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I read your article entitled ‘Metaphors, enemies and empathy’ with great interest and felt that this gave a fresh and compelling insight into the usage of military metaphors within general practice. During my medical degree I have been perplexed by the rhetoric of ‘magic bullets’ to fight ‘global combats against disease’ or ‘the war’ against ‘locally invasive’ and ‘aggressive’ tumours. Also, throughout my intercalated degree in the History of Medicine, I became increasingly interested in the historical context relating to the use of certain linguistic terms in clinical practice. In my dissertation, I chose to focus on the programmes of the British Empire Cancer Campaign, but here I will discuss this more generally.
Prior to the establishment of the cellular basis of disease, described by German biochemist Rudolf Virchow (1821-1902), the causes of illness were unclear. Treatment centred around re-establishing a balance throughout the entire body, whether this be through balancing humours or preventing rot. Owing to developments in technology and biochemistry during the nineteenth and twentieth centuries, the cause of disease was isolated to either a single or collection of cells. This delineation of normal versus diseased cells encouraged doctors to isolate and attack the ‘bad’ in order to protect the ‘good’. One modern example is in the resection of melanoma, where a safe margin is drawn around the growth akin to lines drawn on a battle map. However, Virchow warned about the risks of taking an increasingly pathology-focused approach opposed to treating the ‘whole patient’. Although in melanoma this approach is sufficient, it can become problematic in diseases such as hypertension, where a pill cannot ‘kill’ the disease if there is insufficient counselling of lifestyle and genetic factors. With multi-system chronic conditions on the rise, there may be a need to change the rhetoric.
By identifying enemies, we can declare war that, in turn, permits an organisation to take action that may be otherwise seen as extreme. Politically, this has been reflected through the British Government’s unparalleled response to COVID-19, taking steps to restrict civil liberties in order to overcome what the Prime Minister has called ‘the invisible enemy’. A similar approach has been taken by the Chancellor of the Exchequer, who justified his ‘unprecedented’ furlough scheme as assisting in our ‘greatest fight of peacetime’. War fosters utilitarian values, as the combatants are risking their lives for the greater good.
Medically, this is akin to the ‘carpet bombing approach’ of chemotherapy treatment, where the death of some resident cells is acceptable if the malignant cells are also killed. The above examples detail how if diseases are assailants and doctors are defenders of the great and good then patients become relegated to becoming battlegrounds. Hence it is easier to rationalise the mobilisation of medical treatments and government intervention that may be otherwise appeared to be excessive.
Dr. Salisbury and various other authors have discussed the effectiveness of such rhetoric therefore I will not attempt to assess this. However, there is no doubt that for the meantime, doctors and patients will continue to fight their foe, using the very best weapons to support them.
The military base within medicine - the usage of metaphors in medicine.
Dear Editor
I read your article entitled ‘Metaphors, enemies and empathy’ with great interest and felt that this gave a fresh and compelling insight into the usage of military metaphors within general practice. During my medical degree I have been perplexed by the rhetoric of ‘magic bullets’ to fight ‘global combats against disease’ or ‘the war’ against ‘locally invasive’ and ‘aggressive’ tumours. Also, throughout my intercalated degree in the History of Medicine, I became increasingly interested in the historical context relating to the use of certain linguistic terms in clinical practice. In my dissertation, I chose to focus on the programmes of the British Empire Cancer Campaign, but here I will discuss this more generally.
Prior to the establishment of the cellular basis of disease, described by German biochemist Rudolf Virchow (1821-1902), the causes of illness were unclear. Treatment centred around re-establishing a balance throughout the entire body, whether this be through balancing humours or preventing rot. Owing to developments in technology and biochemistry during the nineteenth and twentieth centuries, the cause of disease was isolated to either a single or collection of cells. This delineation of normal versus diseased cells encouraged doctors to isolate and attack the ‘bad’ in order to protect the ‘good’. One modern example is in the resection of melanoma, where a safe margin is drawn around the growth akin to lines drawn on a battle map. However, Virchow warned about the risks of taking an increasingly pathology-focused approach opposed to treating the ‘whole patient’. Although in melanoma this approach is sufficient, it can become problematic in diseases such as hypertension, where a pill cannot ‘kill’ the disease if there is insufficient counselling of lifestyle and genetic factors. With multi-system chronic conditions on the rise, there may be a need to change the rhetoric.
By identifying enemies, we can declare war that, in turn, permits an organisation to take action that may be otherwise seen as extreme. Politically, this has been reflected through the British Government’s unparalleled response to COVID-19, taking steps to restrict civil liberties in order to overcome what the Prime Minister has called ‘the invisible enemy’. A similar approach has been taken by the Chancellor of the Exchequer, who justified his ‘unprecedented’ furlough scheme as assisting in our ‘greatest fight of peacetime’. War fosters utilitarian values, as the combatants are risking their lives for the greater good.
Medically, this is akin to the ‘carpet bombing approach’ of chemotherapy treatment, where the death of some resident cells is acceptable if the malignant cells are also killed. The above examples detail how if diseases are assailants and doctors are defenders of the great and good then patients become relegated to becoming battlegrounds. Hence it is easier to rationalise the mobilisation of medical treatments and government intervention that may be otherwise appeared to be excessive.
Dr. Salisbury and various other authors have discussed the effectiveness of such rhetoric therefore I will not attempt to assess this. However, there is no doubt that for the meantime, doctors and patients will continue to fight their foe, using the very best weapons to support them.
Robert Cavanagh BMedSci
rxc570@student.bham.ac.uk
Competing interests: No competing interests