Defenders of Prince Charles' continuing campaign for the integration of complementary therapies within the NHS have criticised prominent specialists, who declared their opposition to this campaign, on the grounds that they did not include any GP or other representative of primary care.1 These specialists have been condemned as ‘old-fashioned’ because they do not believe that patients' interests would be served by doctors retreating to modes of treatment, most of which were superseded by modern medical practice more than a century ago. It is bizarre that what is now considered progressive in medicine is a willingness to pursue the hobbyhorses of the heir to the throne and his endorsement of techniques such as homeopathy, the most efficient way yet discovered of turning water into money, as described memorably by Tony Copperfield in a recent Doctor column.
It is indeed sad to see no GP signatory to breast surgeon Michael Baum's letter challenging Prince Charles' truly reactionary campaign. It is also regrettable to note that there appears to be no prominent GP backing for the Oxford Pro-Test campaign in favour of experimentation on animals and against the attempts by animal rights activists to intimidate those involved in the construction of new research facilities. By contrast, it is noteworthy that one of the leading supporters of the campaign is neurosurgeon Tipu Aziz, a pioneer in research and treatment for Parkinson's disease.
James Parkinson, who described the eponymous disease in his celebrated 1817 work, An Essay on the Shaking Palsy, was of course a GP in Hoxton, in what is now the London Borough of Hackney, just down the road from my surgery.2 Parkinson was a man of the Enlightenment, a radical who was a suspect in the ‘Pop-Gun Plot’ to kill George III (with a poison dart) in 1794, a geologist and fossil hunter as well as a physician and surgeon. He offers a model for our confused times.
Parkinson's description of the ‘shaking palsy’ is a masterpiece of clinical observation. Yet it begins and ends with an appeal ‘to those who humanely employ anatomical examination in detecting the causes and nature of disease’ to ‘extend their researches to this malady’. He pays tribute to the anatomists: ‘to such researches the healing art is already much indebted for the enlargement of its powers of lessening the evils of suffering humanity. Little is the public aware of the obligations it owes to those who, led by professional ardour and the dictates of duty, have devoted themselves to these pursuits, under circumstancesmost unpleasant and forbidding’.2 What a contrast with contemporary discussions of human dissection, in which popular distaste is generally met by professional defensiveness.
A recent work of medical history, which offers a welcome challenge to the prevailing post-modernist relativism by embracing the concept of progress in medical science, nevertheless echoes current prejudices in disparaging the anatomists and physiologists of the past for ‘mangling the dead, torturing the living’.3 The author condemns Claude Bernard's pioneering 19th century experiments on animals—generally acknowledged as the foundation of modern physiology—as ‘gruesome and grotesque’. Yet medical understanding—and medical treatment—of conditions such as Parkinson's disease have advanced over the past 200 years through both dissection and vivisection, often in the face of public hostility. Following the localisation of the ‘proximate cause’ of Parkinson's disease in dopamine depletion in the substantia nigra in the midbrain (Parkinson suspected the medulla oblongata in the brain stem), it has become possible to relieve some of the symptoms of the condition with the dopamine precursor L-dopa and with dopamine antagonists. In part, through experimenting on monkeys, Tipu Aziz and others have developed ‘deep brain stimulation’ through implanted electrodes, a technique from which 40 000 people have already benefited.
Instead of seeking royal patronage or pandering to fashionable prejudices (whether for alternative health treatments or against experimentation in any form), today's doctors would better follow the robust republican, democratic and scientific principles of James Parkinson, the Jacobin GP of Hoxton Square.
- © British Journal of General Practice, 2006.