are being pressured into signing ‘do not resuscitate’

On the NHS front line, we’re braced for what’s coming

From the moment when Boris Johnson announced that the country was moving from containment to ‘delay’ in handling coronavirus, the world’s biggest healthcare organisation has been on a war footing. What doctors like me have witnessed over the past days and weeks has been nothing short of extraordinary. Trusts in the NHS declared a ‘major incident’ on the evening of the announcement, and emergency plans swung into action within hours. By the time I came into work the next morning, managers, who had been up all night, had already started to implement profound changes to the way in which the hospital and services were run, and this continued over the