Remodelling Medicine

Do you ever feel vaguely uncomfortable about the dominance of biomedicine in our health system? Do you have a creeping anxiety about the ways in which we are incentivised to focus on diseases rather than people and are you concerned that biomedicine is creating public expectations and economic demands that are undeliverable? I suspect that many of us have these concerns, although we rarely surface them and even less frequently feel able to do anything about them. Biomedicine is powerful and persuasive, so much so that not only doctors but also many patients, policy makers, and system leaders act as if it is the only model on which to base health care.

If you share these nagging concerns then Remodelling Medicine is for you. And if you don’t then perhaps it is even more important that you read the book. The author, Jeremy Swayne, trained as a basic scientist and has worked as a GP, a teacher, a homoeopathist, and a church minister — a good pedigree to challenge medicine from both within and without. In an informative, passionate, and provocative way, Swayne takes us on his personal and professional journey, his battles with values, ideas, and paradigms. It is an aspirational book and a brave one.

Swayne describes how the preoccupation with the scientific method which underpins the practice of biomedicine has led to what he calls ‘a state of paradigm paralysis’. He talks much about the hubris of biomedically-oriented doctors and the need to exhibit greater humility if we are to be more effective in helping our patients. He suggests that we will only rediscover the healing vocation of medicine, we will only be successful in integrating science with caring, if we re-engage with other ways of thinking and knowing. He draws heavily on his expertise in the field of complementary and alternative medicine to illustrate what these other ways of acquiring knowledge could look like.

The book has a meandering style. The prose is sometimes repetitive, and frequent cross-referencing within the text can be distracting. But in many ways these criticisms reflect the joy of the book; the narrative mirrors Swayne’s journey and a rigorous edit may remove the soul of the story.

The author seems to me to adopt a rather narrow and stereotypical view of what science is about. He seems to conflate the design and intent of the scientific method, as a rigorous and systematic way of generating knowledge, with its application in practice. The latter, like all practice, is often imperfect and occasionally flawed. He confuses scepticism, one of the basic tenets of the scientific method, with dogmatism. Well-trained scientists reject ideology, work with ambiguity, and are sensitive to the strengths and flaws of the epistemologies underpinning their methods. Their challenges are not that different from those of grounded clinical practitioners.

But the more significant problem for me with Remodelling Medicine is that it isn’t clear who the book is meant to influence. If it is a manifesto, and it reads like one, then presumably the author has political intent. Is he trying to bolster the views of those who are already persuaded by the arguments, persuade those who are receptive to thinking differently, or convert the sceptics?

The latter is where a difference could really be made but the use of phrases like ‘psychic energy’ and ‘doctrine abuse’ are unlikely to engage those who hold power in the current system, the people who need to be persuaded if we are to challenge the dominance of biomedicine. The book is highly stimulating but I am not confident that it will change the world.

• © British Journal of General Practice 2013