On the 14th of April 1972, the demographer and physician Thomas McKeown wrote to his friend, the epidemiologist and physician Archie Cochrane, to congratulate him on his new book, Effectiveness and Efficiency: Random Reflections on Health Services. In his letter, he praised Cochrane’s “splendid” book and its biting critique of the ineffectiveness and inefficiency of Britain’s National Health Service. It was of course not surprising that McKeown had found a lot to like: Cochrane had compiled his work on the back of McKeown’s own influential debunking of medical progress. Indeed, the book began with a paraphrase of McKeown’s central claim: It was not public health or acute care medicine that had tamped down infectious disease and given rise to the unprecedented population growth over the past centuries, but industrialisation and the improved economic conditions that attended it.
As McKeown had done, Cochrane rested his own charges on the evidence provided by data. For McKeown, the collection and interpretation of historical demographic data punctured the medical establishment’s assertion that improvements in health and longevity were largely owed to “medical progress.” For Cochrane, data was the (largely absent) proof of the woeful state of that medical progress in its current form. As Cochrane put it to McKeown in his reply, data – via the randomized controlled trials that Cochrane promoted - was “the only weapon we have to control the inflationary tendencies of the clinicians and I think we must make the best of it.”
Though medical data has primarily been given significance in terms of the role it played in framing and shifting medical knowledge itself in this talk I want to explore its place in the ideas of McKeown, Cochrane, and their sceptical predecessors and contemporaries - namely, as a means to expose and correct the worst tendencies of a perennially wayward profession. The real problem for them and others, as the journalist Ann Shearer succinctly put it, was that the public had been sold a fraudulent bill of goods (the NHS “rarely cures and does not care,” she wrote in her summary of Cochrane’s work). To these sceptics, data’s promise lay not only in improving effectiveness, but in forging a vital pathway toward accountability, transparency and responsibility.
About
Dr Caitjan Gainty is working at Kings College London, England. She is a historian of twentieth century health and healthcare. She co-runs the Healthy Scepticism project, which examines the work of past and present medical critics and sceptics, activists and reformers, and those dispossessed and disenfranchised by mainstream medicine and uses these findings toward healthcare reform now. She has also worked on medical films and film-making.
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What are SHEtalks
SHEtalks are a serial of informal research seminars held at Center for Sustainable Healthcare Education, University of Oslo. SHEtalks are research lunch lectures. The spring 2023 program was put together by researcher Gabriela Saldanha. Seminars take place at Thursdays at noon (GTM+1) unless otherwise specified. They may be delivered and attended in person or via zoom.