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Analysis Essay

How medicine has exploited rationality at the expense of humanity: an essay by Iona Heath

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5705 (Published 01 November 2016) Cite this as: BMJ 2016;355:i5705

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Re: How medicine has exploited rationality at the expense of humanity: an essay by Iona Heath

Iona Heath's essay, sensitive, worldly and wise, is everything one could hope for, and more, from an intuitive doctor, with a lifetime in primary care.

Iain McGilchrist explored in fascinating detail, the ways in which our right and left cerebral hemispheres interact and influence our perceptions and attitudes. He wondered, in his last chapter, what the world would look like if the left hemisphere became so far dominant that it managed to suppress the right hemisphere’s world altogether ? (1)

Iona Heath’s essay is a succinct response, intended or not, to McGilchrist’s question.

Her table of the ‘Two sides of the consultation’ is almost a juxtaposition of the respective views of the hemispheres. Modern medicine is moving towards the domain of the left hemisphere, where the broader view gives way to a narrower, more detailed but restricted focus.

We hourly, and gratefully, utilise the enormous advantages that flow from applying scientific and technological advances in our community and hospital roles, but our very familiarity with those pathways reminds us that many of the primary care patients we see deserve to be guided away from, protected from, routine over-active, intrusive medicalisation.

Heath’s concerns reecho the plea of Oliver Sacks, forty years ago, “ ..it is the fundamental business of caring for patients - recognising their individual needs and problems, responding to the uniqueness of each situation - which constitutes the first and last duty of being a doctor... the Juggernaut advance of contemporary medicine .. needs a humanisation of its power -- before it is too late.“ (2)

Heath, previously a columnist for the BMJ and a President of the RCGP, is too charitable to comment on the dehumanising efforts of those two institutions.

She briefly refers to the need for publication of more qualitative research, without mentioning the recent negative response of the BMJ to an unprecedentedly large and almost unanimous postbag of requests from readers, asking for more qualitative papers. (3) Nor is there mention of the platform that the BMJ has provided for the abuse of colleagues who choose the very same patient-directed approach that Heath seems to point us towards. (4)

Clinicians, Heath points out, have a responsibility, “to enable sick people to benefit from biomedical science while protecting them from its harms.”

The prescribing of psychotropic drugs is a contentious issue. A vital source of income for the pharmaceutical companies, the appropriateness of much psychotropic prescribing is a cause for serious concern because evidence of their benefit rests, often, on equivocal trial results, and on our profession’s unwillingness to digest the mounting evidence of damage, and deaths, that result from psychotropics. (5,6)

Recent comments on the RCGP’s approach to sponsorship of its meetings, moved the chair of the Council of the College to point out that they have “a robust sponsorship policy that is fully in line with ABPI guidelines.“ (7)

The ABPI represents UK pharmaceutical companies, whose first responsibility is to maximise shareholder return on capital.

If people with mood disorders, PMT, menopausal symptoms, IBS, Fibromyalgia, etc, seek advice from their GP, and leave with an SSRI prescription, are they made aware of all psychotropic safety issues, and RCGP sponsorship details ? And are they informed of other treatment options ?

Perhaps Iona Heath should resume her BMJ column ?

1 Iain McGilchrist, The Master and his Emissary, Yale 2009.
2 Oliver Sacks, British Clinical Journal, January 1974
3 http://www.bmj.com/content/352/bmj.i563
4 http://www.bmj.com/content/351/bmj.h5624/rr-6
5 Peter C Gotzsche, Deadly Psychiatry and Organised Denial. Peoples Press 2015.
6 David Healy http://davidhealy.org/
7 Maureen Baker http://www.bmj.com/content/355/bmj.i5585/rr-0

Competing interests: No competing interests

07 November 2016
Noel Thomas
gp retd/locum
Bron-y-Garn Maesteg Wales CF34 9AL