- Email: [email protected]
Douglas Young
Perspectives
Historical keywords Quack From the Dutch quacken, to prattle, chatter, and perhaps to sound like a duck, quacks were thick on the ground by the 17th century—commonly as “quacksalving physicians”. More or less interchangeable with “empiric”, “mountebank”, and “charlatan”, the label was often deployed by university-educated medical practitioners as a way to distinguish themselves from, and disparage as dangerous, those who advertised products on travelling stages and street corners, or in broadsheets. In a competitive medical marketplace, there were two key issues between quack vendors and the learned physicians. One was special recognition by the state, which no group had in the UK before the Medical Act of 1858. The public had to judge for themselves who was a proper practitioner. The accusation of quackery, therefore, was a way of doing down one’s commercial opponents. The second issue was the question of what constituted best practice. Up to the 18th century, learned physicians claimed that they provided individualised treatment for their patients by taking into account their constitutions and lifestyles. Quacks, by contrast, sold medicines for specific diseases and for all diseases, and advertised them as suitable for all types of patients. For instance, in the late 17th century Lionel Lockyer claimed that his pill “extracted from the rays of the sun” cured “All or Most part of the known Diseases and Distempers of Man”. Similarly, Anthony Daffy’s “elixir of health” acted on all kinds of diseases and was suitable for “all Ages, Sexes, Complexions and Constitutions”. Such products were often chemically based and were popular because they acted more immediately than the herbal remedies of learned practitioners. They were also cheaper than doctor’s visits and provided anonymity in the treatment of diseases like syphilis. Remedies such as Daffy’s began to be distributed across England by the late 17th century. Thereafter druggists and industrially based pharmaceutical companies followed the same philosophy of supplying remedies for specific diseases. Today we have a reversal of who is a quack. Establishment medicine prescribes medicine for diseases rather than treating the individual patient. “Alternative medicine” now fulfils that role and is at times linked to quackery. Perhaps the 20th-century colloquial use of quack, which emerged from Australia and the army to denote any doctor, is a comment on the claims of medicine of whatever kind.
Lunch with The Lancet Douglas Young
Andrew Wear
When I meet Douglas Young in a quiet Soho restaurant, he is still buoyant from the news that his team at Imperial College, London, UK, have just bagged US$11 million from multibillionaire Bill Gates to tackle the health problems of the world’s poor. His excitement is understandable—as research grants go, a Gates grant is as close to hitting the jackpot as it gets. Gates’ charitable foundation recently gave $437 million to top-level scientists around the world, including Young, to solve 14 Grand Challenges in public health. Young’s mission is to investigate latent tuberculosis—a form of Mycobacterium tuberculosis infection harboured by about one-third of the world’s population. Latent tuberculosis is something of a black box; scientists believe it lurks in the lungs, but no-one is certain. The drugs that target the active bacterium are useless against the inert, latent form. In places where people are often co-infected with HIV and M tuberculosis—Africa, for example—latent tuberculosis causes huge problems. Young explains that as the immune system, which suppresses the latent form, becomes ravaged by HIV, the bacterium can become active, speeding up the progression of HIV in the infected person. Young tells me how he was thrust into a first-hand experience of how infectious diseases devastate the lives of the poor during a stint working on leprosy in Mumbai, India, in the 1970s. He was one of several researchers around the world looking into ways to tackle the disease, including diagnostic tests to distinguish it from tuberculosis. But it dawned on him that although leprosy might have been top of the research zeitgeist at that time, tuberculosis was killing far more people. He switched to working on tuberculosis instead, and became “hooked”. “I can’t imagine working on any other disease”, he says. Young’s research project is one of many that are geared to achieve the Millennium Development Goals to be met by 2015, one of which is to halt and begin to reverse the incidence of tuberculosis. What will happen to funding for tuberculosis after 2015 is difficult to predict, but Young hopes it doesn’t go the same way as leprosy. In the 1990s, international efforts strove to eliminate leprosy as a global public health problem by 2000. As the new millennium dawned, money for leprosy projects dried up because of a perception that targets had been reached. Just before we leave the restaurant, I ask what he plans to do when he retires in 8 years. He is refreshingly honest: he plans to give it all up, kick back, and relax. And if, as is more than likely, Young and his team crack the problem of latent tuberculosis, he will have more than earned it.
Wellcome Trust Centre for the History of Medicine at UCL [email protected]
Priya Shetty [email protected]
www.thelancet.com Vol 366 October 1, 2005
1157
Historical keywords Quack From the Dutch quacken, to prattle, chatter, and perhaps to sound like a duck, quacks were thick on the ground by the 17th century—commonly as “quacksalving physicians”. More or less interchangeable with “empiric”, “mountebank”, and “charlatan”, the label was often deployed by university-educated medical practitioners as a way to distinguish themselves from, and disparage as dangerous, those who advertised products on travelling stages and street corners, or in broadsheets. In a competitive medical marketplace, there were two key issues between quack vendors and the learned physicians. One was special recognition by the state, which no group had in the UK before the Medical Act of 1858. The public had to judge for themselves who was a proper practitioner. The accusation of quackery, therefore, was a way of doing down one’s commercial opponents. The second issue was the question of what constituted best practice. Up to the 18th century, learned physicians claimed that they provided individualised treatment for their patients by taking into account their constitutions and lifestyles. Quacks, by contrast, sold medicines for specific diseases and for all diseases, and advertised them as suitable for all types of patients. For instance, in the late 17th century Lionel Lockyer claimed that his pill “extracted from the rays of the sun” cured “All or Most part of the known Diseases and Distempers of Man”. Similarly, Anthony Daffy’s “elixir of health” acted on all kinds of diseases and was suitable for “all Ages, Sexes, Complexions and Constitutions”. Such products were often chemically based and were popular because they acted more immediately than the herbal remedies of learned practitioners. They were also cheaper than doctor’s visits and provided anonymity in the treatment of diseases like syphilis. Remedies such as Daffy’s began to be distributed across England by the late 17th century. Thereafter druggists and industrially based pharmaceutical companies followed the same philosophy of supplying remedies for specific diseases. Today we have a reversal of who is a quack. Establishment medicine prescribes medicine for diseases rather than treating the individual patient. “Alternative medicine” now fulfils that role and is at times linked to quackery. Perhaps the 20th-century colloquial use of quack, which emerged from Australia and the army to denote any doctor, is a comment on the claims of medicine of whatever kind.
Lunch with The Lancet Douglas Young
Andrew Wear
When I meet Douglas Young in a quiet Soho restaurant, he is still buoyant from the news that his team at Imperial College, London, UK, have just bagged US$11 million from multibillionaire Bill Gates to tackle the health problems of the world’s poor. His excitement is understandable—as research grants go, a Gates grant is as close to hitting the jackpot as it gets. Gates’ charitable foundation recently gave $437 million to top-level scientists around the world, including Young, to solve 14 Grand Challenges in public health. Young’s mission is to investigate latent tuberculosis—a form of Mycobacterium tuberculosis infection harboured by about one-third of the world’s population. Latent tuberculosis is something of a black box; scientists believe it lurks in the lungs, but no-one is certain. The drugs that target the active bacterium are useless against the inert, latent form. In places where people are often co-infected with HIV and M tuberculosis—Africa, for example—latent tuberculosis causes huge problems. Young explains that as the immune system, which suppresses the latent form, becomes ravaged by HIV, the bacterium can become active, speeding up the progression of HIV in the infected person. Young tells me how he was thrust into a first-hand experience of how infectious diseases devastate the lives of the poor during a stint working on leprosy in Mumbai, India, in the 1970s. He was one of several researchers around the world looking into ways to tackle the disease, including diagnostic tests to distinguish it from tuberculosis. But it dawned on him that although leprosy might have been top of the research zeitgeist at that time, tuberculosis was killing far more people. He switched to working on tuberculosis instead, and became “hooked”. “I can’t imagine working on any other disease”, he says. Young’s research project is one of many that are geared to achieve the Millennium Development Goals to be met by 2015, one of which is to halt and begin to reverse the incidence of tuberculosis. What will happen to funding for tuberculosis after 2015 is difficult to predict, but Young hopes it doesn’t go the same way as leprosy. In the 1990s, international efforts strove to eliminate leprosy as a global public health problem by 2000. As the new millennium dawned, money for leprosy projects dried up because of a perception that targets had been reached. Just before we leave the restaurant, I ask what he plans to do when he retires in 8 years. He is refreshingly honest: he plans to give it all up, kick back, and relax. And if, as is more than likely, Young and his team crack the problem of latent tuberculosis, he will have more than earned it.
Wellcome Trust Centre for the History of Medicine at UCL [email protected]
Priya Shetty [email protected]
www.thelancet.com Vol 366 October 1, 2005
1157