Beyond Reform: A Renewed Vision of Medicine

If
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.