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Interesting Article on the Clash of Science and Medicine

Discussion in 'Pre-Medical - MD' started by HQAMIGO, Jul 19, 2006.

  1. HQAMIGO

    HQAMIGO Resident
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    View Article http://www.thetriplehelix.org/features/356

    Hey Guys,

    We are an undergraduate run science journal that has chapters at many universities across the US and the world. Here is an interesting article about the intersection of medicine and science. If you are interested to join us, please email our editor in chief his email can be found at:
    http://www.thetriplehelix.org/staff-board


    TEXT:

    At the Crossroads of Science and Medicine
    02/16/06

    A Review of Arrowsmith by Sinclair Lewis.
    The Designer Publishing Company. Inc. 1925.


    Haoming Qiu
    Cornell University

    The dazzling technological and scientific complexity of the modern practice of medicine hides the fact that as recently as one hundred years ago, medicine and science were not only totally separate fields, but were often at odds with one another. The decades between the Civil War and World War II saw a momentous transformation of American medicine. The ancient art of healing the sick, derived from thousands of years of experience, originally stemming from Galen and Hippocrates was being supplanted by the modern science of medicine. These new theories were based upon 19th century breakthroughs in physics, chemistry and biology, as well as methodologies that depended upon the technological wonders of industrialization. To accommodate this significant increase in complexity, the simple country doctor who single handedly took care of all bodily complaints, was replaced by today’s massive medical institutions with its hundreds of specialties and multi-million dollar budgets.


    PHOTO Hippocrates: Ancient Greek Healer.
    Courtesy of wwwihm.nlm.nih.gov

    As with many times of change, this period in the history of American medicine was characterized by a lack of rules and regulations. This was a chaotic time in which physicians of the old order practiced alongside scientific men of a new age, along with charlatans and quacks whose passion for pseudoscience was only matched by their greed. Arrowsmith by Sinclair Lewis tells the story of Martin Arrowsmith, a physician who struggles to maintain his integrity and honesty while bringing American medicine to the age of science. Arrowsmith was published in 1925 and immediately garnered both critical acclaim and financial success. In 1926, Lewis was offered the Pulitzer Prize for Arrowsmith, which he turned down–only to further increase the publicity of the novel.

    The central plot in Arrowsmith focuses on the life of Martin Arrowsmith, from the time he first enters medical school to his final rejection of medicine and realization of his true calling as a scientist. His singular determination to understand the physical basis of biological phenomena and his abject refusal to accept any inconclusive or incomplete data causes Martin to become disillusioned with early 20th century medicine, which was heavily based on anecdotal evidence or questionable experiments. On his way to fulfilling his true calling, Martin is tempted by corrupt elements of society. Money, prestige and women all attempt to lure Martin away from science, but his desire for truth and knowledge proves to be stronger. With the help of his wife, the faithful Leora, and his mentor, the caustic but ingenious Dr. Gottlieb, Martin is able to overcome these distractions to realize his true potential as a scientist.

    Written with the help of a scientist from Rockefeller University, Lewis, whose grandfather was a physician, is able to describe many nuances of the medical profession, both technical and social. Overall, Arrowsmith is highly critical and satirical of the establishment. Many doctors are portrayed as imbeciles who neither understand nor care to learn about the revolutionary changes in human understanding of biology and disease. When Martin first arrives at his medical school, he discovers that “he knows far more of physics and chemistry than many of his medical instructors and finds himself surrounded by glib-memoried, poorly prepared ignoramuses who shine by reason of their parrot-like ability to reel off an enormous number of facts crammed out of textbooks.” Even worse, Lewis portrays many physicians as caring more about making money than curing patients. In one passage, Lewis describes a professor at Martin’s medical school lecturing to his students that “Nothing is more important in inspiring [the patient] than to have such an office that as soon as he steps into it, you have begun to sell him the idea of being properly cured.”

    In contrast, scientists are portrayed in much more a favorable light. Max Gottlieb, Martin’s professor of bacteriology in medical school and his lifelong mentor, is portrayed as an extremely honest and upright man who refuses to accept anything less than absolute truth in scientific investigation. He lives in a small shack on the outskirts of the university and spends all of his time in research instead of giving speeches at dinner clubs or fraternizing with local elites. Lewis’s portrayal of Gottlieb is based upon a factual scientist of the time named Jacques Loeb. It is no coincidence that Gottlieb is German rather than American. As it can be seen throughout the novel, American physicians, and even scientists, are portrayed unflatteringly as mere social climbers, while true knowledge and intellect are often embodied by Europeans.


    PHOTO Lewis portrays doctors as social climbers.
    Courtesy of www.doc.missouri.gov

    Many critics, including both physicians and scientists, have commented on the lack of realism inherent in Lewis’ portrayal of physicians as purely bad and scientists are purely good. The physician William Ober called the characters in Arrowsmith “one dimensional and drawn in the crude linear manner of a cartoonist.” Lewis clearly had an agenda to debase the physician and promote the scientists. However, the question remains why Lewis would want to purposefully degrade one of America’s most cherished professions. The reason, as we shall see, is twofold. First, is Lewis’ belief that American medicine has yet to deliver on the miracles that it has often promised. Lewis’ dark portrayal of is a reminder of how far this country lagged behind Europe in incorporating science into medicine at the turn of the century.

    Secondly, on a more metaphorical level, Lewis’ portrayal of physicians as corrupted resulted from his desire to satire the entirety of the corrupt and decadent American society in the 1920’s. Charles Rosenburg asserts in his criticism Martin Arrowsmith: The Scientist as Hero that Lewis’s selection of the scientist as the hero of the novel in is a reflection of his rejection of the materialism and superficial culture prevalent in America during the 1920’s. Then as now, physicians represented the elite of American society. Their very image is that of social status, wealth and power. Thus, by exposing the corruption of the medical profession, the very bulwark of respectability in American society, Lewis implies that the rest of society is even more corrupt and decadent. The scientist, on the other hand represents a detachment from society. In the pursuit of his narrow research topic and his singular focus on an intractable and unbending truth, the scientist rejects the compromises that oil a well functioning society. Thus, the spirit of the individual researcher, expressed in his tenacity, rugged individualism and refusal to submit to social authority was what Lewis felt to be the antidote to the American society of the 1920s and its fixation on social status and wealth.

    Eighty years after initial publication, many of the critiques of the medical profession in Arrowsmith remain true today. Rising health care costs, the mass exodus of a large percent of the population to alternative medicine, and the implication of physicians and medical journals in pharmaceutical safety scandals show that the physician class has not completely reached its altruistic ideals. However, the lack of hard evidence in medicine that led to its inevitable clash with science, as observed in Arrowsmith, has been greatly diminished.

    Today, the integration of science in clinical medicine, medical research and medical education in many of our nation’s academic medical centers and teaching hospitals is impressive. The National Institutes of Health spends millions each year supporting dual degree MD/PhD programs that attempt the bridge the gap between medicine and research. Licensing exams require would-be doctors to comprehend a larger body of scientific knowledge than ever before.

    In conclusion, Arrowsmith should be treated as a historical document that addresses many of the problems facing American medicine as it transitioned from an unregulated system full of inconsistencies and loopholes to our system today, which while admittedly imperfect, is one of the most advanced in the world.

    References:

    1. Lewis, Sinclair. Arrowsmith. New York: Harcourt, Brace and World, Inc., 1925.

    2. Rosenberg, Charles E. “Martin Arrowsmith: The Scientists as Hero.” Twentieth Century Interpretations of Arrowsmith. Ed. Robert J. Griffin. Englewood Cliffs, NJ: Prentice-Hall, Inc., 1968.

    3. Ober, William B., MD. “Arrowsmith and the Last Adam.” Twentieth Century Interpretations of Arrowsmith. Ed. Robert J. Griffin. Englewood Cliffs, NJ: Prentice-Hall, Inc., 1968.
     
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