The medical establishment has become a major threat to health.
— Ivan Illich
In 1975, Ivan Illich radically claimed that medicine had become its (our) own nemesis. Instead of bringing health, which it was created to do, the medical establishment was systematically creating new forms of un-health. A victim of its own hubris, medicine was structurally promoting individual helplessness, harmful expectations, and misery through its “counter-intuitive misadventures.” No matter how well meaning, medicine was too powerful and too faulty for its own good. In other words, modern medicine was a golem.
A figure of Jewish mythology, a golem is a good-natured yet clumsy creation of man that knows neither its own strength nor the extent of its own ignorance. Thirty years ago, Illich warned against such flawed enterprises ultimately resulting in the propagation of harm. In Dr. Golem: How To Think About Medicine, their third book in a themed series, authors Harry Collins and Trevor Pinch issue a similar caution using the golem as allegory for modern medicine. Yet where Illich plunged into complex (and controversial) socio-analysis, Collins and Pinch stay much closer to the surface. Driven by the defensive concept of what to do in the face of imperfect medicine, Dr. Golem is an interesting but frustratingly incomplete investigation of the complexities and limitations of medicine.
It’s a strong metaphor: modern medicine, through all its mutations, has evolved into a discipline that wields the power to heal but acutely suffers from blindness to its imprecision. No matter how sophisticated the science of medicine has become, there are still countless concepts, actions, and effects that are myopic, clumsy, and paradoxical. And as individuals who interact with the medical establishment, it is critical for us to understand “how to think about” them.
That’s where Dr. Golem is right. Medicine is ripe for another sociological analysis, and instead of writing a rehashed Illichian diatribe, Collins and Pinch, as experts in the sociology of science, created Dr. Golem to encourage personal inquisition. Using case studies molded from source material and original research, Collins and Pinch sensibly explore eight modern medical dilemmas while charting some of the arrogance and imprecision that threatens our understanding of how we treat our health. By presenting real challenges, like the evaluation of the efficacy of Vitamin C in treating cancer and the individual versus collective risk-benefit of vaccination, we are provoked to examine our own notions of medicine: Is it science or succor or both? How should we weigh our own health in relation to our neighbors’? And how does the role of medicine in our lives affect the way we interact with it?
It is a valid endeavor and the questions they pose are relevant. But as they are not interested in providing answers, ultimately the value of Dr. Golem is in the context it provides to consider its questions — and the crude perspective it offers can be quite misleading.
If only the authors would have heeded their own metaphor. The book opens with grand ideas and good intentions, but the clumsy treatment of these big questions ultimately hurts their case. From the opening page, modern medicine and public health are placed in opposition (“medicine as we know it does little to increase the average expectation of life; diet, hygiene, and lifestyle have a much greater impact”) despite their overlapping existence in most communities — and this segregation muddles the very questions they raise about the expectations of medicine. In exploring the supposed misgivings of the placebo effect as a comment on how we establish the “science” of medicine, Collins takes no more than a cursory look at the biases inherent in research. An entire chapter is included documenting the existence of bogus doctors, an interesting and troubling phenomenon, but one that is about as common as finding a needle in a haystack. The book goes on to look at the prevalence of tonsillectomies, the definitions of survival after CPR, and the classification of chronic fatigue syndrome, otherwise known as the “yuppie flu.” In choosing to only focus on dubious and fringe cases in medicine, Collins and Pinch lose the strength of their broad-based and timely metaphor.
While several of the stories are fascinating reads, sadly it ends there. Dr. Golem fails to examine the real heart of medicine, instead leeching examples from its most distal extremities. Reading Dr. Golem is like looking at a diseased heart on an electrocardiogram with improperly placed leads; you can clearly tell something is wrong, but the angles are all distorted. Indeed, medicine is a golem, but Collins and Pinch do not provide the sharpest picture of why it is.