Summary :
Speaking of the origin of an idea a historian once remarked: 'It is always earlier than you think'; and certainly it is not possible to name the sceptic who first questioned the effectiveness of medical procedures. But at least from the time of Montaigne, the notion that treatment of disease may be useless, unpleasant, and even dangerous has been expressed frequently and vehemently, particularly in French literature. Moliere's Le Medecin Malgre Lui, the famous operation in Madame Bovary and Proust's account of the psychiatrist's cursory examination of his mortally ill grandmother ('Madame, you will be well on the day when you realize that you are no longer ill. . . . Submit to the honour of being called a neurotic. You belong to that great family ... to which we are indebted for all the greatest things we know') are examples of the irony and bitterness with which some of the greatest writers have expressed their conclusions about the work of doctors. Remarkably, considering the eminence of the critics, such views have had little effect on medicine or the public's estimate of it. Perhaps they were not meant to be taken quite seriously; indeed Proust wrote: 'To believe in medicine would be the height of folly, if not to believe in it were not greater folly still, for from this mass of errors there have emerged in the course of time many truths.' Or possibly, being expressed humorously, the criticism incurred the risk of being considered frivolous; it is at least arguable that Shaw's lively Preface to The Doctor's Dilemma had less influence than the Webbs' seriously worded essay on a public medical service in The Report of the Poor Law Commission. Whatever the explanation, until recently the contribution of medicine to prevention of sickness, disability, and premature death was taken essentially at its own evaluation

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