Dr. Golem: How to Think about Medicine

259 Pages·2005·0.93 MB·English

by  Harry Collins

DR. GOLEM

HARRY COLLINS & TREVOR PINCH
DR.GOLEM
HOW TO THINK ABOUT MEDICINE
THE UNIVERSITY OF CHICAGO PRESS • CHICAGO AND LONDON
HARRY COLLINSis distinguished The University of Chicago Press, Chicago 60637
research professor of sociology at The University of Chicago Press, Ltd., London
Cardi¤ University, where he also directs © 2005 by The University of Chicago
the Center for the Study of Knowledge, All rights reserved. Published 2005
Expertise, and Science. Printed in the United States of America
TREVOR PINCHis professor and chair 14 13 12 11 10 09 08 07 06 05 1 2 3 4 5
of the Department of Science and ISBN: 0-226-11366-3 (cloth)
Technology Studies and professor
of sociology at Cornell University. Library of Congress Cataloging-in-Publication Data
Collins, H. M. (Harry M.), 1943–
Dr. Golem : how to think about medicine / Harry
Collins and Trevor Pinch.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-226-11366-3 (cloth : alk paper)
1.Medicine, Popular. 2.Medicine—Philosophy.
[DNLM:1Sociology, Medical. 2.Consumer Par-
ticipation. 3.Delivery of Health Care. 4.Physician-
Patient Relations.] I.Pinch, T. J. (Trevor J.) II.Title.
RC81.C6952005
616(cid:2).001—dc22
2005001621
øThe paper used in this publication meets the mini-
mum requirements of the American National Stan-
dard for Information Sciences—Permanence of Paper
for Printed Library Materials, ANSI Z39.48–1992.
Contents
PREFACE AND
ACKNOWLEDGMENTS vii
INTRODUCTION Medicine as Science and
Medicine as Succor
1
1
The Hole in the Heart of
Medicine: The Placebo E¤ect
18
2
Faking It for Real:
Bogus Doctors
35
3
Tonsils: Diagnosing and
Dealing with Uncertainty
61
CONTENTS
vi
4
Alternative Medicine: The
Cases of Vitamin C and Cancer
84
5
Yuppie Flu, Fibromyalgia, and
Other Contested Diseases
112
6
Defying Death:
Cardiopulmonary
Resuscitation (CPR)
132
7
The AIDS Activists
153
8
Vaccination and Parents’
Rights: Measles, Mumps,
Rubella (MMR), and Pertussis
180
CONCLUSION The Themes Revisited
205
NOTES 225
BIBLIOGRAPHY 235
INDEX 241
Preface and
Acknowledgments
In the two earlier volumes of the Golemseries we set out our claim
that the products of science and technology are better thought of
as “industrial diamonds” rather than brightly polished jewels—
science, as we explained, is often untidy and messy. Science is a
golem. As we said in the first volume in this series:
A golem is a creature of Jewish mythology. It is a humanoid made by
man from clay and water, with incantations and spells. It is powerful.
It grows a little more powerful every day. It will follow orders, do your
work, and protect you from the ever-threatening enemy. But it is
clumsy and dangerous. Without control a golem may destroy its
masters with its flailing vigor; it is a lumbering fool who knows nei-
ther his own strength nor the extent of his clumsiness and igno-
rance.
A golem, in the way we intend it, is not an evil creature but it is a
little daft. Golem science is not to be blamed for its mistakes; they are
our mistakes. A golem cannot be blamed if it is doing its best. But we
must not expect too much. A golem, powerful though it is, is the
creature of our art and of our craft.
To clear up a frequent misreading, it is not the danger of the golem
to which we refer but its well-meaning clumsiness. vii
PREFACE AND ACKNOWLEDGMENTS
viii This claim about the clumsiness of science comes as less of a
novelty in the case of medicine than in the case of physics and the
like because death and illness are always with us, so we know that
medicine is fallible.1 The really hard question that remains is,
“Knowing medicine is fallible, what should we do?” In the cases of
science and technology looked at in our earlier volumes, we sug-
gested that the biggest change needed was in perception. If the
public knew how science and technology really worked, they
would be better at making choices that turned on these issues, and
this would eventually a¤ect their lives, mediated, for example, by
the way they acted at the ballot box. The di¤erence in the case of
medicine is that, as individuals, we do not have the luxury of wait-
ing for “eventually.”
To put this another way, the authors of the two earlier books in
this series had two kinds of relationships with their material. In
the bulk of the case studies, we redescribed episodes of science
and technology where others had done the primary research; in
some of the cases, however, we did the primary research ourselves.
In this book we find we have a still greater intimacy with the mate-
rial. In several of the chapters we find ourselves mentioning our
own involvement in medical dramas, major or minor. We find
ourselves discussing our own decisions about what to do in a way
we never had to in the earlier two volumes. Indeed, the disagree-
ment between the authors in the matter of vaccination, indicated
in the last substantive chapter of the book, twice came within a
whisker of ending the entire project, until we found a way of ex-
pressing two di¤erent views about medical choice within the one
analytical frame. Dr. Golemhas, then, been a much harder book to
write than The Golemor The Golem at Large;the two earlier books
were less involving—less direct. Here we have to decide what to do
as well as what to think.And we could have used many more ex-
amples from our own experiences: the doctor whose view of treat-
ment was so completely “scientized” that he treated diagnosis as a
“fault tree,” and never examined the patient himself (one of the
authors) but sent him for an x-ray and looked at nothing but the
technical report. That bad doctor put one of us through an agoniz-
ing summer before a pharmacist explained how to handle the ex-
cruciating symptoms of the not very serious underlying damage.
We could have described the complete failure of orthodox medi-
cine to cure a chronic bad back, misdiagnosed and wrongly treated
with drugs, the resolution of which was begun with a simple ma-
nipulation by a chiropractor. We could have described the unrea-
sonable pressure put on one of us to have a serious operation
when mild medication proved suªcient to alleviate the symptoms
if not the cause.
Generalizing from this kind of personal experience is danger-
ous, however. Because orthodox medicine represents the “oªcial”
view, it is its occasional failures that make the headlines, not its
steady successes. For each of these cases of failure, there are many
more where the pharmacist’s advice or the alternative medical
treatment would fail, whereas medical sciencewould get it right.
For each case of overenthusiasmfor a radical intervention, there
are one or more cases where any kind of intervention was wisely
advised against—including one which would have put money in
the pockets of a private consultant. Indeed, both authors and their
families have benefited many more times, and just as strikingly,
from their regular doctors’calm prognoses, sound recommenda-
tions, and even from the occasional display of brilliant diagnostic
virtuosity.2Knowing, as all of us must, that even if we are lucky
enough to have had few such experiences in our lives, the time will
come when the failing body will start to ask serious questions, we
have tried to find a way through the tangle of an imperfect medi-
cine that can often work dramatically well. Just pointing to the
problems would not be good enough. We have felt obliged, if not
to find a solution, at least to provide materials and arguments that
help us think better about issues.3 ix
PREFACE AND ACKNOWLEDGMENTS