The best books about how medicine should be

Every book by Annemarie Mol is good but The Logic of Care is simply the best book on what medicine should be. It is short, deceptively simple but leaves no hiding places. Everyone will be able to understand it in the same way from a teenager up through a Professor of Medicine to a Minister for Health but don’t expect any Ministers to admit to reading it any time soon. Mol outlines a relationship-based rather than technology-based medicine. How do we ensure medical techniques help us to live the lives we want to live rather than force us to live lives that suit the companies that make the technologies want us to live? How do we care for people rather than service them?

Medicine loves stories about heroic men who made breakthroughs that have saved lives and given us the life expectancies we have today. It has never celebrated women and yet it was a woman, Josephine Baker, who in two decades starting in 1908, by focusing on antenatal and postnatal care, laid a basis for saving lives that has given us the life expectancies we have today. She did so against fierce opposition from doctors who argued that creating conditions that make infants and children healthy would be bad for medical business. Now that life expectancies are falling, and were falling before Covid, we desperately need to recover Baker and her insights. Her book written in 1939 gives clear hints of how unimpressed she would likely be with today’s medical business.

Modern medicine has dramatically extended life expectancies. But as our life spans extend, our fear of death grows. As our hope of living a long life and seeing our children survive grew, we became more rather than less anxious about losing out. We might have expected the opposite. Aries vividly illustrates how people viewed death as a part of life before the nineteenth century and how they reconciled themselves to it. He picks out 1886 as the point where Tolstoy in The Death of Ivan Illych recognized that medical advances were creating anxiety rather than hope. This book may make you less fearful of death. It will ask you whether you can now achieve serenity half as well as those before us did and whether medicine is bad for our sanity? 

Most of us figure doing evil, even if good results, is not ethical but without this, there would be no medicine. Martin Pernick covers the discovery of anesthesia and the ethical dilemmas this new ability to save lives by poisoning people posed. Anesthesia is a technique and techniques are amoral. How do we ensure they enhance rather than diminish us? How do we avoid seduction into a sleep during which we can be cosmetically enhanced? Is there a limit to how many drugs we give children to manage their behaviour – just because we can? Treating and stopping are not the same as not treating. Pernick doesn’t tell us how to manage this calculus, but he makes us aware modern life involves more of a calculus than we might have thought.   

AIDS was the pandemic before Covid. Unlike Covid, it mobilized people to take the science and efforts to find a cure into their own hands – especially people on the fringes of society. Nothing like this had ever happened before. It appeared to mark a watershed where medicine would become a servant of the people rather than people being enslaved to its commercial priorities. Sadly this is not how things worked out. The discovery of Triple Therapy was a high point of modern medicine but we have gone downhill since then with few if any drugs saving lives the way Triple Therapy did. Impure Science shows you vividly what we are up against.