She explores the lack of empathy within the system and the ever-present yet unspoken mantra of cost-effectiveness. Yes, we must confront what our bloated health system costs. But also … must the bottom line affect how we treat our sick and elderly? This line of questioning is a return to her brilliant 2015 Quarterly Essay Dear Life: On Caring for the Elderly. Hitchcock has no answers, although I know I would welcome her at my bedside. But then again, maybe she does have the answers. She herself has changed how she approaches her profession, and The Medicine chronicles that change.
But perhaps the most fascinating insights Hitchcock provides to one without medical training is the point of drugs. How they are researched, how they get approval, how they are marketed and most horrifying of all, what they actually do (or don’t do). She asks us to remember that pharmaceuticals are a commercial product, and they are not always the answer to our health concerns.
She writes: “… the actions we need to take are societal: make it easier for people to move and eat well, strengthen education, and promote community participation and meaningful work. Our collective delusion is that … we can attain health by inventing and buying drugs. It is hard to know which is the more utopian vision: magic pills or a society serious about prevention.”
And Hitchcock is not afraid of prevention, nor does she shy away from an idea that might make you – or society – uncomfortable. In 2013 she received blowback from the body positivity movement for her essay in The Monthly, Fat City. She reflects on that here, but has not changed her mind. In fact, she asks us to re-evaluate that movement in light of what the science tells us.
But throughout it all, she remains aware of the power of her words and the responsibility that comes with that. At one point as she writes about her experience treating morbidly obese patients in a bariatric clinic she stops to reveal, “I feel terrible typing these sentences. I apologise; they are ugly.”
Hitchcock is one of the first authorised prescribers of medicinal cannabis in Australia. Her approach is compassionate, thoughtful and patient-centred, and I recommend these chapters for anyone interested in medicinal cannabis. The same is true for her chapters on drug-law reform, in particular calling out the differences between the 2018 Victorian Parliamentary inquiry and the Victorian government’s subsequent response.
The Medicine also offers many lighter titbits that we should all perhaps know. For example, do you know how the annual flu vaccine is put together, and why sometimes it doesn’t seem to work? There is also a fascinating essay on Andrew Denton’s podcast Better Off Dead, in which Hitchcock rails against the way “euthanasia makes terrific TV”.
Hitchcock’s insight matters. She is a high achiever – a practising GP with a PhD in English – and manages to reach across disciplines to highlight what we, as individuals and as a society, must consider.
Karen Hitchcock is a guest at the Sydney Writers’ Festival, April 27-May 3 (swf.org.au). Astrid Edwards presents The Garrett podcast.