Review

Treatments for foreign bodies

MEDICINE AND CULTURE: NOTIONS OF HEALTH AND SICKNESS
Lynn Payer
Gollancz, 1990, £4.99

Deep down, you’ve probably always harboured an irrational belief that foreign doctors don’t really know what they are doing. Well, this is the book to confirm your worst suspicions - but you may also come away from it wondering whether British doctors know either.

Lynn Payer is an American journalist who seems to have spent most of her adult life jotting down odd snippets of conversation gleaned from attendance at medical conferences throughout Europe and North America. The result is Medicine and Culture, an exploration of the ways in which medical practices in Germany, France, the US and Great Britain are shaped by the “national characters” of their respective countries.

Inevitably, there is a degree of stereotyping. The French appear obsessed with their crises de foie, the British with their sluggish bowels and the Americans with viruses and clean toilet seats.

But despite such caricatures, Payer manages to draw together an impressive range of oral evidence from witnesses in each country, attesting to the idiosyncrasies of their own and others’ medical cultures. She assembles a strong case that medicine everywhere - modern, clean, scientific medicine - is shot through with the philosophies, beliefs and practices of its own country.

In a sense, this is no surprise. We have always known, in a theoretical sort of way, that medicine is more art than science, as much a cultural product as national costume or cooking. Yet here are professors of immunology and famous surgeons telling us the same thing. Somehow, in the modern global village, we don’t expect such quaint customs to persist.

Examples range from the banal to the disturbing. The French are advocates of rectal thermometers, high birth rates and X-rays of everything. The Germans are anxious about their hearts, with widespread Herzinsuffizienzboosting prescriptions per capita for cardiac drugs to six times that of the British. The Americans wage medicine as they wage war, mercilessly and with little provocation. Though it remains unexplored here, chilling evidence emerges of the American covert operation against women’s bodies. Caesareans are the commonest operation in the US, hysterectomy the second commonest.

But what of the British? How do we fare in the eyes of others? Despite the rhetoric of the reformers, British doctors are noted as economical and empiricist. “The British do less of everything”, says Payer, citing our low rates of surgery in general and coronary bypass in particular. Doctors abroad see the parsimony of British medicine as a result of many years of state rationing, coupled with our stoical belief that death may, in any case, turn out to be preferable to life after all.

Though often speculative, occasionally off track and generally neglectful of the perspective of the patients, this is a highly readable book. One question lingers: why did the British invent the chilblain?