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Book review: saints and sinners within the healing arts 'Island Practice' and 'Charlatan'.

Island Practice: Cobblestone Rash, Underground Tom, and Other Adventures of a Nantucket Doctor

By Pam Belluck

Hardcover, 274 pp, PublicAffairs, 2012

Two non-fiction books trace recent and past medical personalities reflecting polar opposites, each expressing variations on the theme of good versus evil.

For the former trait, in Island Practice, you read about 68-year-old Dr. Timothy J. Lepore who does practice on an island, Nantucket Island. He is both expert surgeon and old-fashioned family doctor.

Immediately Lepore reminded me of Dr. Sam Abelman from the novel and movie, The Last Angry Man, who, like Lepore, was a noble anachronism. Abelman quotes Thoreau. Both Abelman and Lepore aspire to Thoreau's lifestyle. Abelman grows corn in the backyard of his office-home sitting amid the poverty and squalor of the decaying Brooklyn neighborhood where he practiced. Leporc, like Thoreau, treks through the woods, hunts, and arrives at some of his home calls. He also arrives at becoming an expert in Lyme disease and other tick-borne disorders.

In other settings, both Abelman and Lepore speak out against the quacks, against the "galoots," against those conscienceless drug companies concerned only for profit, and against a medical world driven by insurance companies and health care chains.

With Lepore you can also find a touch of Lucas Marsh from the 1950s novel become movie, Not as a Stranger, a modicum of the TV neurosurgeon Ben Casey and a touch of Marcus Welby and Dr. Kildaire, even a bit of the seeming curmudgeon Dr. House seeps in at times.

But above all, like Dr. Sam Abelman (Last Angry Man) and like Thoreau, Lepore marches to the beat of his own drummer. For instance, you will read about a scalpel he carved out of obsidian (granite-like black volcanic glass).

Idiosyncrasies aside, he is scrupulously honest, caring, old fashioned, and unconventional in the sense that besides making house calls, he accepts payment at times per the old barter system. Above all, he is competent, the doctor we all thought we aspired to emulate until reality intruded its ugly countenance.

The book has many chapters telling of his medical escapades and the characters he befriends along the way, not unlike Thoreau roaming through the woods of Walden Pond. Possibly there are a bit too many vignettes because before long you get it. On the other hand, this is a story that must be told.

In the last chapter, Lepore's smaller community hospital on the island has been taken over by a larger healthcare chain. He must make some kind of compromise and more or less conform. That issue rages on supplying dynamic material for another book. What seems clear, sadly, is that a Dr. Lepore may not only be a dying breed but one that is soon to become extinct.

Not so extinct, however, rather like the cancer cell that has learned the secret of eternal life, so too has the not-so-fine art of quackery thrived over the ages. In fact, the subtitle of the next book Charlatan, "the age of flimflam" is misleading because medical flimflam has existed throughout the ages.

Charlatan: America's Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam

By Pope Brock

Softcover, 324 pp, Crown Publishing Group, 2008

In the story Charlatan the focus is on a unique, if not malevolent, flimflammer, John R. Brinkley (1885-1942), a "doctor" with dubious medical credentials coupled with a persona of rather dubious grata 'n clinical terms, a sociopath.

Brinkley enters the field of quackery with his virility treatments, specifically the transplant of goat testicles into the scrotums of farmers complaining of their seeming decline in virility.

The book is fast-paced despite having to cover much ground. The author's sentences are well-crafted often with a sense of wry humor, sprinkled here and there with both irony and euphemisms.

The reader is given some of the history of late 1800s and 1900s quackery with a few respectable scientists inadvertently adding their names to that ignoble gallery. For example, mentioned in the book is Dr. Charles-Edouard Brown-Sequard, a prominent neurologist and researcher who ferreted out the pathology of what would be labeled the Brown-Sequard Syndrome, where there is hemi-section of the spinal cord giving sensory symptoms on one side of the body and motor on the other side. Another "finding," the product of his research, was where Brown-Sequard claimed to have regained his previous virility after eating extracts of monkey testis.

Many other "scientists" devised their own variations on the theme of animal testicles. But Brown-Sequard, whose purported regain of virility was likely placebo effect since his work could not be scientifically replicated; nevertheless, it was a serendipitous venture leading to sex-gland research with later isolation of testosterone and steroids. Speaking of serendipity, as a result of its battles with Brinkley, the American Medical Association would grow to become a more viable oversight body in medicine.

Back to Brinkley--he would meet his waterloo at the hands of Morris Fishhein, muckraking editor of the Journal of the American Medical Association. Having made anti-semitic remarks about his ardent pursuer it was Brinkely who had the chutzpah to sue Fishbein for defamation, a suit Brinkley would lose, while at the same time suffering public exposure revealing him for what he was. That and a high casualty rate among his patients ultimately destroyed Brinkley.

But he put up a good fight along the way. Even earlier, 1930, undaunted by having lost his medical license, three days later he announced his candidacy for governor of Kansas, narrowly losing. He would also open an unregulated one million-watt radio station in Mexico from which he could broadcast his "cures" statewide. And in 1939 he was one of the dignitaries at Hollywood's premier showing of Gone with the Wind.

How did he get away with it as long as he did? One clue not developed in the book is manifest in the story of Harry Hoxsey. Hoxsey, if I may digress, was one of Berkley's aides and is only mentioned briefly at the beginning of chapter 27. Hoxsey had devised a mixture of herbs as a cure for cancer. Sans medical license he opened clinics only to shut them down and move away to new locations. His cure of 400 cancer patients was totally discredited. In fact the Hoxsey Method was no help to him for his prostate cancer from which, in 1974, he died. But like Brinkley, his gig metastasized to Mexico where it now flourishes. It is enlightening to do a Google search for Harry Hoxsey and read the current testimonials of his adherents.

For it is not necessarily the pathogenic organism that is the cause; rather it is the territory upon which it preys--us.

A typical Brinkley patient is quoted in Charlatan as saying, "I knowed he was bilking me, but ... I liked him anyway."

Early in the book, the author makes a profound statement of why in medicine, (and with some political and religious figures), the mountebank is so successful. "Unlike most scams which target greed," he writes, "quackery fires deeper into Jungian universals: our fear of death, our craving for miracles. When we see night approaching, nearly all of us are rubes."

Yes, nearly all of us ...

By Paul J. Kiell, MD
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Author:Kiell, Paul J.
Publication:AMAA Journal
Article Type:Book review
Date:Jan 1, 2013
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