Wednesday, November 29, 2006

Idols have feet of clay

"Another event at Elsterhorst had a marked effect on me. The Germans dumped a young Soviet prisoner in my ward late one night. The ward was full, so I put him in my room as he was moribund and screaming and I did not want to wake the ward. I examined him. He had obvious gross bilateral cavitation and a severe pleural rub. I thought the latter was the cause of the pain and the screaming. I had no morphia, just aspirin, which had no effect. I felt desperate. I knew very little Russian then and there was no one in the ward who did. I finally instinctively sat down on the bed and took him in my arms, and the screaming stopped almost at once. He died peacefully in my arms a few hours later. It was not the pleurisy that caused the screaming but loneliness. It was a wonderful education about the care of the dying. I was ashamed of my misdiagnosis and kept the story secret."

From the same author:

“Population control should not be very expensive. Free contraception is unlikely to cost more than can be saved from prescriptions for vitamins and psychotropic drugs and as abortions place less demand on the NHS than childbirth there should be a net gain, unless the number of abortions rises much more steeply than the decrease in births”

-AL Cochrane. Effectiveness and Efficiency: Random Reflections on Health Services. London, The Nuffield Trust, 1972

As part of some research I've undertaken I’ve drawn upon the work of the man credited as being the father of evidence-based medicine, Professor Archie Cochrane. Both quotes are from his 1972 monograph, Effectiveness and Efficiency. The second quote smacks of the worst kind of Soviet-style totalitarianism.It brings a shudder to the soul when you read stuff such as this. Clearly on one level, as a physician Cochrane could be eminently humane, working in the worst possible circumstances. Similarly, he worked all his professional life after the war to improve the lot of miners in the Rhondda Fach, Yet when writing as a public health physician he could be so disregarding of human life.

Does this mean that I cannot use his work? I think not. His work to ensure that what doctors do is based on a firm epistemological base is a profound act of justice (to ensure that what we do ensures effective care and limits harm to patients). I set aside his views on “population control”, but it does temper my view of the praise heaped on Cochrane by the medical profession.

The web of our life is of a mingled yarn, good and ill together:
our virtues would be proud if our faults whipped them not;
and our crimes would despair if they were not cherished by our own virtues.
-All's Well That Ends Well, 4.3.84


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1:22 PM  

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