Medical pieties

Second Opinion: doctors, disease and decisions in modern medicine

Richard Horton <em>Granta, 256pp

Richard Horton was appointed to the editorship of the Lancet, the second most prestigious medical journal in the world, at a younger age than any previous editor. Perhaps this explains why his importance is exceeded only by his self-importance.

Not all the essays in this collection of his writings are bad, but only one of them is good: "The Danger Zone", an extended review of a memoir by an intensive care physician, first published in the New York Review of Books. For the most part, reading Horton is like being harangued by the missionary from the British Humanist Association who used to set up his stall every Sunday at Speakers' Corner: he was intelligent, but you couldn't help thinking there was something missing.

What is missing from Dr Horton's writing (apart from humour: there is not one intentional joke in more than 500 pages) is originality. If you want a compendium of contemporary pieties, expressed in language that makes the work of 18th-century Anglican divines seem exciting, this book is for you. There is virtually no modern orthodoxy to which he does not subscribe. He wants the Royal Society, the scientific organisation with probably the most distinguished record in the whole of human history, to be ethnically monitored: that is to say, to choose its fellows according to racial criteria.

Horton does not always have the courage of his platitudes. He often sounds like a medical Tony Blair, who gives two sides of an argument separated by a wilderness of words, not so much in recognition of the complexity of things, but to avert criticism. Thus he informs us that access to information on the internet is profoundly liberating for the patient, but a few pages later states (quite rightly) that much more than raw information is needed to make wise medical decisions. This being the case, information - and misinformation - on the internet is just as likely to provoke anxiety and foolishness as it is to liberate, but this thought is far too contentious for Horton.

There is no plumbing the shallows of Dr Horton's thought. He is against misery and poverty, but seems to think that doctors, beyond curing or alleviating illness, have some special providential role to play in the betterment of the world. But while good health is obviously desirable, it is not, as he thinks it is, a precondition of development. My father was born in a London borough at a time when its health indices were worse than those of most third world countries today. But Britain was not undeveloped when he was born.

Horton writes sometimes as if health itself were an inalienable human right, and sometimes as if healthcare were such a right. But if health itself were a human right, then all human life would be an infringement of our rights, since disease and death are inescapable parts of the human condition. On the other hand, healthcare cannot be a human right, because it is a tangible benefit brought about by human endeavour. There cannot be an inalienable right to a house in a society in which no one builds houses. A society in which the sick are cared for is more humane, in this respect at least, than one in which they are not, but that is all that can or need be said.

The well-meaning banality of Horton's judgements soon starts to grate. Just because they are banal, however, doesn't make them right. He attributes terrorism to injustice and poverty, and therefore believes that the elimination of injustice and poverty is a step towards the eradication of terrorism. But the perpetrators of the attack on the World Trade Center were not poor, and most of them came from a country that, it could be argued, would be much poorer if there were more justice in the world, since its wealth is derived from its geographical location more than from the efforts of its population. Only a very unimaginative person supposes that justice necessarily results in people behaving better or being better off.

Horton believes that the utterance of fine sentiment is nine-tenths of virtue. His book is accordingly unctuous, self-righteous and dull. Furthermore, though this is the fault of his publisher, it is exceptionally unpleasant as a physical artefact - yet is by no means cheap.

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