An idiot's guide to medicine

Emyr Gravell

doi:10.3399/bjgp08X342606

Just when I thought I was getting used to my children growing up in unexpected quantum leaps my teenage daughter wrong-foots me by doing the opposite. She seems to have suddenly regressed to a toddler, sitting in the car singing merrily along to a nursery rhyme tape. Instead of the sounds of Rihanna, The Pussycat Dolls, or McFly, she's treating us to Polly Put the Kettle On, Little Miss Muffet, and the Grand Old Duke of York, as we speed along to our holiday destination. This holiday has been a regular annual event since the children were tiny. Singing along to these familiar songs used to be part of the desperate strategy to keep them entertained for the trip but now it's happily metamorphosed to become part of the ritual of excited anticipation of the holiday.

Happy childhood events become treasured emotional landmarks. Hearing my daughter's carefree singing transports me back to my childhood when the intense joy of being away from it all on holiday could seem like heaven on earth. I get a deep satisfaction from feeling that we are sowing similar happy memories in to our children.

Unfortunately it does cut into a few days of school time. We have permission from the school but they have to hand out a letter from the Welsh Assembly, sending us to the parent's naughty corner. The Education Minister patiently briefs us on the importance of education and the dangers of our children missing school. Only an idiot could object to its logical argument.

So here are my objections. Education is not just about knowing that Bejing is the capital of China or what happened in 1066 — important though this is. The word apparently comes from Latin meaning to draw out and doesn't mean to cram in. For my children this brief time away has once again worked that mysterious alchemy of imagination and memory that embeds something special in their young personalities, something that will, I hope, be a part of them maturing as more secure, more rounded people.

Only an idiot could quibble with the spectacular advances in scientific and evidence-based medicine, but the search for scientific objectivity can swamp the power of our imagination and creative belief.

The doctor and journalist Ben Goldacre, is a tireless promoter of rigorous evidence-based medicine and destroyer of junk science. Recently he presented a couple of radio programmes on the placebo effect. He showed that this went much further than curious responses to harmless sugar pills, but more fundamentally revealed the power of the human imagination to have astonishing therapeutic effects. Effects as diverse as numbing severe pain or causing the body to act as if a pacemaker had been inserted. He also pointed out that there could be a reverse effect. For instance, patients who were not told that they were getting post-operative morphine had nowhere near the same analgesic effect as those who knew. In the drive to measure, target, and be accountable the human spirit and imagination is sidelined. We are complex beings, not robots and I don't think we respond to robot doctors despite Lord Darzi's apparent enthusiasm for R2D2 ward rounds.

There doesn't have to be a conflict. Fire and water, two good servants but bad masters, said the proverb on my primary school classroom wall.

Evidence-based medicine is the same, it needs to stay a valuable servant not as the master often imposed on us by politicians, admindroids, or even occasionally colleagues who have moved to the dark side. ‘Cum scientia caritas’ (‘Science with compassion’) puts it succinctly. I don't know if my memory is playing tricks but I'm sure that the motto used to be prominent on anything published by the College but now when I look it seems to have disappeared from the website and the Journal cover.

Maybe Latin mottos are also only for idiots.