Jame Le Fanu, 1999, 2012
In my last post I was inspired to reflect upon my personal experiences relevant to a patient I had cared for. I don’t read a lot of medically inspired books and this blog is primarily an outlet for my own memories and inspirations pertinent to the many books I read. I was reading James Le Fanu’s book, The Rise and Fall of Modern Medicine during a challenging period in my nursing career and felt that it was appropriate to apply some of the discussion material of the book to a patient case that had deeply affected me.
If you, reader of this blog aren’t aware, I am a registered nurse at a large medical institution. And if you know me well, you are aware that I have been intimately involved with medicine most of my life since my career prior to nursing involved work at several large and small biotech companies associated with the “big” pharmaceutical industry. In many ways I have been self-aware for several years about the double edged nature of my involvement in the medical field. Medicine does great good but the business and high cost of medicine is slightly unsettling because the efforts of profits distract from my altruistic intent in being involved in medicine. I had left the pharmaceutical industry primarily because my ten plus years working in the industry failed to fulfill my inherent desire to help my fellow human kind. At the end of my workday I knew that despite the indirect knowledge that the my workaday efforts assisted the patients in need of the drug therapies my companies had manufactured, my daily efforts were ultimately and directly best serving the corporation and the shareholders of the companies that I had worked for. The choice to pursue nursing was one of the best and most formative choices of my life. However, I am not naive to think that in becoming a nurse I have morphed into an idealized altruist. As I have taken on leadership roles within my profession I am all to aware of the influence of reducing costs of care and lengths of stay, but these are necessary realities that are married to the great reward of working in a profession that intimately touches the lives of people whom I would never had contacted otherwise.
Now, with that aside and off my chest, I feel that I need to say a few things about The Rise and Fall of Modern Medicine that weren’t appropriate to say in my last post about this expansive book. This book was originally published in 1999 and I read the 2012 updated copy of the book. For a book that argued so much about the lack of integrity in medical science, I was sorely disappointed in the format that Le Fanu had updated his book. The updated copy wasn’t really an updated in as much as Le Fanu had written a few new chapters that were applicable to the 13 years since his original publishing but the original content of the book was completely unedited from its 1999 presentation. This was most notable in the references to costs of medical expenditure in the 1990’s that could have easily been updated with 2012 figures without needing to add on new redundant chapters to cover the last decade.
Another drawback to this book is that in being British and enjoying the benefit of a single-payer medical service, Le Fanu completely omitted any reference to the debilitating influence of American style medical insurers as a downfall to the medical system. Le Fanu did make reference to the overall expenditure of the US economy, but he seemed to completely ignore one of my most influential factors in the US system, that being that a myriad of insurance providers have an overly influential power with regard to dictating care administered because the insurance providers influence the cost of care received. Furthermore, in ignoring the influence of insurance providers Le Fanu takes no notice of the plight of the uninsured who do not receive the benefits of preventative medicine because they avoid the cost of seeing a medical provider. Shannon Brownlee’s OverTreated provides a much more thorough analysis of the labyrinthian influence of the American medical system and I would recommend that book over Le Fanu’s if you have interest in the cause for the high costs of medicine.
On less of a criticism of content and more a criticism of style, I did feel that The Rise and Fall of Modern Medicine was an easy and approachable read. I was able to breeze through its 500 pages in just under two weeks. However, after reading it I found my dissatisfied with the personal substance of its subject matter. Le Fanu’s book is fact heavy on the historical development of modern medicine and he does make reference to many of the key players that participated in the defining moments of medicine. However, as a story teller, Le Fanu stuck to the simple facts without adding any sense of personal appreciation for the characters that were the people involved in the development of modern medicine. Siddhartha Mukherjee’s Emperor of All Maladies was a much more touching book that sought to achieve many of the same goals as Le Fanu’s he Rise and Fall of Modern Medicine. Mukherjee’s Emperor was entirely focused on the history of cancer and therefore its scope was not as encompassing as Le Fanu’s exploration of all of modern medicine, yet Mukherjee’s book was far more satisfying as a read due to the numerous personal anecdotes and interviews that were included in the text.
Despite these criticisms, The Rise and Fall of Modern Medicine was a worthwhile and informative book that I would recommend as a good point of reference to anyone with interest in the applications of modern medicine.