Doctor's orders in a time of pandemic

As we’re repeatedly and rightly told, in this time of pandemic we need to be guided by scientific and medical experts basing themselves on solid evidence. Not by a series of bigoted views based on no more than gut feel.

On the right, Dr Fauci, a medical expert to follow
With him, a buffoon it might be wiser to shun

Unfortunately, the evidence is patchy and experts don’t always agree on how to interpret it.

• Does recovery from Covid-19 leave you immune to the disease or could you be infected again? It’s not clear.
• Are masks worth wearing or do they provide little real benefit? Views differ. 
• How quickly will an effective vaccine be available? No one really knows.

None of this is a cause for worry. It’s in the nature of science. Scientific principles are never proved, they’re merely accepted as good working theories for just as long as they’re not disproved.

To believe that science offers certainty is to misunderstand its fundamental nature.

Now I’m going to step into an intellectual minefield. Doctors tend to have a fairly favourable view of the extent of their knowledge. Whereas my view is that uncertainty is even greater in medical science than in most of the others, because medical science is still in its infancy.

A recent study of 3000 Randomised Control Trials, the most powerful type of clinical trial, showed that 396 of them (13%) led to what are known as ‘medical reversals’. That’s when a new finding leads to what was previously regarded as good practice being found to produce no benefit or, even, to do positive harm.

What that says is that medicine is still a long way from reaching the kind of stability of a field such as physics.

This all came to mind just the other day, as I was working on a project of mine that has lasted too many years, but which I can now focus on more completely, following my retirement. It’s a novel based on the life of Emilie du Châtelet, a remarkable intellectual of the eighteenth century, a time when it was more difficult even than today for a woman to be taken seriously as an authority.

A fairly large collection of her correspondence has survived, and I’ve been reading it as a way of getting as close as I can to her voice and, even more important, to her feelings. I’m now into the last few of her letters, when she was already carrying the baby of the entirely unworthy man for whom she developed a terrible, and ultimately fatal infatuation (yes, her life really is that surprisingly interesting).

In one of her letters to him she writes:

It’s true that I have been feeling so unwell for the last week that I was obliged to submit to bleeding, to avoid the same accident as happened at Commercy. So I came here to be bled… Since the bloodletting I’ve been feeling even worse, but at least I’ve done what I had to do to avoid the danger which worried me more in my current state than in any other. I’ve felt sick and had a headache ever since the blood was taken.

Bloodletting. This was a standard practice, and perhaps the most common surgical procedure in Western medicine for something like 2000 years. Emilie du Châtelet obviously hated and dreaded it. But she went through it, because in her “current state” – i.e. pregnant – it was clearly something that she “had to do”.

She “had to do” it? That was only because that’s what physicians of the time would have told her to do.

Today, we know that, except for the treatment of a small number of specific blood disorders, this kind of intervention isn’t just useless, it’s harmful to the patient. But, back in 1749, it was regarded as an absolute must. Practically all doctors agreed.

It’s often said that the difference between a doctor and God is that God doesn’t think he’s a doctor.

Well, the information that doctors have isn’t handed down from on high, carved on tablets of stone. The sheer number of medical reversals proves that. What’s believed today is the best available working hypothesis but no more.

Still, a good working hypothesis is as good as it gets while we await further evidence. So it’s best to follow it. In other words, we do, as I said, need to respect medical experts’ views, because they have the best information available in the state of knowledge today. Though we should remember that it could change tomorrow.

Respect isn’t quite the same as reverence. In particular, it allows us to indulge in a measure of scepticism. Always, I feel, a good approach when it comes to protecting our health.

After all, look what happened to Emilie.

Emily, whose words speak to me still

One of the benefits of retiring is that I have, over the last few weeks, renewed my acquaintance with a fascinating woman.

Actually, I think it’s more than a mere acquaintance. I like to think of it much more as a friendship.

It’s a one-sided friendship, I grant you that. Well, it could hardly be any other way. Because Emily, as I like to think of her though she’d be more properly referred to as Emilie, does not include among her stellar qualities – brilliance, drive, generosity – the rather practical one of being alive. In fact, she died well over 250 years ago.

Emily at work

As it happens, even if we had been contemporaries, I doubt my friendship would have been reciprocated. As a member of the French aristocracy, and an outstanding intellectual, she would have been unaware of my existence.

Emily may be one of my friends, but I would not have been one of hers.

None of that stopped me working on a novel based on her life. It takes the form of a confession, from her death bed, in which she reflects on all she has done or failed to do, the things that might have gone better, the things that could have been or actually were disasters. I was fascinated by the subject and got the whole thing written bar perhaps twenty pages some three or four years ago.

Other things then got in the way. Work was one, but that has finished. A different novel also held me up: this is the one where I make space available for Misty, our cat, along with Luci, our first toy poodle, and Toffee, the second and the most turbulent of the three, to express their views. These I have stolen from their diaries, and I’m proud of all three for their achievement: after all, most peoples’ pets can barely hold a pen let alone keep a diary.

The first book of their diary extracts (wittily entitled Through a cat’s eyes and dogs’ tales) is now complete and is only looking for a publisher (I say ‘only’ but that’s a far bigger undertaking, it seems to me, than writing the dratted thing in the first place). 

All three animals with Danielle
One of the illustrations by my daughter-in-law Senada

So now I’ve been able to get back to Emily. 

One of the pleasurable aspects of the book is that I’ve used her voice wherever possible. We have a lot of her correspondence, so I know what she actually said about certain events and people (not necessarily what she thought about them: as the politics of today’s world show, what people say isn’t always what they think).

She also wrote a lot, though she didn’t always publish it. For instance, she kept her Discourse on Happiness strictly to herself in her life, though we’ve published it since.

The best way of making sure of happiness, she argued, was to make it depend entirely on yourself. Study, she says, is the best way to achieve that aim. And yet:

…the passion which can give us our greatest pleasure and make us happiest, leaves our happiness entirely dependent on others: you understand that I am talking about love. This passion is perhaps the only one that can make us desire life, and make us grateful to the creator of nature, whoever he might be, for giving us our existence.

Emily had such a passion. The one great love of her life, among many other lesser ones, was for the most celebrated wit and polemicist of their time, Voltaire. But:

I don’t know however whether love has ever brought together two people made for each other to such a point that they would never feel the surfeit of pleasure, or the cooling to which ease and security lead, nor the indolence and half-heartedness which arise from familiarity and the long continuance of a relationship

That was the fate of her bond with Voltaire. Towards the end of her life, they were both indulging in affairs with others. Indeed, she fell pregnant at 42, a dangerous age at that time, as a result of an infatuation for a much younger and entirely inappropriate man. She died as result of an infection associated with childbirth.

Hence the death bed with which my novel starts. But it’s striking that gathered around it, as well as the young man who’d fathered the newborn daughter, there were her husband, always a loyal and supportive friend to her, and, whatever cooling there may have been in their relations, Voltaire, grieving his coming loss.

They remained attached to the end, then. Though Emily was clear that it was she who ensured that was so. There are loves so great, she tells us, that there’s never more than one in a century. Hers was one of those. And it persisted, returned or not, and despite any side dalliances they may have had. The soul that loves, she tells us:

… has to love so much that it loves for two, and that the heat of its heart makes up for what is in fact missing from its happiness.

Across the centuries, I’m as moved as ever by those words from an exceptional friend, however remote she may be.