The Rise and Fall of Modern Medicine

James Le Fanu ★★★★★

This was a really interesting book!

I’m fascinated by biology and medicine, and I liked that the book is quite technical. It is really about modern medicine: practically, medicine after the 1930s or so.

There are separate chapters for different milestones in medical history: penicillin, cortisone, streptomycin, the discovery of the harmful effects of smoking, open heart surgery, hip replacements, cancer treatments, kidney transplants, and so on. Every chapter is truly fascinating.

There was one chapter which made me extremely curious and perhaps a bit sceptical: that of the Rise and Fall of heart disease. The chapter first highlights some signs of nutrition playing a big role in cardiovascular disease, but then seems to steer in a different direction, and suggests that it does not matter as much as we think, and that heart disease has an epidemiology curve which resembles that of an infectious disease. According to the author, it is extremely difficult to lower blood cholesterol by making changes in ones diet: substantial diet changes are required for minimal reductions in cholesterol level. It is an interesting chapter overall but it did leave me hanging, with only one short page about that potential infectious agent. Weird.

Do check out the Bradford Hill criteria on Wikipedia - it’s the set of principles that scientists use to establish causal relationships between an action (like smoking) and an effect (like lung cancer) - really interesting stuff.

The first edition came out in 1999. The second edition, published in 2011, contains a substantial epilogue that reflects on the ten years elapsed since the first publication of the book. I quite like that - the author reflects on some of the points made in the first iteration.