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Failing the Ailing Ment of the Subjects, Depending on Their Math- Ematical Backgrounds NATURE|Vol 443|21 September 2006 BOOKS & ARTS advances in supernova research brought about by observations of SN 1987A. Different readers may want different treat- Failing the ailing ment of the subjects, depending on their math- ematical backgrounds. Longair’s discussion of Bad Medicine: Doctors Doing Harm Since in the light of his fundamental new insight. For Einstein’s general theory of relativity, for exam- Hippocrates the notion that there is any sort of continuity in ple, provides sets of equations that may scare by David Wootton the medical enterprise is fundamentally mis- off non-physicists. But most of his treatments taken, he declares: we need to develop a his- Oxford University Press: 2006. 320 pp. are non-mathematical, and many are human- £16.99, $25 tory of error, albeit often honest error, followed ized with quotations. For example, Longair not by a new history of triumph. This latter alone only points out that Jocelyn Bell first recog- Andrew Scull constitutes “the modern history of medicine, nized the signals we now know as pulsars, but David Wootton has made a truly remarkable grounded in constantly developing scientific describes how he was present when the Soviet discovery that he can’t wait to share with the understanding”. astrophysicist Iosif Shklovsky told her, “Miss rest of us: medicine didn’t work very well for A small fraction of the book is devoted to Bell, you have made the greatest astronomical millennia. Indeed, it almost certainly didn’t medicine’s successes: Lister’s development of discovery of the twentieth century” (at least as work at all. For most of recorded history, it antiseptic surgery, John Snow’s work on cholera far as 1970, when the encounter took place). seems, doctors secretly did little except harm in the mid-nineteenth century, and the advent Those familiar with the history of the discus- their patients while pretending to cure them. of antibiotics, especially penicillin. For the most sion over credit for the discovery may note that “Before 1865 all medicine was bad medicine,” part, however, Wootton’s eye falls on medicine’s he gives Antony Hewish, Bell’s supervisor who he writes in his book, appropriately called Bad failures and missteps. For two thousand years, shared the 1974 Nobel prize for physics for his Medicine. But then came Joseph Lister and the galenic and hippocratic approaches domi- work on pulsars, an acknowledgement for read- antisepsis, Louis Pasteur and germ theory, nated Western medicine. The remedies they ing the chapter from which this book sprang. and Alexander Fleming (or was it Howard proffered, Wootton reminds us, were painful Longair also tells the story of an under- Florey?) and penicillin. And from that point and actively harmful, except to the degree ground seminar (literally, given its location on, science was in place, medicine worked, and that they produced placebo effects. Of course, in the basement of the Leiden Observatory in we entered an era of continuing progress and there were developments in the understanding the Netherlands) in 1944, at which Jan Oort enlightenment. of human biology and in medical technology asked a young H. C. van der Hust to calculate Unfortunately, Wootton laments, benighted in these years: Andreas Vesalius produced his whether any spectral lines would be detectable medical historians have somehow overlooked stunning work on human anatomy; William in the radio part of the spectrum. Longair’s dis- this state of affairs. Instead they have either Harvey discovered the circulation of the blood; cussion describes the result (a spectral line at constructed narratives of progress when Antonie van Leeuwenhoek and others used 21 cm) and explains how it was used to map the medicine wasn’t progressing, or (in a perverse microscopes to reveal the world of the infinitely quasi-spiral arms of the Milky Way. He then reversal extending over three decades now) small; René Laennec invented the stethoscope; describes the subsequent detection of 125 dif- have decided that it’s wrong to write tales of and François Magendie, Claude Bernard and ferent molecules in the interstellar matter, and heroes and villains that describe an onwards- others used unspeakably cruel vivisections to explains how the unexpected relationships of and-upwards march to scientific nirvana. explore the physiology of the body. But none of their abundances led researchers to deduce The sources of this historiographic perver- these developments led to therapeutic progress, how the molecules were formed. sity are never clearly articulated, nor are many and those that might have done so (such as the The section on exoplanets — unfortunately of the offending historians identified by name, ability to see germs) went unexploited for dec- only a subsection of the chapter on the inter- for Wootton’s is a blanket condemnation. He ades, even centuries. stellar medium — explains the importance of alone has been privileged to see the true state The brief sketches Wootton provides of high-precision spectroscopy, and starts with of affairs, and henceforth the history of disease these and other episodes in the long reign of the pulsar planets discovered by Aleksander and its treatment will have to be radically recast error are rendered deftly and vividly. When he Wolszczan and Dale Frail. Longair then dis- cusses the first optical detections of exoplan- ets by Michel Mayor and Didier Queloz, and a chapter endnote directs readers to The Extra- solar Planets Encyclopaedia if they want to keep up-to-date. I think it would have been fair to LIBRARY WELLCOME also mention the extensive work in the field by Geoff Marcy and Paul Butler, and their ency- clopaedic website at www.exoplanets.org. Little of astrophysics and cosmology escapes the gaze of Longair, a former astronomer royal for Scotland who now heads the Cavendish Laboratory in Cambridge, UK. Readers, espe- cially those already familiar with many of the topics, will enjoy his prose. Certainly all gradu- ate students in the field should read this book. And anyone interested in the history of science would enjoy it as bedside reading if they were willing to skip the equations. ■ Jay M. Pasachoff was president of the International Astronomical Union’s Commission on Education and Development, and is at the Hopkins Observatory, Williams College, Williamstown, Massachusetts 01267-2565, USA. A saw point? Some medical practices may have done more harm than good. 275 ©2006 Nature PublishingGroup BOOKS & ARTS NATURE|Vol 443|21 September 2006 attempts to address larger themes, however, men — “doctors were determined no scientific Perspective (Harvard University Press, 1986). things do not always go so well. Frequently he discovery would alter their traditional thera- His global characterization of the state of medi- points to missed opportunities to exploit the pies of bleeding, purging, and vomiting” — are cal history strikes me as woefully wide of the implications of technical advances and key crude and unsatisfying. He claims that medical mark — the subtle relationship between sci- discoveries. He cites as examples the long hia- historians have glorified the link between the ence and medicine requires a far deeper under- tus between the discovery of bacteria and the laboratory and advances in basic science but standing than anything on offer here. And his link to infectious disease, and the shorter but overlooked the fact that these discoveries led to assertion that the history of modern medicine still significant gap between the first observa- no immediate therapeutic advance. But this is can be reduced to a paean to scientific progress tions of the antibacterial effects of Penicillium simply false, as would be made clear by a quick is a recipe for bad scholarship, of which there is moulds in the 1870s and Florey’s development perusal of such sources as William Bynum’s already far too much in the world. ■ of a therapy that worked in the 1940s. Science and the Practice of Medicine in the Nine- Andrew Scull is in the Department of Sociology, But Wootton’s attempts to blame these fail- teenth Century (Cambridge University Press, University of California, San Diego, 9500 Gilman ures on the blinkered self-interest of medical 1994) or John Harley Warner’s The Therapeutic Drive, La Jolla, California 92093-0533, USA. A miracle in sight Adam Elsheimer painted the starry heavens in 1609. Martin Kemp The lynx is renowned for its sharp sight. So when the Accademia dei Lincei in Rome bound its inaugural documents into a single volume in 1603, the young German artist Adam Elsheimer provided a painted image of a lynx as its frontispiece. Founded by the ALTE PINAKOTHEK, MUNICH PINAKOTHEK, ALTE Roman nobleman Federico Cesi, the new academy was dedicated to the sciences of Earth and the heavens, and provided a vital forum for Galileo and a cluster of leading intellectuals who were reforming the way that science was conducted. Elsheimer had travelled a long way in a short time, both geographically and intellectually. The son of a tailor in Frankfurt, he travelled via Venice to Rome, where he settled by 1600. He was quickly cultivated by a circle of avant-garde thinkers and artists, including the Flight into Egypt back on the left (and partly obscured here), Rubens brothers, Peter Paul (shown here), two peasants tend a blazing fire that shoots (the painter) and Philipp characteristically fusillades of sparks high into the night air. (a humanist scholar). The painted on copper. The scene was painted in 1609, a year former wrote emotionally on Within its small before Galileo published his telescopic Elsheimer’s early death in 1610 that compass of just 31 observations. Given the circles in which “he had no equal in small figures, in 41 cm, Elsheimer frames Elsheimer moved, it is highly likely that he landscapes, and in many other subjects”.
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