Abstract
The Rise and Fall of Modern Medicine has potential appeal for psychiatrists with an interest in the history and future of medicine. The book examines the paradox that achievements in post-war medicine have been many and phenomenal, yet medicine's future appears to be guarded. The ominous signs, according to the author, are that doctors are becoming increasingly disillusioned, that alternative medicine is soaring in popularity, that people are more worried about their health than ever in the past and that health-care costs are spiralling. Le Fanu attributes the imminent demise of medicine to the devaluing of clinical scientists, to our difficulty harnessing new technologies and to the fact that genuine breakthroughs in pharmacology are becoming rare.
Attributing cause and speculating about the future are pastimes that leave one exposed and open to criticism. Thus – among other examples – I find it difficult to accept Le Fanu's very notion that medicine, despite its many challenges, is in dire trouble, or that the introduction of important new drugs has slowed. My personal observations of the major changes brought about by novel antipsychotics and the rain of visits from representatives of the pharmaceutical industry suggest otherwise.
The book has a wealth of information about key events and figures in medicine's recent history. The style is racy. Indeed, psychiatrists will find the description of the discovery of chlorpromazine (listed among the ‘twelve definitive moments’ in post-war medicine) more engaging than many standard accounts. Unfortunately, other references to our discipline lack balance and perspective, and are too simplistic. In particular, the account of psychoanalysis is undeservedly damning and that of cognitive–behaviour therapy overly effusive (‘In contrast to psychoanalysis, cognitive therapy is simple, straightforward, lasts weeks rather than years, but above all permits the patients to make sense of and thus control their psychological problem. It also works …’). Such an appraisal leads me to wonder about the accuracy of the book's handling of other areas of medicine with which I am less familiar and thus, overall, makes me reluctant to recommend it.
Apology
In the last issue of the Journal we published an anonymous review of Assessment Scales in Old Age Psychiatry. The Publisher would like to extend apologies to Simon Stafrace, who is the author of the review. His name was incorrectly inserted into reference two, due to an error in production.