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Physician-poets
THE LANCET 3
4 5
Rothman KJ (ed): Causal Inference. Epidemiology Resources Inc., Chestnut Hill, MA, 1988. Senn SJ. Falsificationism and clinical trials. Stat Med 1991; 10: 1679–92. Poole C. Feelings and frequencies: two kinds of probability in public health research. Am J Publ Health 1988; 78: 1531–33.
SIR—I was surprised to read,1 that research clinicians are suspected of having a secret method of translating their trial results into a language easily understood by their patients. The problem was solved with the introduction of the National Lottery in the UK, but the solution was so obvious that it did not seem worth publishing. The average layman knows that his chances of winning the lottery are small, but he also knows that “it could be you”, and he plays the lottery on that understanding. He or she can therefore easily understand, for example, that although the risk of death during coronary artery bypass is 1–2%, “it could be you”. I always now explain risks and benefits of surgery or other treatment on that basis, and it works very well without adding much to the consultation time. John Hampton Department of Cardiovascular Medicine, Queen’s Medical Centre, Nottingham NG7 2HU, UK
1
Editorial. And now all this. Lancet 1997; 349: 1.
Field of distinction
No of physicians
Poetry Fiction, general literature Scholarship, bibliography, scientific collecting Invention Crime Art, music The church Piracy Governors, administrators Philosophy Law, politics Explorers Sports, games Drama Philanthropy Aeronautics Ambassadors Saints The stage Soldiers Rosicrucianism
72 63 16 16 14 13 12 12 11 10 10 7 7 7 4 4 4 3 2 2 1
Doctors’ fields of distinction outside medicine
that medicine and poetry have a special affinity, although this may also, of course, reflect the greater ease of maintaining dual careers in the two than in, say, medicine and piracy or medicine and sainthood; and it may also be that the editors of the Dictionary of national biography (Monro’s principal source) are more sympathetic to including, for example, doctors who are also minor poets than doctors who are also minor criminals. Chris McManus Academic Department of Psychiatry, Paterson Centre for Mental Health, Imperial College School of Medicine at St Mary’s, London W2 1PD, UK
Physician-poets SIR—Do doctors have an exceptional interest or talent for poetry (Jan 25, p 275),1 or is it instead merely inevitable that by chance alone some good poets will also be physicians? Perhaps, even, there is some antipathy between the callings, so that the physician-poet is a peculiarly rare beast? Hard statistical information there may not be but an interesting resource is Thomas Kirkpatrick Monro’s The physician: as man of letters science and action,2 first published in 1933 with a second edition in 1951. The work provides classified biographies of 395 doctors who distinguished themselves in nonmedical fields, excluding 20 from America, 106 from Europe and elsewhere, and 17 “students of medicine who never qualified” who are not classified. Ignoring the 105 doctors also distinguished as scientists, since that almost seems part of the job description, and with the use of Monro’s own somewhat eccentric classifications, the table shows the various categories in descending order of frequency. That poetry is at the top of the list perhaps gives some support to the idea
Vol 349 • March 1, 1997
1 2
Jones AH. Literature and medicine: physician-poets. Lancet 1997; 349: 275–78. Monro TK. The physician: as man of letters science and action (2nd ed). Edinburgh: E&S Livingstone, 1951.
SIR—Although not intended to be exhaustive in coverage, it is regrettable that Jones’ article omitted Erasmus Darwin (1731–1802)—grandfather of Charles Robert—and arguably the greatest of the physician-poets.1 Through his The botanic garden (1789–91) and The temple of nature (1803), Darwin—the most eminent physician of his age, and a noted polymath (philosopher, botanist, inventor, evolutionist, and founder of the Lunar Society)—had a profound influence on the great romantic poets of the early nineteenth century,2,3 in particular, Wordsworth, Coleridge, and Shelley. As King-Hele3 has pointed out, they were especially influenced by: The loves of the plants (1789), The economy of vegetation (1791), and The loves of the triangles (1798). G C Cook Hospital for Tropical Diseases, London NW1 0PE, UK
1 2 3
Jones AH. Literature and medicine: physician-poets. Lancet 1997; 349: 275–78. Krause E. Erasmus Darwin. London: John Murray, 1879; p 216. King-Hele D. Erasmus Darwin 1731–1802. London: MacMillan & Co, 1963; p 183.
Psychiatric diagnosis in addiction treatment experiments SIR—The public health emergency of AIDS underlines the growing need for more medical treatment of substanceabuse-related disorders. Across-culture treatment of drug abuse has been found consistently to be a principal determinant in the prevention of the spread of AIDS. Furthermore, a galling limitation of AIDS prevention interventions is the prevalence of psychopathology in the target population, which curbs the effectiveness of services. Substanceabuse disorders have grown in medical importance and are now a focus for progress in psychiatry. However, progress in diagnosis is not reflected in treatment protocols. Treatment is often triaged to professions without the training to make a psychiatric diagnosis and effective clinical decisions:1 sympathy is scant for a person with a perceived self-inflicted disease. It turns to aversion if that person refused to conform to the patient role and comes from socially excluded populations. Substance abuse is life-threatening, but it has favourable recovery rates after treatment. Without intervention a progressive disease is often fatal. Patients drop out of treatment for many reasons. The lack of adequate psychiatric services to help the patient to cope with an underlying psychopathology needs to be addressed. In the Netherlands, clinical management of patients with a dual diagnosis of substance-related disorder and another psychiatric illness has become a priority because proposals for new treatments such as heroin maintenance are being planned. The addiction severity index (ASI), first validated in Europe on a Dutch addict population, showed high levels of psychopathology.2 Estimates by the Dutch National Council of Public Health indicate that 40–70% of the drug-using population show evidence of psychopathology in addition to substance-abuse diagnosis. In studies in home and clinical settings that use intensive time-sampling techniques, the daily lives of such people are characterised by hidden, undiagnosed psychopathology, detectable in mood disorders and craving behaviour.3 The
655
4 5
Rothman KJ (ed): Causal Inference. Epidemiology Resources Inc., Chestnut Hill, MA, 1988. Senn SJ. Falsificationism and clinical trials. Stat Med 1991; 10: 1679–92. Poole C. Feelings and frequencies: two kinds of probability in public health research. Am J Publ Health 1988; 78: 1531–33.
SIR—I was surprised to read,1 that research clinicians are suspected of having a secret method of translating their trial results into a language easily understood by their patients. The problem was solved with the introduction of the National Lottery in the UK, but the solution was so obvious that it did not seem worth publishing. The average layman knows that his chances of winning the lottery are small, but he also knows that “it could be you”, and he plays the lottery on that understanding. He or she can therefore easily understand, for example, that although the risk of death during coronary artery bypass is 1–2%, “it could be you”. I always now explain risks and benefits of surgery or other treatment on that basis, and it works very well without adding much to the consultation time. John Hampton Department of Cardiovascular Medicine, Queen’s Medical Centre, Nottingham NG7 2HU, UK
1
Editorial. And now all this. Lancet 1997; 349: 1.
Field of distinction
No of physicians
Poetry Fiction, general literature Scholarship, bibliography, scientific collecting Invention Crime Art, music The church Piracy Governors, administrators Philosophy Law, politics Explorers Sports, games Drama Philanthropy Aeronautics Ambassadors Saints The stage Soldiers Rosicrucianism
72 63 16 16 14 13 12 12 11 10 10 7 7 7 4 4 4 3 2 2 1
Doctors’ fields of distinction outside medicine
that medicine and poetry have a special affinity, although this may also, of course, reflect the greater ease of maintaining dual careers in the two than in, say, medicine and piracy or medicine and sainthood; and it may also be that the editors of the Dictionary of national biography (Monro’s principal source) are more sympathetic to including, for example, doctors who are also minor poets than doctors who are also minor criminals. Chris McManus Academic Department of Psychiatry, Paterson Centre for Mental Health, Imperial College School of Medicine at St Mary’s, London W2 1PD, UK
Physician-poets SIR—Do doctors have an exceptional interest or talent for poetry (Jan 25, p 275),1 or is it instead merely inevitable that by chance alone some good poets will also be physicians? Perhaps, even, there is some antipathy between the callings, so that the physician-poet is a peculiarly rare beast? Hard statistical information there may not be but an interesting resource is Thomas Kirkpatrick Monro’s The physician: as man of letters science and action,2 first published in 1933 with a second edition in 1951. The work provides classified biographies of 395 doctors who distinguished themselves in nonmedical fields, excluding 20 from America, 106 from Europe and elsewhere, and 17 “students of medicine who never qualified” who are not classified. Ignoring the 105 doctors also distinguished as scientists, since that almost seems part of the job description, and with the use of Monro’s own somewhat eccentric classifications, the table shows the various categories in descending order of frequency. That poetry is at the top of the list perhaps gives some support to the idea
Vol 349 • March 1, 1997
1 2
Jones AH. Literature and medicine: physician-poets. Lancet 1997; 349: 275–78. Monro TK. The physician: as man of letters science and action (2nd ed). Edinburgh: E&S Livingstone, 1951.
SIR—Although not intended to be exhaustive in coverage, it is regrettable that Jones’ article omitted Erasmus Darwin (1731–1802)—grandfather of Charles Robert—and arguably the greatest of the physician-poets.1 Through his The botanic garden (1789–91) and The temple of nature (1803), Darwin—the most eminent physician of his age, and a noted polymath (philosopher, botanist, inventor, evolutionist, and founder of the Lunar Society)—had a profound influence on the great romantic poets of the early nineteenth century,2,3 in particular, Wordsworth, Coleridge, and Shelley. As King-Hele3 has pointed out, they were especially influenced by: The loves of the plants (1789), The economy of vegetation (1791), and The loves of the triangles (1798). G C Cook Hospital for Tropical Diseases, London NW1 0PE, UK
1 2 3
Jones AH. Literature and medicine: physician-poets. Lancet 1997; 349: 275–78. Krause E. Erasmus Darwin. London: John Murray, 1879; p 216. King-Hele D. Erasmus Darwin 1731–1802. London: MacMillan & Co, 1963; p 183.
Psychiatric diagnosis in addiction treatment experiments SIR—The public health emergency of AIDS underlines the growing need for more medical treatment of substanceabuse-related disorders. Across-culture treatment of drug abuse has been found consistently to be a principal determinant in the prevention of the spread of AIDS. Furthermore, a galling limitation of AIDS prevention interventions is the prevalence of psychopathology in the target population, which curbs the effectiveness of services. Substanceabuse disorders have grown in medical importance and are now a focus for progress in psychiatry. However, progress in diagnosis is not reflected in treatment protocols. Treatment is often triaged to professions without the training to make a psychiatric diagnosis and effective clinical decisions:1 sympathy is scant for a person with a perceived self-inflicted disease. It turns to aversion if that person refused to conform to the patient role and comes from socially excluded populations. Substance abuse is life-threatening, but it has favourable recovery rates after treatment. Without intervention a progressive disease is often fatal. Patients drop out of treatment for many reasons. The lack of adequate psychiatric services to help the patient to cope with an underlying psychopathology needs to be addressed. In the Netherlands, clinical management of patients with a dual diagnosis of substance-related disorder and another psychiatric illness has become a priority because proposals for new treatments such as heroin maintenance are being planned. The addiction severity index (ASI), first validated in Europe on a Dutch addict population, showed high levels of psychopathology.2 Estimates by the Dutch National Council of Public Health indicate that 40–70% of the drug-using population show evidence of psychopathology in addition to substance-abuse diagnosis. In studies in home and clinical settings that use intensive time-sampling techniques, the daily lives of such people are characterised by hidden, undiagnosed psychopathology, detectable in mood disorders and craving behaviour.3 The
655