Medical Decisions: An Appeal for Reasonableness

Lewis Thomas wrote that when his father attended the College of Physicians and Surgeons of Columbia University at the turn of this century, medical teaching was just beginning to be influenced by the assertions of "therapeutic nihilism." This revolutionary thesis was a reaction to long-standing over-treatment by doctors with bleeding, cupping, violent purging, and the use of prescriptions compounded from long lists of bizarre substances and botanical extracts mixed together under the influence of nothing more than pure whim. The new teaching, led by William Osler at Johns Hopkins, argued that most of the remedies in common use were more likely to do harm than good: "There are only a small number of genuinely therapeutic drugs-digitalis and morphine the best of all." When Thomas himself entered medical school in 1933, very little had changed: "We were taught," he remembered, "that we could do nothing to change the course of the great majority of diseases we were so busy analyzing." Despite this confession of helplessness (and unlike earlier times when physicians were regularly criticized for their pretensions and their greed), the profession began to enjoy unprecedented social esteem. Burnham labeled the first half of this century "American medicine's golden age." Publicity about medicine became increasingly favorable. It came to be regarded as a model profession; opinion polls from the 1930s to the 1950s consistently ranked doctors equal to or higher than Supreme Court justices. In 1952, an elderly doctor remembered that when he was young, the townspeople of Worcester, Massachusetts, customarily tipped their hats, in a gesture of respect to the physician as he passed by.