History will be the judge

The most important lesson of history is that we don't learn
the lessons of history. Modern medicine is practised by and
large in an existentialist way as if nothing went before
and that only a wonderful road of “progress” stretches
before us. As a chest and sleep physician who has final
medical students doing one to one rotations with me, I
start the first day with what had led up to our current
notions of pulmonary physiology starting with the Greeks.
Whereas the occasional final year student knows who first
"sorted out" the circulatory system, not one has ever told
me who "sorted out" the lungs, when did he live and what
other minds and discoveries led up to this and filled out
the picture thereafter. Who discovered oxygen and what does
the word mean?

From an intellectual perspective, we cannot appreciate the
lungs and how they work without knowledge of what was
happening between the 17th and 19th century or for that
matter in Classical Greece which so dominated medical
thinking for so long. Indeed the French word for a chest
physician, <<pneumologue>>, encompasses an atavistic memory
of all that went before in the world of respiratory
medicine; pneuma + logos. Herodotus was amazed at the
Egyptians doctors of his time who had super-specialised,
long before modern trends millennia later. It is like a
wine buff ignorant of the terroire or history of a vintage.
If we claim to be intellectuals (I believe most doctors are
not), we should act the part. This is called “higher
learning”. “Doctus” by name, “doctus” by nature? Yes, even
intellegentia?

Imagine a master craftsman of the 17th century knowing
nothing of the history and development of his craft. It
would be inconceivable in a traditional Australian
Aboriginal culture for a person not to know his own
"Dreaming" or the traditions of that tribe which date back
to the Dreamtime (our version of the Big Bang or The
Creation Story).

In Western medicine, we practice in a historic vacuum as if
the past never existed and there was never a time before a
HRCT chest, stress "echo" or serum BNP. To put it in a
linguistic paradigm, it is as if we only now the present
tense and not the aorist, imperfect let alone the
pluperfect and heaven forbid such uncertainties of the
subjunctive or the optative. We look forward only to the
future tense.

We older physicians can see the passage of medical history
in their time. I have just written an autobiography of
childhood in the house of a country G.P. in the 1950s and
recount my father's haemoglobinometer and how he tested
urine for glucose and protein over a methylated spirits
burner and how he developed his own radiographs in a
hospital dark room....and that was in my lifetime.

My daughter who is majoring in mediaeval history hopes to
do post-graduate work at Cambridge. A relative asked me the
other day, "What will she do with that?" I was speechless.
I thought to myself, she might even do medicine, God bless
her.

Without knowing the history of our craft we run the risk of
becoming medical Laundromats; the dollar in the slot
approach; vocationally trained like existential marketing
managers or stock-brokers.

As for Australia and our war on the ravages of tobacco, I
believe we have lost our rage as doctors. When I visited
Greece in 2008 it was like travelling back in a legislative
time machine and was appalled at the numbers of doctors
smoking at a medical conference and the billboards
advertising thin cigarettes smoked by thin young female
models.

We must maintain our rage. Inertia by both government and
the medical profession in Australia meant it took fifty
years for asbestos to become the bête-noire. Some of my
older colleagues were employed by asbestos companies to
review men still working in asbestos factories.

Tobacco is now the rabbit in the spotlight and as the word
“Smoko” for morning tea is relegated to the annals of
Australian linguistic history.

Competing interests:
None declared

Editor,

"As members of a profession not always known for its humility, we
need to remember and understand the blind alleys that medicine has gone
down, the unnecessary suffering it has caused, the important innovations
that have been ignored or suppressed ...."

How true Dr Godlee.

There is no better example of a blind alley than the blind faith in
the fabricated medical "triad" - encephalopathy, retinal and subdural
haemorrrhages - which has been and still is the cause of much suffering.

Today I received this message –

"The children have been ripped apart from their family for more than
two and a half years now. During every visit, the children ask their
parents the same question: “Are we going home yet?”

Michael Innis

Competing interests:
As previously declared

While I won't pretend to understand the unpredictably of fashion
trends, the idea that the tobacco industry would so actively oppose a
measure that could increase smoking is baffling. Surely, if plain
packaging had an inherent risk of becoming "cool" the tobacco industry
would have long ago stripped their boxes of pretty pictures and eye
catching imagery. If plain equals cool, the industry would have gone there
long before any health minister.

In the early 1990's the industry tried to raise this same argument as
a reason why governments should not enact plain packaging. Board members
and stockholders would have demanded such a measure if it meant a smoking
frenzy would result.

Plain packaging does not mean that cigarettes will be sold in
gleaming white boxes that speak to your inner fashionista. Plain packages
will be dominated by graphic health warnings - a measure we know already
works to discourage smoking, even when competing with the appealing visual
elements of a cigarette pack.

Plain packs are not next year's little black dress but a policy that
completely robs the tobacco industry of its style.

Competing interests:
None declared