Michael Dixon, Kieran Sweeney

Radcliffe Medical Press, £17.95, pp 176 

ISBN 1 85775 369 0

Rating:

Ever since the Enlightenment, medical science has sought to regard the human body as an object that can be analysed scientifically, and its "defects" have been treated accordingly. The subjective experience of the human mind has been marginalised and the inextricable mutual dependence of body and mind within a unique individual ignored. Only now are we rediscovering the extent to which the objective body responds to the values, aspirations, and emotions of the subjective mind. Each individual has the capacity to respond to care and concern from others, and this is the foundation of "the human effect" in medicine. This book explores the increasingly impressive evidence of the power of this effect.

When threatened by the unpredictability of illness, the primordial human solution has been to seek out another individual in whom to place trust. Within this tradition, a strong empathic relationship between doctor and patient can help the patient to feel less alone and less afraid. When this happens patients can begin to feel more in control of their illness, more able to cope, and, thus, able to be themselves. Evidence suggests that this direct human effect is the basis of the long recognised power of the placebo. The emerging science of psychoneuroimmunology is showing us the pathways involved in this placebo effect. Dixon and Sweeney do us an enormous service by the coherence of their thesis and their painstaking collation of the relevant evidence.

However, their enthusiasm is such that they start to succumb to the Bevanite fallacy that the exploitation of these new realisations will lead to the control of illness and disease on a scale that will reduce the need for conventional health care. This remains far from proved, and their argument is weakened by an almost complete omission of any sociopolitical critique. This leads, ultimately, to the assertion that coronary artery disease can be largely prevented by changes in behaviour and attitude. This is dangerously simplistic in the absence of any analysis of the failures of social justice that underlie behaviour and attitudes and which generate poverty and powerlessness, culminating in illness, disease, and premature death.

The authors' exclusive reliance on science based knowledge makes the discussion of empathy seem a little superficial. Surely if medicine is, at last, to pay due regard to the subjective in human experience, it must begin to incorporate knowledge and wisdom from the long traditions of humanistic study in literature and art, where the subjective has always held the pre-eminent position.

Per Fugelli contends that "Medicine= biology × individuality × culture × (politics)²." The recent history of medicine has been dominated by biology. This book perpetuates the neglect of culture and politics but makes a major contribution in reasserting the vital importance of the individual capacity for healing.

Iona Heath, general practitioner. 

London