In a 30-part radio series (15 mins per episode), Andrew Cunningham from Cambridge University offered a fascinating insight into the history of modern medicine. The series was first transmitted on BBC Radio 4 over a six-week period in February and March 2007 (see here for episode guide). I only managed to catch the final two episodes, The Crippler and Transplant, but both contained fascinating bioethical conundrums.
The Crippler tells the story of polio, and more specifically, the development of vaccine against the virus. Ethical dilemmas included whether to use a killed virus or a live-attenuated virus (in fact both were developed) and suitable timing to swap from animal testing to human testing of the vaccine. There was a genuine risk that these early vaccines might have inadvertently led to infection with an active or reactivated form of the virus, so who to include in the human trials was also an issue. The decision made in 1950s America was to innoculate the residents of a home for mentally handicapped children! As subsequent history shows, the vaccine turned out to be effective and mass innoculation programmes followed.
Transplant begins with Christiaan Barnard’s pioneering work on heart transplantation in 1967-68 (see BBC News report at time of his death in Sept 2001 – requires realplayer). Cunningham asks to what extent those early pioneering operations can be considered successful in a medical sense (as opposed to proof or principle about surgical techniques, for example) and to what extent present day success in transplantation is, in fact, dependent upon breakthroughs in immunosuppresive drugs made in the late 1970s. He raises questions about the overall place of transplantation in modern medicine – it absorbs a large slice of the resources available to medicine, it captures the public imagination, but for all of that involves a very small percentage of patients.
The final episode closes with some more general reflections on the ethical and social implications of medicines increasing adoption of science and technology. These include the shift from focusing on the individual and their personal symptoms, to emphasising the disease, with the patient reduced to the role of someone who has the disease. Cunningham talks about medicine as an arena in which the division between rich and poor has been broken down – disease A is the same whatever our bank balance. Personally, I think that this is rather an oversimplification; our likelihood of being struck down by certain illnesses is definitely not evenly distributed across classes, and our subsequent ability to garner resources to challenge the disease is also proportional to our income.
Other bioethical conclusions are rather less controversial. The programme highlights the increasing reliance on machines in medicine (there is a nice poem written by an unnamed dialysis patient which echoes the marriage vows, beginning “do you take this machine, in sickness and in health…”). Transplant technology has also prompted a re-evaluation of what it means to be an individual in an age where we have exchangeable internal organs, and a change in the definition of death, from a focus on heartbeat pre-1968, to brain death or indication of irreversible coma.
Sadly, as a joint Open University production, the Making of Modern Medicine series is not covered by the Educational Recording Act and as such copies cannot be purchased from the BUFVC (OU programmes require a separate licence). The BBC has, however, released it as a Radio Collection for personal use. It seems like the sort of series that is highly likely to be re-broadcast at a later stage, so it may be worth setting up a TRILT alert so that you can catch it when repeated.