Beyond Reform: A Renewed Vision of Medicine
we win the fight for a real national health system, a single-payer
program, in the United States, it will signal the beginning of more
than just the way we pay for or allocate health services. It will be a
step toward the reinventing of medicine as a way to achieve social
justice, not to make a profit. I have seen that kind of medicine in
Britain, where I lived through the eighties, and, despite challenges
and contradictions, it worked.
Twenty-five years ago, when Margaret Thatcher's brutal assault on the British working class was well under way, my now ex-wife and I moved into the central London district of Bayswater. It was an area of immense social contradictions. There were the obvious signs of gentrification, but Bayswater also bore the brunt of Thatcherite policies affecting the entire city. As the national unemployment rate soared past three million by 1982 (triple what it had been a decade earlier), the London poor found it difficult, not just to find work, but to find shelter. Homelessness was on the rise.
The response of many of the city's boroughs was to lodge families in Bayswater's numerous small shabby hotels, where they suffered from the health and educational problems that typically afflict people living indefinitely in such inadequate conditions. Inevitably, this stirred political activists, including socially-conscious physicians, who realized that there could be no normal medical solutions for health problems created by national policies. One local response, therefore, was the Bayswater Hotel Homeless Project, created, as Stella Lowry wrote in 1990 in TheBritish Medical Journal, "to cater specifically for homeless families...Theproject pays local general practitioners for sessions at a special surgery. When a family attends it is temporarily registered with the doctor on duty, and after three months permanent registration is arranged." One of the leading figures in the Bayswater Hotel Homeless Project was Dr. Richard Stone.
As it happened, when we moved into the area and needed to find a doctor, we ended up registering with a practice that Stone ran with four other doctors. Of Lithuanian Jewish background, Stone was an exceptional physician, unencumbered by a narrow sense of what health care required. His views, consciously or not, owed much to a tradition that arose in the mid-nineteenth century, of which one of the most impressive figures was a hero of mine, the German pathologist and anthropologist, Rudolf Virchow, one of the giants of what is now called "social medicine." As others developed the germ theory of disease, which, within the framework of profit-driven 20th century medicine, would become a profoundly reductionist approach, giving primacy to a biomedical model of disease over a sociogenic one, Virchow resolutely maintained that "Medicine is a social science and politics is nothing else but medicine on a large scale."
In Britain, between the two world wars, this vision was kept alive by doctors such as Scottish-born A.J. Cronin, who, as a young physician, briefly practiced in Tredegar, a mining town in South Wales that also happened to be the birthplace of Aneurin (Nye) Bevan who would later be one of the chief architects of the National Health Service. Cronin himself served briefly as Inspector of Mines for Great Britain, until he moved to London, where he practiced in Harley Street, before eventually establishing a less lucrative surgery in Bayswater.
Given the realities of health in Western society, good doctors often feel compelled to move beyond medicine in a conventional sense. In the 1930s, Cronin turned to writing novels to express his conviction that medicine should be an instrument of social justice. His most famous book, The Citadel (1937), is often regarded as an inspiration for the NHS. As it was for Cronin, so for Richard Stone. In his office, he treated his patients with understanding and patience. But, he never regarded a pill as the ultimate answer to social problems and we grew accustomed to seeing him on the evening news, protesting the fall-out of Thatcher's policies. Then, at the age of 54, Stone left medicine.
He became more deeply engaged in the volatile issue of race relations in London that increasingly preoccupied people of conscience during that period. By the late nineties, Stone was Vice Chair of the Runnymede Trust, an independent policy research organization that sought to advance equality and justice in a pluralist society. As such, he was adviser to Sir William Macpherson's 1997-98 Inquiry into the death of Stephen Lawrence, a black British teenager who was stabbed to death on a bus stop in April, 1993. The Inquiry concluded that the failure to convict five suspects was because the original investigation had been compromised by the "institutional racism"of the London police, a judgment that sent deserved shock-waves through the British system. Subsequently, Stone was also a member of an NHS inquiry into the death of David Bennett, a Black patient in a medium secure psychiatric hospital in Norwich. Since then, he has focused on the twin issues of Islamophobia and Jewish-Arab relations.
Sitting in the waiting-room o fRichard Stone's practice a quarter century ago, what you noticed were large photographs on the walls, stills from the 1938 film, The Citadel. The book and the movie tell the story of Dr. Andrew Manson's journey from his early practice in a Welsh mining village (much like Tredegar) to his setting up a clinic in a small town. Cronin, of course, established his own practice in Bayswater and the pictures were hanging there because Stone's practice was, in fact, the actual descendant of A. J. Cronin's. We had fortuitously found our way into the very heart of what is best in Western medicine, an example of what I hope it may be like some day throughout the United States (and the world). It always reminds me why a national health system is essential, but that the struggle for what that ultimately means has just begun.