Medicine for Beginners: maybe, but where does medical hegemony stop?

David Zigmond served as an NHS psychiatrist and Principal GP from the 1970s. In retirement he now works as a psychotherapist and campaigns for Doctors for the NHS. His writings can be accessed on his website.

What is the legitimate nature and influence of scientific medical knowledge? Medicine for Beginners, a short, paradoxical and provocative book was written forty years ago by two young authors with no formal training in history or philosophy. Yet their prophetic insight should continue to disturb us.

About a century ago GK Chesterton wrote: ‘Humour can get in under the door while seriousness is still fumbling at the handle.’ His aphorism certainly underlies the spirit of Medicine for Beginners, which flaunts a fragmented and roughly crafted comic strip format – it does this to engage timeless and weighty questions which are inescapably bound to medical practice.

This is a reprint – almost unchanged – of a sell-out publication from 1984. Its lead author – Richard Clark – now asks: ‘Is it still relevant? A lot has happened since 1984, in the world of medicine…’

My surprised answer is yes; the issues and predicaments this eccentric and often discordant little book raises remain seminal to anyone thinking deeply about, or practising, healthcare. Clearly the style of engagement here is not subject to diligent academic discipline, balance or protocol: this is a polemical jumping-jack intended to awaken, excite or even startle the reader out of conventional assumptions.

Those conventional assumptions are that advances in scientific medicine are, a priori, always a good thing: so that includes the ceaseless development and expansion of all screening, testing, diagnosis, specialisation, drug prescriptions and surgical interventions… The whole edifice of allopathic medicine, the authors propose, has become something of an overweening empire: often nepotistic, avaricious, expansionist, xenophobic of other approaches, ideologically-purblinded, authoritarian … the list could grow.

In another format these notions would be likely read as a kind of fully-loaded paranoid rant – a commonplace form of ambush now by keyboard warriors and trolls if we linger and stray online. But this is not my experience with Medicine For Beginners: its (superficially) chaotic kaleidoscope of cartooned spoofs, parodies and representations make the shuttle between reading, looking and thinking a skittish and irreverent pleasure – a kind of Ivan Illich meets Monty Python (both recent cultural icons in 1984).

So the title of this slim pot-stirrer is deliberately and mischievously misleading: it is definitely not a primer sensibly informing the curious reader of the working principles of medical practice. It is a passionate pole-vaulting polemic, a klaxon-call to waken us from a kind of medical somnambulism with its many oblivions and hazards.

Many of its items-for-the-prosecution are partly and importantly true, but only partly. For example, the implication that ‘science’ has led to many of our current addictions and afflictions: this 1984 book cites ever-increasing psychotropic consumption and opiate addiction as clear examples. Now, in 2024, viewing the tragic and shocking human destruction wrought by ‘advanced’ synthetic opioids in the USA, it is certainly chilling to acknowledge where scientific manufacture and commercially incentivised distribution can lead us. But science is not responsible for the perverse pattern of our human appetites, commerce and distribution … how we abuse its gifts.

Medicine For Beginners starts with an abbreviated yet very interesting history of mankind’s attempts to heal and treat: how the fear-and-hope inspired religions and superstitions were slowly dismantled – over centuries – to give way to scientific empiricism and rationalism. From this came the undeniable, if painfully slow, advances in reliable and curative treatments, yet also the opportunities for mass-produced folly and commercial exploitation. This provocative book bypasses the former blessings and draws us, with mordant playfulness, to gaze at the latter – the curses.

So our problematic and increasing overuse of antibiotics, analgesics and psychotropics (all significantly worse since 1984) receive sharp focus, but not the extraordinary advances and successes in, say, drug cures for many leukaemias, HIV, or the life-retaining forms of cardiovascular or prosthetic surgery.

So what we have here is satire and polemics more than any systematic disquisition. Yet running beneath its many barbed challenges, I think, is a sage and unifying theme: that science itself has, paradoxically, all-too-often, become a new religion: Scientism. It is such Scientism, not our intelligent and sentient application of science, that leads to slavish algorithms, unempathic proceduralism, rigid care pathways and extinction of so much that is humanly valuable but unmeasurable. It is Scientism that didactically insists on treatment, but misses opportunities to heal.

So, to my mind, the damage, hazard and follies that are here brassily identified are more about our human nature and how we use science – it is about our impatient restlessness and unrequited appetites; our fear of death, uncertainty, emptiness and loss of control; and then – often – our need to control others to give us the illusion of possession of certainty and control.

And then our uniquely human flaw: our unwisely unboundaried cleverness – how we do not know how to stop using our own clever inventions, so creating even bigger and more intractable problems…

This book was written forty years ago by two young idealistic friends as a fun, collaborative project. Clark, a young doctor, was mostly responsible for the text; Pinchuck, a similarly aged psychologist, created the graphics. Now in older age they re-offer it, wondering what we will make of it.

Some may find this youth-generated, other-era’d work dated and callow in its righteous thrust and simplistic polarisation. When asked for my review I feared this might be my reaction. But my response was quite different: despite a multi-decade medical career thinking about these issues, I found myself stimulated, challenged and refreshed to conjure these associated thoughts. Medicine For Beginners delighted, amused and motivated this old practitioner here to think afresh and then enthusiastically write this review.

If you delve into this historical work of youth I think your reactions will be similarly catalysed.

Chesterton was right: Humour can get in under the door…

Featured Book: Richard Clark and Tony Pinchuck (illustrator), Medicine for beginners, first published in 1984 by Writers and Readers. A 2024 fortieth anniversary edition is now available, distributed by Kindle Direct Publications. ISBN 979-8870881256

Featured image by Volodymyr Hryshchenko on Unsplash