Beyond Science

The suprascientific in clinical medicine: a challenge for Professor Know-All

BMJ 2001; 323 doi: http://dx.doi.org/10.1136/bmj.323.7327.1452 (Published 22 December 2001) Cite this as: BMJ 2001;323:1452
  1. F I D Konotey-Ahulu ([email protected]), visiting consultant physician
  1. Cromwell Hospital, London SW5 0TU

    I first heard of him half a century ago. He is one of those people who become more articulate, more cocksure, and more formidable in debate the older they get. Continental Europeans call him Erik the Genius. Although he is highly esteemed in the United Kingdom, he impresses Americans less. I call him Professor Know-All because every time a new fact emerges in science or medicine, he has expected it. Nothing puzzles him. So I decided to see what he would make of these four case histories.

    Inherited age of death

    A 58 year old Indian merchant working in an African country was admitted to hospital with severe retrosternal pain radiating upwards and down the right arm. His wife and 35 year old son were with him when electrocardiography confirmed posterior myocardial infarction. He believed he was about to die. Before treatment was started, he said: “Doctor, you know I am 58. My elder brother died three years ago, aged 58 years. My father died at 58 years. His younger sister, my auntie, also died in India at 58, and…” I interrupted him, thinking it amazing how superstition creeps into scientific medicine: “You are not going to die, sir. You need a good night's sleep. Just say good night to your wife and son.” “And my grandfather,” he continued from where I had interrupted him, “father's father, collapsed and died of a heart problem, I am told aged 58 years.”

    After I sent his wife and son out of the private room, she asked me to let her stay with him overnight. But the received wisdom in those days did not allow relatives to sleep in. In Britain, even mothers were sent away from their babies. Britain was the gold standard; why should anyone prescribe less for an African country? The son pleaded with …

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