Virginia Bottomley says managers can learn from an optimistic book that records the pace and causes of change in the huge health industry. The Rise & Fall of Modern Medicine by James Le Fanu - Little, Brown & Company £18.99.
The Rt Hon VIRGINIA BOTTOMLEY, MP - was health secretary, 1992-95.
Many management best-sellers are about getting through a job interview, writing a CV or preparing for the next job. Dr James Le Fanu is more concerned with avoiding unnecessary early exit from this life. He records great events, selecting 12 definitive moments in 45 years from the second world war. After describing the rise of modern medicine and the end of the age of optimism, he gets into the brave new world of genetics, and considers the seductions of social explanations linked to lifestyle, pollution and poverty before winding up with his conclusions from learning from the past and looking to the future.
The assault on disease has been an achievement equal to the success of modern management, and the book will be interesting to managers seeking to understand the pace and causes of change that affect one of the world's biggest industries. The principle remains: find what works and spread good practice.
This means cutting out waste. In the history of medicine, he points out that it is now almost impossible to imagine life in 1945, when death in childhood from polio and whooping cough were commonplace, there were no drugs for tuberculosis, schizophrenia or rheumatoid arthritis, or indeed for virtually every disease the doctor encountered. He describes developments that brought immeasurable benefits, including greater freedom from the fear of illness and untimely death, and the amelioration of the chronic disabilities of ageing.
The themes are the decline in infectious disease, the widening scope of surgery, key developments in the treatment of cancer, mental illness, heart disease and infertility, and improvements in diagnostic techniques.
The author is more than dogmatic. He notes four paradoxes which may seem incompatible with medicine's recent success: Why are doctors disillusioned?
Why are people who are enjoying better health growing more concerned about their health?
Is there a state of 'healthism' - a medically inspired obsession with trivial or non-existent health threats? Why should the demonstrative success and effectiveness of modern medicine be associated with soaring popularity of alternative medicine?
What about spiralling costs of healthcare: does the financial largess of the past 10 years (his words) suggest that it is incorrect to believe that more generous financing alone could solve the problems of the health service?
Le Fanu also lays into what he identifies as insupportable assertions by experts. The reader may get the message that a chief medical officer need not lay down the law on what is the safe number of lamb chops that may be eaten. We learn also that air pollution from traffic is unlikely to be a full or even a partial explanation for increased asthma in children, because locations without significant traffic have experienced equal or greater increases in the affliction.
Then we have to accept that modern medicine has pushed the major burden of illness to near the end of life. The odd thing about illnesses in middle years, such as adult diabetes, rheumatism, MS, Parkinson's and others, is that their causes are unknown. Enigmatic origins render them impossible to cure or prevent. Yet.
This interesting book ends with an optimism that may be challenged in part by others in medicine. Le Fanu contends that doctors will in future be less likely to regret their choice of career, that the public will have fewer reasons to be unduly concerned for their health, and that the limited prospects of future medical advances should by now be recognised so there is no need for costs of medical care to continue to spiral upwards. 'Thus, the present discontents of medicine may be resolved and its future guaranteed.'
I hope that the good doctor, and those who in part may not agree, will all live long enough to realise the extent to which Le Fanu is right.