The Virchow Enterprise

(From Heavy Years).

I dropped in on Nasty to talk about books on Brazil, and Mal Combes broke into our conversation to say, ‘Poet, stop this conceptual backpacking. You need to retrench, and think seriously about what’s left of your future. You haven’t yet found a point of application in life, and your gay abandon is beyond its sell-by date.’ He loped off looking pleased with himself. Nasty laughed, and remarked, ‘You spend so much time in the cinema, maybe you should become a projectionist. But what Mal says is true. You’re not as nifty on your feet as you once were.’ Nearing forty, I knew it was time to put away childish things, turn my back on the hustling, and take on a real job. If possible a useful one with a large idea behind it. I resolved to become my father’s son, in a small way.  

Before making myself useful, I first had to find a trajectory. Two ideas gripped my imagination: Virchow’s anthropological law on the interface between medicine and politics, and Bernard Kouchner’s Droit d’Ingėrence. Kouchner, co-founder of Medicine Sans Frontiers, advocated an aggressive form of medical intervention, military if necessary, to rescue exploited peoples sunk in famine and disease. Eliminate the wicked and the good people will thrive.  Kouchner’s voice was seductively clear, but it sounded too loud, like a charismatic preacher, drowning out background noises, to pound out his message. The thought of a new form of global colonialism based on righteous humanism gave me pause. The solution would be playing the same game of suppression that caused the misery in the first place. I dismissed ingėrence humanitaire with St Augustine’s words, ‘Power should be withheld from the righteous.’

Rudolf Virchow (1821-1902) was a celebrated pathologist who went into German politics to oppose Bismarck’s Empire building. Unlike Kouchner, his law didn’t involve regime change, only a change of heart. ‘Medicine is a social science, and politics is nothing but medicine on a larger scale.’ His spur was Descartes whose discourse on the centrality of health in the general welfare of mankind had inspired the French Revolution to make medicine a significant arm of the State (arguably for the first time in history). Gentlemen scientists were replaced in the national institutes by vocational biologists, such as Geoffroy Saint-Hilaire, Georges Cuvier and Jean-Baptiste Lamarck. However, during Bismarck’s blinkered reign by blood and iron, Virchow’s holistic idea met with deaf ears. He was dismissed as a ‘medical mystic’, and is only remembered now for his seminal  work on the nature of cells. 

There was nothing revolutionary about Virchow’s basic tenet. The prime object of life is for humans to be as happy and healthy as possible. He was merely prioritising common sense. I decided that while working on the fringes of the established order, I would dedicate myself to asserting his wisdom by indirect action, achieving improvements in the quality of life which would help to invert the primacy of politics over public health. I kept this to myself, as radical ideas like Christianity and Islam are best proven by exemplary enactment. 

I was looking for a job where I would be able to get life-enhancing things done in a small way, if possible without being noticed. I would avoid vainglorious ambition, not as a reaction to Mal Combes (he was gloriously vain), but because  my childhood wish to be sight unseen still prevailed into my middle years. I would quit the mad world of freelance research and find a niche to bury myself in the mainstream of medicine from which I had hitherto marginalised myself.

My large idea revolved around the gulf between academic research and its application in the real world. This exists as practical implications, not least political consequences, have to be considered. For instance, the hypothesis behind the aborted rice rat study on tooth loss and aging was based on Hall McCall’s incipient ideas on auto-immunity and Descartes’ wistful dream of ‘reversing the infirmity of old age’. As the Medical Research Council would have had to consider the world historical consequences of ultimately increasing longevity, he obfuscated it when seeking ethical approval and found funding elsewhere.

Macro-solutions require a revolution, and waiting for one in England would be a Spurious Infinity. For example, James Douglas’s famous cohort studies in the 1940s/1950s showed that health expectations in the population could only be equalised by the levelling of the class system. Doll and Bradford Hill’s studies in the 1950s showing smoking caused cancer and premature births, despite widespread publicity, didn’t begin to change habits until almost three decades later when Governments, realising its tax potential, invested heavily in health education and price control. By then heart disease and strokes had been added to its undesirable effects. Even so the tobacco industry, if unable to call the tune anymore, could tone it down.

Micro-solutions, incrementally introduced, might help to build up expectations, and be educational without hectoring against what people wanted to do. However, I knew that closing the gap between publication and the application of steady advances can take so long that momentum is lost, and the idea is quietly shelved. On the other hand, if the research has a dramatic public profile, and doesn’t expect people to change their way of life, the political world jumps to speed it through. For instance, findings on lead in petrol and its damage to children’s brains led to its banning before follow-up studies could confirm it. There must be, I thought, unsung breakthroughs lying dormant in the journals, waiting to be implemented. If I identified some feasible examples, I could present myself to Health Authorities with proposals. My mission statement would be, ‘Putting Proven Solutions into Practice.’    

Mal Combes couldn’t resist mocking me. ‘You are, my Poet, thinking like a functionary: achieve the inevitable. And the iron bottoms won’t feel challenged.’ He was in a roaring good mood because Oswald the Guru of Fortnum and Mason’s had found his daughter Una an eligible Messiah, and they were leaving the Cult together.

Even when Mal Combes asked me what proven solutions I had in mind, and I had to admit that it was only a notion, and still vague, he praised the idea, saying ‘it will be your point of entry into the inner circle, and in that case you might as well know who’s who’. Mal Combes then proceeded to give me a breakdown of the establishment’s pecking order…

 ‘Now you know the cast, and how to play them, the question is who you can trust?’

He handed me a folded page. It was blank. ‘Not even my name, Poet. Get one thing right: know that nobody loves anyone else unless they have to.’

Thumbing devil’s ears, he concluded, ‘Welcome to the portal of hell.’