In the course of Otto Preminger’s film Bunny Lake is Missing, released in 1965, a mother seeking her lost child tries to escape from confinement in a big London hospital. Looking for an exit in the brick-walled basements of the building, she strays into a half-dark room which she then discovers to be full of caged monkeys. It’s a research hospital, therefore, a grotesque touch in the film but a common enough institution, then as now. Another British fiction of that period provides a more thorough, though hardly more amiable, account of such places: the novel by Colin Douglas, with the illuminating title The Greatest Breakthrough Since Lunchtime. The novel’s hero – or rather anti-hero, since his leading interests are drinking and having sex with nurses – is a young doctor (as the author had been), recently qualified and now putting in some years of research (“It’s expected behaviour.”). His topic has been selected for him by his supervisor, the keenly ambitious Dr Rosamund Fyvie; it’s ‘faecal vitamins’. Having done a few hours of half-hearted preparatory reading, Campbell provides a colleague with this sarcastic prognosis of his research career:
After a preliminary survey of the literature, I am now in a position from which I may eventually advance to prove conclusively that faecal vitamins have nothing to do with anything. I could start by proving they had nothing to do with a few important things . . . Then get some PhD students to tidy up the odd little corners, like ‘Bantu diet as reflected in faecal vitamins’ and ‘Faecal vitamins in albino coypus’. My epidemiological group would do prospective cohort studies on how faecal vitamin assay is of no use in predicting who’s going to get appendicitis. And my clinical staff would devote themselves to proving that vitamins had nothing to do with any known form of cancer. You’ve got to be in cancer. That’s where the big money is.
But the research is being paid for by a drug company, and Campbell recalls the old aphorism that “Drug companies don’t give money to pessimists” (i.e. they prefer the sort of attitude suggested in the novel’s title: more of this later). He concludes that Dr Fyvie, who secured the funds, has been able to see possibilities in faecal vitamins: “possibilities, that is, of results and hence publications, by Fyvie and somebody and somebody else and Campbell, leading to greater fame for her, and the nearer prospect of the professorial chair she coveted so much.”
Campbell’s absurd research is at least human-centred (he collects his samples from the hospital’s patients), but his reluctant labours are paralleled by the more dedicated work of an animal-research colleague, “a girl who produced endless publications on mouse prostaglandins as though by a strange compulsion”. Such diligent fixations are still a noticeable feature in the bio-science journals.
Bunny Lake is a crime thriller, The Greatest Breakthrough a comedy or farce, and both of them predate the UK’s Animals (Scientific Procedures) Act of 1986. Distorted pictures of the unregenerate old days, then? Unfortunately not: the animals are almost certainly better looked after now, but an up-to-date survey of medical research and hospital life suggests that the human system to which their lives have been made subject is further than ever from justifying that subjection. It comes in a book by a former NHS doctor, Seamus O’Mahony, with the ominous title Can Medicine Be Cured? The Corruption of a Profession.
Much of Can Medicine be Cured? is about medical research and its pathologies. The book doesn’t ever focus on the part force-played by animals in that research, but their involvement is well established early on, when O’Mahony is recalling his own early research stint. The theme of that research – “whole gut lavage” – and its likely value accord well with the fictitious Dr Campbell’s work. As practised on mice, it had been his supervisor’s speciality, and O’Mahony was required to develop the technique for clinical use. His paid helpers at the Edinburgh hospital had been Dougie and Ewan, two “foul-mouthed technicians from the animal unit”, and he knew that unit and its denizens. There were the mice, of course; O’Mahony recalls the laboratory definition of ‘mouse’: “an animal which if killed in sufficient numbers produces a PhD”. There were also monkeys and, by hearsay, goats. “I managed,” says O’Mahony, “to avoid killing any of these innocent animals”, though he does witness one of the mice being “expertly dispatched” against the edge of the lab bench.
In any case, the gut lavage research and its associated publications “produced little of lasting consequence”. O’Mahony attributes his unfitness for academic medical research to the fact that “although cynical, I was not quite cynical enough.” We are on page 19 here, and the author explores the implications of that dismal explanation in the remaining 250 pages of the book.
The most conspicuous thing about the medical scene as O’Mahony presents it is that it suffers from runaway hypertrophy: drug-based medicine in general, and medical research in particular, have grossly outgrown their useful proportions. And just as what used to be called the ‘military-industrial complex’ has engaged the talents, labours, and commercial interests of countless parties, without (fortunately) requiring a war to justify it, so this “medical-industrial complex” (O’Mahony’s habitual term) is a self-sufficient monster, having no necessity to account for itself in healing:
A medical research laboratory is a factory, which produces the raw material of data. From these data, many things may be fashioned: presentations to conferences, publications in journals, doctoral degrees, successful grant applications, even air miles. What went on in the nearby wards seemed of little consequence.
Yes, publications! These are the stairway to success, and their own proliferation (output of scientific papers apparently doubles every nine years) is part of a pathological symbiosis. With a sure market in medical institutions of all kinds, and unpaid contributors (some journals even demand payment from their contributors), they can be highly profitable enterprises. They were in fact the basis of Robert Maxwell’s one-time great wealth. For their part, researchers need to appear in them as often as possible, for frequency is much easier to notice and to record than quality. Not only individual careers but also grants for further research demand this published evidence.
O’Mahony describes some of the techniques for stretching and glamorizing any given amount of work, but of course the most obvious one is fraud. The unhappy case of Dr William Summerlin shows that the temptations (‘incentives’ might be the better word) were already there in the 1970s. He was researching organ transplantation at a New York laboratory, and was found to have fabricated his evidence for the successful grafting of skin and corneas in mice and rabbits. Part of his explanation was this:
Time after time, I was called upon to publicize experimental data and to prepare applications for grants from public and private sources. There came a time in the fall of 1973 when I had no new startling discovery . . .
O’Mahony doesn’t in fact mention the Summerlin affair, but he doesn’t have to, because fraud of one kind or another has now “become commonplace in medical research.”
Where animals are used, as in Summerlin’s case, fraud is a special kind of abuse, fatally and uselessly involving them in a lie. But there are less actionable kinds of misrepresentation, and one of the natural consequences of over-population in the research scene is what O’Mahony calls “boosterism”. “Real scientists,” he says, “tend to be reticent, self-effacing, publicity-shy and full of doubt and uncertainty, unlike the gurning hucksters [a memorable phrase] who seem to infest medical research.” He reports a calculation that there had been a 25 times increase, between 1974 and 2014, in use of the terms ‘innovative’, ‘ground-breaking’ and ‘novel’ in PubMed abstracts (these abstracts are really as much adverts for the articles as summaries of them). Perhaps even more damaging to good medicine is the sort of collective boosterism which constitutes medical fashion. Here all sorts of interests coincide in pursuit of funds and their own versions of success, including drug companies, “Gadarene researchers” (because “medical research is a conformist activity”), popular paperback writers, patients’ groups lobbying for particular diseases, and professional lobbyists themselves. It’s a matter of chance whether these appropriators of resources will really be of any help in what O’Mahony calls “the mundane business of treating the sick”.
That 25 times increase in boastful phrases (‘ground-breaking’, etc.) is quoted from an article titled ‘The natural selection of bad science’, and the badness of medical science constitutes a sort of refrain in O’Mahony’s book: “the great majority of medical research is a waste of time and money [p.13]. . . Big Science has a Big, Bad Secret: it doesn’t work  . . . nearly all papers in medical journals are dross. ”
But since much of the funding for medical research (about three quarters of it in the case of drug-testing, says O’Mahony) is provided by pharmaceutical companies, wouldn’t they be making sure that most of it was sound and productive? Well yes, productive of medications at any rate. O’Mahony recalls that his own period of research included evaluating a drug to treat coeliac disease, even though there was by then a known effective cure for the condition: a gluten-free diet (which has since developed a profitable hypertrophy of its own). He found no efficacy in the drug, but when he wished to publish his results, the drug company which had financed the trials was unhelpful (remember Dr Campbell’s aphorism about pessimists), and the journal to which he nevertheless submitted his report did not even put it out for peer review.
Nobody wants to be associated with negative results. It’s part of that “natural selection of bad science” that research is sieved in this way, regardless of its quality. When, by contrast, the research behind the anti-inflammatory drug Vioxx (research involving African Green monkeys and five other species of animal) was published in the New England Journal of Medicine, Merck Pharmaceuticals bought one million reprints of the report for distribution to doctors. That was good for Merck (80 million prescriptions were subsequently written out for Vioxx, before it was withdrawn as unsafe in 2004), and good for the NEJM too, but not good for science or for health. How many drugs, of the very few which do translate successfully from animal-testing to clinical trials, really are good for health? Even such lasting commercial successes as statins – the ideal drug for business purposes, since it doesn’t simply put something right and then depart, like an antibiotic, but indefinitely ‘prevents’ – are of doubtful value unless funds are limitless. In fact preventative medicine, where it means medical interventions rather than sensible diet and life-habits, is helping to push forward what O’Mahony calls “healthism”: the trend towards re-classifying the whole healthy population as at-risk.
Meanwhile, the ordinary doctor in clinic or hospital (as opposed to the medical academics and managers) is caught between this vast and pushy production system on one side, and the information-maddened consumerist patient on the other, as a sort of trading agent: “the medical profession”, says O’Mahony, “has become the front-of-house sales team for the industry.” For the point of healthism is to make a sort of self-run hospital out of each one of us, sick or well: hence the rather sinister title of one of the many books that promote this patient ‘awareness’, The Patient Will See You Now. This decline in the authority of the doctor, the devaluation of his experience and expertise, is the saddest part of the whole bad story for Seamus O’Mahony. But he shows, of course, that the decline is equally a loss for the authentic patient in need of that “mundane business of treating the sick”.
And in the shadows of the book, like the monkeys in Bunny Lake is Missing, are the animals which service this medical colossus with their own health and lives. In the European Union and in Britain, the 1986 legislation has kept their numbers more or less steady, so that they form a shrinking proportion of the giant whole. But elsewhere in the world this is not so. It’s very obvious in the journals, for instance, how much of the animal research is now being done in China, which has indeed overtaken the USA as the world’s most rapacious user of animals for scientific purposes. And for the world as a whole, a meticulous estimate of animals killed for science in 2005 was published some while ago in the journal Alternatives to Laboratory Animals: 115.2 million. When the theme was re-visited more recently, the total for 2015 was put at 192.1 million, an increase of about 65% in ten years.
We now have some idea of how worthwhile that enormous and continuing sacrifice has been.
Notes and references:
The Greatest Breakthrough Since Lunchtime was published by Canongate Publishing in 1977. Can Medicine be Cured? The Corruption of a Profession was published by Head of Zeus in 2019.
Much of O’Mahony’s case was anticipated in Ivan Illich’s Medical Nemesis: the Expropriation of Health, published in 1974 and reissued in 1976 as Limits to Medicine: Medical Nemesis. In fact Seamus O’Mahony has written an excellent essay about the book, its origins and relevance, in the Journal of the Royal College of Physicians Edinburgh in 2016 (it can be read online here: https://www.rcpe.ac.uk/sites/default/files/jrcpe_46_2_omahony_0.pdf.). But Illich was almost absolute in his opposition to modern medicine and its ideology, whereas O’Mahony argues that there was a ‘Golden Age’ of medical discovery between the 1930s and 80s. He believes, however, that the challenges and possibilities of medicine are very different now, and that failure to recognize this is what has allowed Big Science and Big Pharma to become the predators on the public health and purse that he shows them to be.
Robert Maxwell set up the Pergamon Press as a science publisher at Headington Hill Hall, Oxford, in 1951. When it closed in 1991, it owned about 400 different journals.
The Dr Summerlin affair is discussed in Alexander Kohn’s False Prophets: Fraud and Error in Science and Medicine, Basil Blackwell, 1986, pp.76-83.
‘The natural selection of bad science’, an article by Paul Smaldino and Richard McElreath, appeared in Royal Society Open Science 3(9), 2016, online at http://rsos.royalsocietypublishing.org/content/3/9/160384.
The calculation of global animal numbers is published in ATLA, 24 February 2020: the authors are Katy Taylor and Laura Rego Alvarez, and it’s accessible online here: https://journals.sagepub.com/doi/full/10.1177/0261192919899853. Some of the increase in numbers is attributed by the authors to shortage of information in 2005: i.e. that number was an under-estimate. Many of the countries that practise animal research do not publish numbers, so that calculations cannot be authoritative.