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Dr. Golem

How to Think about Medicine

A creature of Jewish mythology, a golem is an animated being made by man from clay and water who knows neither his own strength nor the extent of his ignorance. Like science and technology, the subjects of Harry Collins and Trevor Pinch’s previous volumes, medicine is also a golem, and this Dr. Golem should not be blamed for its mistakes—they are, after all, our mistakes. The problem lies in its well-meaning clumsiness.

Dr. Golem explores some of the mysteries and complexities of medicine while untangling the inherent conundrums of scientific research and highlighting its vagaries. Driven by the question of what to do in the face of the fallibility of medicine, Dr. Golem encourages a more inquisitive attitude toward the explanations and accounts offered by medical science. In eight chapters devoted to case studies of modern medicine, Collins and Pinch consider the prevalence of tonsillectomies, the placebo effect and randomized control trials, bogus doctors, CPR, the efficacy of Vitamin C in fighting cancer, chronic fatigue syndrome, AIDS cures, and vaccination. They also examine the tension between the conflicting faces of medicine: medicine as science versus medicine as a source of succor; the interests of an individual versus the interests of a group; and the benefits in the short term versus success rates in the long term. Throughout, Collins and Pinch remind readers that medical science is an economic as well as a social consideration, encapsulated for the authors in the timeless struggle to balance the good health of the many—with vaccinations, for instance—with the good health of a few—those who have adverse reactions to the vaccine.

In an age when the deaths of research subjects, the early termination of clinical trials, and the research guidelines for stem cells are front-page news, Dr. Golem is a timely analysis of the limitations of medicine that never loses sight of its strengths.

Read an excerpt.

258 pages | 1 halftone, 3 line drawings | 5 x 8 | © 2005

History of Science


Philosophy of Science

Sociology: Medical Sociology, Theory and Sociology of Knowledge


"Why might it be better for you to be treated by a bogus doctor than a real one? How would medicine deal with the imaginary condition Undifferentiated Broken Limb? Such examples make serious points. Using lessons from the sociology of medicine, the authors show the ways in which clinical trials have changed in method owing to challenges from informed AIDS activists and ’rogue’ cancer researchers. A vividly detailed explanation of the placebo effect is the base of the book’s argument that medical knowledge is limited and provisional. A related strand of argument is an examination of the tension between medicine as "succour" for the individual and medicine as a (theoretically) perfectible science. What makes sense for one person may be in conflict with what is best for everyone. Thus the authors offer an illuminating way of thinking about ’alternative’ medicine or the MMR vaccine scare. If you do not vaccinate your child for fear of some risk, you put the population as a whole at greater risk of epidemic. Some measure of informed scepticism is often warranted, but the medical establishment is rarely the enemy, the authors sensibly conclude."

Steven Poole | The Guardian

“It isn’t enough, [Collins and Pinch] contend, for people to know about medicine. They must know what to do with that knowledge. For example, while it is perfectly understandable for parents to want to make the decision about, say, vaccinating their children, they must weight the implication of widespread decisions against vaccination to make their final judgment. And just what is one’s obligation to the greater good when personal health is at stake? While that is a trick question with no unanimously subscribed correct answer, Collins and Pinch present the kind of information that is helpful when thinking about the issue.”


"This gem of a book is well written, thought provoking, and an enjoyable read. Highly Recommended."


“The authors write as patients as well as sociologists, and the chapter on the MMR [vaccine], on which subject Collins and Pinch have diametrically opposed attitudes, is particularly effective. . . . The authors want medicine to be more scientific, not less so. Their volume is hardly a plea for alternative medicine or even for the uncritical democratization of conventional medicine. Rather it is an analysis of the problems of contemporary medical knowledge, and is stronger on diagnosis than on prescription.”

W. F. Bynum | Nature

“Collins and Pinch carefully tease out key conflicts in the way that medical knowledge is constructed and used and endeavor to show how necessarily complicated medical decision-making must be. . . . They investigate three important issues that lie at the core of medicine’s uncertainty: individual versus collective interests; medicine as a science versus a healing art; and the nature of medical expertise. . . . The authors neither jump on the critical bandwagon nor apologize for medicine’s failings, rather they show that the inherent discrepancy between the pace of medical discovery and the need for immediate succour is one that must be addressed jointly by physician and patient.”

Noah Raizman | Lancet

"A set of interesting and sometimes humorous or even alarming stories from the recent history of medicine, including accounts of the debates around whether vitamin C prevents cancer, what kind of illness is Chronic Fatigue Syndrome, and whether MMR vaccine causes autism....[Dr. Golem] is a refreshing way to understand a lot of what goes on
behind the white coats."

Mel Bartley | International Journal of Epidemiology

“The writing is interested, intelligent, and explanatory. . . . Much of the book’s quality comes from its steady, generally clear-sighted explanation of some of the ordinary within medicine.”

Druin Burch | Times Literary Supplement

"In provoking discussion and debate, perhaps [the book] will help make medicine seem less a clumsy Golem and more the insightful, compassionate, yet fallible creature to whom some of us were attracted."

Omar A. Khan | JAMA

"Beyond its appeal to a reading public, Dr. Golem would make a useful addition to bioethics and medical sociology courses at undergraduate and graduate levels. Readers may not always agree with Collins and Pinch’s views, but they will be intrigued by them."

Kathy Charmaz | American Journal of Sociology

"Dr. Golem is a very welcome third volume in Harry Collins and Trevor Pinch’s well-known ‘Golem’ series dealing with the nature and ironies of science and technology….Like the other volumes in the series, Dr. Golem works wonderfully well as an introductory text to the sociological analysis of medicine.”

Neil Pemberton | British Journal for the History of Science

Table of Contents

Preface and Acknowledgments
Introduction - Medicine as Science and Medicine as Succor
1. The Hole in the Heart of Medicine: The Placebo Effect
2. Faking It for Real: Bogus Doctors
3. Tonsils: Diagnosing and Dealing with Uncertainty
4. Alternative Medicine: The Cases of Vitamin C and Cancer
5. Yuppie Flu, Fibromyalgia, and Other Contested Diseases
6. Defying Death: Cardiopulmonary Resuscitation (CPR)
7. The AIDS Activists
8. Vaccination and Parents’ Rights: Mumps, Measles, Rubella (MMR), and Pertussis
Conclusion - The Themes Revisited

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