Wer zuletzt lacht...

I have always regarded critics of the medical profession as ill informed, ill intentioned, or ill adjusted—or, of course, all three. I have known several newspaper editors, for example, who were profoundly anti-doctor, a hostility I ascribe to the fact that doctors are held in far higher public esteem than journalists. If journalists cannot improve their own reputation, they can at least try to destroy that of others. Politicians are of the same ilk as journalists.

Of the great critics of the medical profession, none was more ferocious and uncompromising than Jean-Baptiste Poquelin, better known as Molière. The last play he wrote was Le Malade Imaginaire, and as usual he makes fun of doctors in it. The hero, or protagonist, is Argan, the hypochondriac who is completely under the sway of his doctor, Monsieur Purgon.

The opening scene has Argan adding up his apothecary’s bills for all the clysters, pills, potions, electuaries and so forth that he has been prescribed and has dutifully taken. He remarks that the bill is so exorbitant that henceforth no one will want to be ill. But his faith in medicine remains absolute. "This month," he says, "I have taken eight mixtures and 12 clysters; last month I took 12 mixtures and 20 clysters. No wonder I don’t feel as well this month as last." Argan says he will tell Monsieur Purgon so that he can put matters right.

It so happens that on my way to work I used to pass an establishment, in appearance halfway between a hairdressing salon and an adult bookshop, that advertised colonic irrigations as the key to wellbeing. Some illusions, it seems, die hard.

Towards the end of the play, Argan’s brother, Béralde, who is not a believer in medicine, tries to wean him from his dependence on doctors. He advises him that it would be a good thing if he were to attend some of Molière’s plays on the subject of doctors and medicine. Argan exclaims: Devil take it! If I were only a doctor, I would revenge myself on his (Molière's) impertinence. When he fell ill, I would let him die without assistence. He could say what he liked, I wouldn't prescribe even the slightest blood letting for him, the smallest enema, and I would say to him 'Die! Die! That will teach you another time to make fun of the faculty!'

To Béralde medicine is nothing more than a confidence trick: "You have only to speak in a cap and gown, and gibberish becomes scholarship and the greatest nonsense wisdom."

As often happens—it is the saving of the profession—the doctors had the last laugh. Molière acted Argan in the first four performances of Le Malade Imaginaire, but he collapsed on stage during the fourth and died within hours without benefit of medicine.

Of course, nothing that the Faculty could have prescribed would have saved him. One has only to read of the treatment meted out by doctors to dying monarchs such as Philip II, Louis XIV, and Charles II to realise that Molière didn’t miss much; quite the contrary. But faith in medicine is not proportional to its efficacy—it might even be inversely proportional to its efficacy. I wonder what evidence based medicine has to say on this subject?

Molière acted Argan in the first four performances of Le Malade Imaginaire, but he collapsed on stage during the fourth and died within hours without benefit of medicine

Theodore Dalrymple
BMJ 2008;336:673 (22 March), doi:10.1136/bmj.39518.696204.94