Dr James Le Fanu once stormed off the platform at a meeting of doctors training for general practice because a member of the audience had the temerity to disagree with his analysis of the medical status quo. The venue, a mock 1950s picture house complete with Wurlitzer organ, was the three-dimensional equivalent of the Daily Telegraph, a medium in which Dr Le Fanu works well. He is entertaining and provocative. Not surprisingly, his book is lots of both.
The list of worthies interviewed is impressive, but by its nature, is also virtually devoid of non-medics and almost as deficient in women. Dr Le Fanu is more than just a friend of medicine - he sees the advance of modern medicine as a succession of Great Men. This is not entirely his fault - female discrimination is only just being resolved.
At the same time, the 'ever upwards, ever onwards' approach is being eroded. Society is taking a more measured approach to what the Great Men can offer. By the end of the book, we are asking whether this is really a 'decline' or rather a readjustment into the real world where men are just men and not necessarily heroes, especially medical men.
Of the 490 pages,183 are devoted to 'Twelve Definitive Moments', ranging from the discovery of penicillin in 1941 to the association of Helicobacter with peptic ulceration in 1984, all made infinitely more interesting by personal interviews with the research workers involved. Yet Fleming's discovery of penicillin shares with the rest of the 'moments' in having little connection with public health which, as Le Fanu correctly states, took the back seat on a very long bus on a very long ride.
The rest of the book is split into the 'rise and fall'. His conclusions are not very optimistic. Doctors will continue to become more disillusioned because medicine increasingly attracts the 'cream of intelligentsia', who will inevitably become bored with their intellectually undemanding lot. Meanwhile, Joe Bloggs is epitomised by the 'worried well' demanding ever more from health services unable to meet their expectations.
Even the Black report is brought into question over its emphasis on the impact of poverty on health.
Interestingly, he doesn't pursue his previous position over HIV risk and sexual persuasion with nearly the same vigour. This book is not, however, simply a vehicle for Dr Le Fanu's theories on health and disease. It is a marvellous overview, full of factual and anecdotal medical history.
Health professionals and social scientists will find it absorbing and fattening food for thought. It is also a very personal view of medicine, and as Andrew Mackenzie said in Scotland on Sunday: '. . . (Le Fanu) never let the scientific facts stand in the way of what is a rattling good story'. Like most things in medicine, there are two ways of interpreting this.
Dr Ian Banks Chair, Men's Health Forum.