Bad Medicine: Doctors Doing Harm Since Hippocrates

by David Wootton

We all face disease and death, and rely on the medical profession to extend our lives. Yet, David Wootton argues, from the fifth century BC until the 1930s, doctors actually did more harm than good. In this controversial new account of the history of medicine, he asks just how much good it has
done us over the years, and how much harm it continues to do today.

Genres: History, Nonfiction, Science, Medicine, Health, Medical, History Of Science

320 pages, Hardcover

First published January 1, 2006

About the author

MA, PhD (Cantab), FRHistS

David Wootton is Anniversary Professor of History. He works on the intellectual and cultural history of the English speaking countries, Italy, and France, 1500-1800. He is currently writing a book entitled Power, Pleasure and Profit based on his Carlyle Lectures at the University of Oxford in 2014. His most recent book is The Invention of Science, published by Allen Lane.

In 2016 he will give the annual Besterman Lecture at the University of Oxford.

He was educated at Oxford and Cambridge, and has held positions in history and politics at four British and four Canadian universities, and visiting postions in the US, before coming to York.

Reviews

[J. Lee Hazlett · Rating 4 out of 5]

I learned a lot from this book, and I did enjoy reading it. I'd say it's more of a 3.5 or 3.75 star than a 4 star, however. This rating is due to the fact that there are sections (namely the introduction and the conclusion, which are a combined 30 pages, or about 10% of the book) where the author evinces an almost aggressive attitude towards existing histories of medicine and towards the frameworks that underpin them. He goes on to demonstrate that there are real problems with these works and their frameworks, but the reader is left feeling rather off-put by Bad Medicine's early tone. A shadow of this tone slinks back in at later points. There were moments when I felt that the author was so passionate about lost opportunities to improve actual medical practice that he lost sight of the fact that the people of the past (yes, even the scientists and doctors) were still people, and there susceptible to human oversights, follies, etc. This judgemental thread is the sole reason why this isn't a 4.5 or 5 star book. If you can look past the tsk-tsk tone, this is a well-structured and well-argued work. Its explanations are such that most readers with a basic (standard 'core knowledge') college-level understanding of European history and biology can follow along and understand the points being made. And there were many parts that were truly fascinating, such as the sections about scurvy and smallpox. Read through carefully, the work makes you think differently about how our ancestors (and ourselves) thought about things and made decisions both large and small (and not just about medicine). There's a lot to digest and unpack here if you sit down and really think about what you're reading, especially if you happen to have a little more than the average knowledge of European history and can add context from other reading. All in all, I wouldn't say that this is a book I'm likely to read again in the near future, but it is definitely a book that I'm glad I read.

[l · Rating 2 out of 5]

The material is interesting but the 'I'm going against the grain! Look at me! Against the grain! Here is my against the grain thesis statement once more!' tone made me kind of wary. I'm also not sure what he says about ancient medicine and its influence is entirely correct. I just didn't really get a sense that Wootton knew what he was talking about - most of it sounded like cherry picking. It's a shame because the idea - trying to find out why medicine took as long as it did to advance - is interesting. It just doesn't translate into anything in this book. I have really no sense of why x idea/practice wasn't adopted when it was discovered apart from the fact that stasis exists and scientists back then weren't very methodical.

[Alexis Kaelin · Rating 4 out of 5]

I think the best description is thought-provoking. I can see how many other reviewers would believe that Woottton hates doctors, but it certainly is not that. He is perhaps appalled by the lack of understanding among doctors of their collective history, though the blame for that most likely resides in the medical history textbook rather than the doctors. Do doctors even study the history of medicine in med schools? I find his treatment of early medicine fascinating and spot on. However, once he passes Leister and breezes over some late 19th/early 20th century developments, it begins to feel that he is passing over some big areas in the interest of his thesis. I would have to do more reading on the time period to challenge him further, but still, food for thought.

[Laura Weatherspoon · Rating 2 out of 5]

After reading Bill Bryson's The Body (which was brilliant) I found this listed in the bibliography and thought I would read it. It was poorly written, sentences were muddled and difficult to follow. The anecdotes related were not that interesting. I couldn't be bothered to finish it.

[Lee · Rating 4 out of 5]

History of science is so much more interesting when it focuses on its flubs, bungles, and delusions. Lemons were a known solution for preventing scurvy by the 1600s, but on academic medical advice navies replaced them with totally ineffective treatments of vinegar and bloodletting, killing millions.

There are many such awkward examples. Harvey is usually credited with using experiments on animals to discover that the heart is like a pump for blood, joining new methods to contemporary mechanical analogies unavailable to the ancients. But Wootton points out that Galen did the same experiments centuries before, and the mechanical comparison of the heart to bellows was well-known and went back to Aristotle. The real puzzle is why it took so long for medicine to appreciate what blood and the heart are doing. Wootton surveys contemporary scholarship on the issue and reports that the consensus seems to be puzzlement: we just do not have an explanation for the delay.

Another infamous delay that is somehow instead celebrated as an advance is the germ-theory of disease. Leeuwenhoek saw "germs" under his microscope in 1677; but the germ-theory didnt vanquish its rivals until the late 1800s, inexplicably stalling the development of antibiotics for two centuries.

Since medicine began intelligent observers had been endorsing "therapeutic nihilism," the belief that most treatments were quackery. And yet it continued through the ages. If we need a memorable metonym, take the lancet: an instrument for bloodletting carried by doctors that was for centuries the symbol of the profession. The title of the prestigious contemporary medical journal take its name from it. Yet one of the great medical advances was to "sheath the lancet," ie to (very gradually!) stop the useless and dangerous practice. Wootton looks for explanations of the delay and reports that the leading theory is that doctors simply wanted to "assure the family that everything possible had been done."

We are prone to reach for functionalist explanations of historical developments too quickly: when a practice catches on, we attribute that to its working. Wootton's counterexamples don't seem cherrypicked to me -- they are the most famous developments in medicine, and they just don't fit the model. What's worse, the functionalist framework leads us to misread the past, passing over and leaving unexamined the strangely delayed discoveries and continuations of deadly practices.

One view, which Wootton seems inclined toward, is that this nonsense gradually stopped with the introduction of randomized controlled trials and the ascent of evidence-based medicine. Perhaps there was a profound change after that. But doubts remain, and I wonder if a special medical brand of (adapting a term of the philosophy of science) pessimistic induction might be justified. Whatever capacity permitted us for so long to to delude ourselves, trusting our lives to junk science, is presumably still with us. And that lends credence to contemporary medicine skeptics lecturing us on similar contemporary delusions. See Stegenga's Medical Nihilism for an example.

By the way, Wootton is a great guide to the past, not just the history of medicine. His language talents allow him to dig deeper than most, reading and quoting original texts and highlighting their strangeness (eg, Galen on fever). His *Invention of Science* and *Power, Pleasure, and Profit* have similar qualities, and I would also recommend.

[Andrej · Rating 4 out of 5]

This appears to be a slim book, but don't be fooled. The print is rather small so there's a lot of stuff inside, all very interesting, most rather sobering, some extremely depressing. I bet most people are not aware that "there was very little medicine before 1865", and what actually passed for medicine was just bloodletting, purges, and emetics. Not only that doctors didn't help their patients, they largely just contributed to their speedier and more painful demise. If anything appeared to help, it was just nature doing its work, or some sort of placebo effect, only they didn't even know about placebo back then. It is hard to believe that the best advice one could give to any pregnant woman, until about 1860s was: "For God's sake, don't go to a hospital, no matter what! Stay home, have your child there, and your chances of survival are way better". Why not 5-stars then? I think this book will not achieve its potential effect, as it may be too detailed and long for a "Pouplar Medicine" category, and for an average reader, who may sooner or later give up, or even decide not to tackle it, in the first place. And this is a pity, as I believe that this subject should be common knowledge, maybe even a part of school curriculum.

[John Hancock · Rating 5 out of 5]

Read it. https://psychiatricsurvivors.wordpres...

[E. Kahn · Rating 3 out of 5]

The thesis of this book is that the teleological narrative of medical history consciously or unconsciously adhered to by popular histories is false and that the history of medicine is in fact rife with false starts and setbacks that have caused untold suffering and death. A second thesis might be that the Great Man vision of medical progress also to be found in pop history is dead wrong as well, and that the great heroes of medicine (Pasteur, Lister, Fielding etc.) have only become the giant figures they seem as they have been unfairly credited with the insights and work of many other now obscure researchers.

Now, I'm completely down with those views and I would have agreed with it even before reading this book, but the way the arguments are presented failed to engage me. It's not that the book is boring or dry, it just seems to build and then peter out in each chapter, resulting in an unsatisfactory read.

[Gregory · Rating 4 out of 5]

I came to this book with an interest in the question of why so many bad medical practices continued for so long. A little reading of 18th and 19th-century novels shows the same incorrect and even damaging practices going on long after it seems that people should have realized that they were actually sickening or killing patients. Why?

Wootton comes up with a number of answers to this question, ranging from guild competition to statistical ignorance. These all struck me as being very good answers, as well as the implicit conclusion that it was not just one thing that was responsible. This suggests that even now we have to worry about the professional, scientific, social, and political aspects of medicine if we want to get effective treatments.

Overall, a well-written and interesting bit of history, and not too technical for the average person to enjoy and understand.

[Peter · Rating 3 out of 5]

Although much of the history was sound and the book as a whole was very readable, I found myself questioning David Wootton's approach to certain discoveries. He did appear to be dismissive of reasons for delay, and although in medicine it needs to be established why delay took place - such as between Schwann and Lister's developments in the field of antiseptics - it also needs to be viewed from a completely neutral perspective. Wootton's approach to this was ahistorical at times, and although this was a good, enjoyable read, I'm not convinced it was the best history it could have been.

[Emg · Rating 4 out of 5]

One of those books that is not over when it's over. So many questions, so many different perspectives to consider, so much teaching to wish undone. Now I look at my doctors as technicians and have paid more attention to how much they rely on prescriptions to treat symptoms and accept disease as a given (sort of feels like the new Bad Medicine) with so little interest in or curiosity about the cause or the effect on the patient.

[Eileen Thomas · Rating 4 out of 5]

I agree with many of the reviews written about this book- I did enjoy it and did learn a great deal- even knew an answer on Jeopardy! But it was a difficult read- more a 3.5 star rating than the 4 I gave. It took me quite a while to get through it. The author does not shy away from his opinions on how poorly medicine was developed and managed. He does seem to ruminate about the lack of advances. TG I was born in times of modern medicine!

[Leah · Rating 4 out of 5]

Very interesting though the conclusion felt a bit rushed. He didn't seem to weigh how much sanitation improvements may have been influenced by medical discoveries and the hypothesis that sexual activity significantly increased so that it would account for immense population gains without considering factors like amenorrhea due to malnutrition or infanticide ("overlaying" or other forms)

[Diego Samanamu · Rating 3 out of 5]

Nice small book to stop seeing medicine as a long tradition. The author argues right about the history of medicine in three parts. Some chapters may seem like to in-depth but he luckily summarizes each part really well so not to miss the point. Incredible how little has medicine contribute to humanity.

[Zeyd · Rating 4 out of 5]

Engrossing and terrifying investigation into the history of medicine. Read with a sick bag handy, if of weak disposition.

[Magnus Danielsson · Rating 3 out of 5]

Is good

[Ayan Dutta · Rating 5 out of 5]

Superb !

[Sue · Rating 5 out of 5]

Brilliant and insightful.

[Tlaura · Rating 3 out of 5]

This is an interesting, brisk potted history of medicine written for people like me who have read some history of science but don't know much about the history of medicine. Unfortunately, it's marred by the author's weird, grandiose attempts to turn minor disagreements with mainstream historical interpretations into existential critiques of academic history. For example, Wootton dates the birth of modern medicine in 1865 with the rise of Listerian antiseptic surgical practice. Other academic historians (apparently following Foucault) have chosen to date it from the 1790s when, in France, medicine began to be provided by state-provided doctors working in public clinics rather than mainly through private practice. For Wootton, this difference in opinion is due to the fact that "many [historians] don’t actually believe that science progresses." This argument doesn't make much sense on its face and Wootton's attempts to elaborate don't really help. Wootton defends his dating by arguing that medicine couldn't progress until the germ theory came in during the second half of nineteenth century but Bad Medicine contains three examples of eighteenth century innovations -- the treatment of scurvy with lemon juice, widespread use of the birthing forceps, and Jenner's cowpox vaccination for smallpox -- that are now thought to have reduced fatalities more than antiseptic surgery did. Earlier, he makes a fuss over the neglect of one of his heroes, Felix Platter, a German anatomist living just before Harvey who hypothesized something that looks like a modern germ theory. In fact, Platter is one of the few characters in the book I had heard of because he is a big deal in the history of optics. Platter published a very accurate anatomy of the human eye which probably facilitated the discovery of the retinal image (another discovery, like the circulation of the blood, that was ignored or contested by much of the medical establishment for at least a century after its appearance even though it was picked up and accepted by physicists and mathematicians almost immediately.) So the issue is apparently that Platter isn't celebrated for the right reasons, an interesting, even thought-provoking suggestion, of which there are many in Bad Medicine. But it's hardly grounds for the claim (quoting Wootton in response to one of his critics) that "What is at stake here is nothing less than what is history, and who controls it.".

[Noel Bullock · Rating 4 out of 5]

In 2006 David Wooton, Professor of History at the University of York (UK), published “Bad Medicine; Doctors Doing Harm Since Hippocrates.” I read it years ago and loved it. If nothing else, Wooton has a superb writing style. Even (as elsewhere) when I disagree with his conclusions, I still love how he tells a story. But given all the hoopla about around vaccines and the need for science to support medical practice, I’ve found my thoughts often going back to Wooton’s book.

Wooton surveys scientific discovery and medical practice in western medicine. Originally it was based upon the Greek understanding of anatomy, chiefly as practiced by Galen. The body was thought to be made up of four humors. This understanding of the body led doctors to practice blood-letting, induce vomiting and other forms of expulsion as a way to put the humors back into balance. (The Lancet is still the name of an important medical journal.) As this was happening, scientific discoveries were being made that gave us a more accurate understanding of the body, but medical practice did not change to incorporate these understandings. This section of the book Wooton terms, “revolution delayed.”

It was only in the 20th century as medical practice integrated these scientific advances that medical practice improved. And by “improved” I mean, diminished pain and prolonged life.
All this to say, long before the recent pandemic, from a historical angle it was abundantly clear that solid medical practice needed to be informed by scientific research and discovery. (Which is why I would resist non-scientific intrusions into health care.)

His telling of Vasalius is great too!

[Endre Fodstad · Rating 4 out of 5]

Wootton's book is thought-provoking for a number of reasons, especially when you, as I am, are interested in early technology. His point about the basis of Hippocratic/Galenic medicine (as apart from remedies not related to the underlying theory, and practical surgery) being complete ineffective nonsense - which, of course, is essentially true - should be made more often by the historians of ancient, medieval and early modern medical history. I knew the system was stubbornly maintained long beyond its expiration date, but I was surprised at Wootton's examination of its persistense into the 19th and even the 20th centry. His book might read as being more aggressive than it really is - it is a story of BAD medicine, so the success stories get only brief mention. Sometimes, this is a problem, as you get the impression that he is overstating his case. On the whole, however, this is a book everybody interested in the history of western and middle eastern medicine should read before they read anything else - it serves a bitter, but necessary, pill to the idea of constant progress and reminds us that often, the "wisdom of the ancients" and respect for old authorities was a leg iron to the progress of human advancement.

[E. Davies · Rating 4 out of 5]

Terrific. Brief, pointed, thoughtful and superbly original. Wootton, who is not a doctor, points out what they rarely do - that throughout human history, going to see a doctor has generally been bad for your health. He explores why this was and why it changed, all with gripping prose and a surprisingly small number of pages.

[Luke Echo · Rating 3 out of 5]

Randomly picked this up at Oxfam the other day. Its quite interesting stuff and really gets going towards the end. I thought it needed a rather more thorough editor though. Its a bit plagued by repetition in parts.

[Harvey · Rating 3 out of 5]

- choppy, accusatory argument that medicine, as an organized profession and historical fallacy, plotted to hinder progress, resist life-saving innovations, and experiment with vivisection

[Arica · Rating 2 out of 5]

K. Codell Carter's books are far better in explaining the history and philosophy of medicine.

[Christina Miller · Rating 3 out of 5]

Extremely interesting but quite repetitive and difficult to follow at times.