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The progress of medical knowledge


The Oxbridge fallacy: the importance of knowing your facts
Harold Lambert Physician
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I remember once I was woken at night by some houseman, who asked me about something on antibiotics and I said, 'I don't know. I'll go and look it up in my book', and Joan, who'd stirred to the surface, said, 'How do you know what you think until you see what you've written?' and I thought that was quite a smart remark. Which is good, isn't it?

No, of course you have to keep looking things up more and more, but there's quite a lot of things... you see that's a phoney business about medical education. We're supposed to have this... learn all this pharmacology and physiology and then derive our medicine from it. I call that the 'Oxbridge fallacy' because as much physiology has come from medicine as medicine has come from physiology. Well, I mean, if you think of it, certainly, certainly students should know the general... the generalities of clinical pharmacology. Of course they should. Absorption, excretion, where the stuff goes to and how it gets rid of, of course they should. But if you're saying, if you're extending on that and implying that you can derive from that any kind of adverse effect or how drugs it's completely untrue, isn't it? It's just not the case, partly because most of us as doctors don't know that much pharmacology and partly because you don't know what's going to happen. I mean, did anyone actually know with AC inhibitors that people are going to get a terrible, frightful cough which would go on and on? I don't think it was, as far as I know it wasn't reported at all and I suppose there's probably a science behind it now which I don't actually know but that was totally unexpected so it, it just, it's just bogus to say you could derive all this from your scientific thing. You've got to actually know a lot and, above all, of course, take time to find out. Like people forgetting to ask about drugs and stuff, which is the obvious example.

British doctor Harold Lambert (1926-2017) spent his career tackling infectious diseases, helping in the development of pyrazinamide as an effective treatment for tuberculosis. He also published work on the rational use of antibiotics and was a trustee and medical advisor for the Meningitis Research Foundation.

Listeners: Roger Higgs

Roger Higgs was an inner city GP for 30 years in south London, UK, and is Emeritus Professor of General Practice at Kings College London, where he set up the department.

He gained scholarships in classics at Cambridge but changed to medicine after a period of voluntary work in Kenya in 1962. He was Harold Lambert's registrar for 18 months in the early 1970s, the most influential and exciting episode in his hospital training. He set up his own practice in 1975. He helped to establish medical ethics as a practical and academic subject through teaching, writing and broadcasting, and jointly set up the 'Journal of Medical Ethics' in 1975.

His other work included studies in whole person assessment and narrative in general practice and development work in primary medical care: innovations here included intermediate care centres, primary care assessment in accident and emergency departments, teaching internal medicine in general practice and establishing counselling services in medicine.

He was made MBE in 1987 for this development work and now combines bioethics governance, teaching and writing with an arts based retirement.

Tags: antibiotics, medical education, pharmacology, physiology, ACE inhibitors

Duration: 1 minute, 52 seconds

Date story recorded: October 2004

Date story went live: 24 January 2008