One particularly interesting claim is, at first glance, counterintuitive. Several recent books argue that full implementation of AI in medicine will be a boon to the doctor-patient relationship and make clinical practice more humane. Anmol Madan’s The Machines Will See You Now (2026)², argues that automated medicine will deepen, rather than diminish the humanity at the heart of health care. “How Artificial Intelligence Can Make Health Care Human Again” is the subtitle of Eric Topol’s Deep Medicine (2019)³. Shannon Vallor presents a more measured, but still optimistic, perspective The AI Mirror (2024)⁴. In this essay, I want to explore the potential for traditional values in medicine at a time in the future when most diagnostic and treatment decisions may be made by large language model generative AI systems.  

Health care is already benefiting from automation, in which algorithmically driven programs interpret radiographic images and EKGs, enhancing the accuracy and efficiency of interpretation.  In one recent multicenter study, endoscopists performing colonoscopy with images analyzed by AI discovered 21% more adenomas than those performing colonoscopy without AI. However, a drawback is already apparent in evidence demonstrating a “de-skilling effect” of reliance on AI among radiologists and ophthalmologists after using AI assistance for some time.⁵ Once accustomed to passive verification of AI findings, clinicians find it difficult to engage in active observation to their former level. In a less “mixed blessing” way, automation is also producing benefits in clerical and administrative areas.  

The Machines Will See You Now characterizes the current situation as Level 2 in his four-step roadmap to fully automated health care. We are now entering the era of high automation (Level 3) in which AI will have the ability to make many or most diagnoses and treatment decisions, with human physicians limited to consulting in cases of patients with complex conditions. It should be noted that Anmol Madan is a prominent information technology scientist and not a physician. He rejects the term “patient” because it signifies passivity and a power imbalance between the consumer (aka patient) and provider (aka physician). He believes AI-assisted health care will lessen this imbalance and may eliminate it when we reach Level 4, which is defined as “the transition of health care provided by humans to health care supported and eventually delivered by algorithms.”^2,21 This may not be realized for several decades, but in the meantime much of the work of physicians in primary care specialties and psychiatry will be performed by machines in Level 3. Nonetheless, after describing impressive advances in AI technology, Madan notes, almost in passing, “Researchers have not yet figured out how well these seemingly compelling accuracy and performance results translate to real world use in health care,”^{2, p. 82} 

Eric Topol is a physician, and he better understands the humanity at the heart of healing. Because of this, he deplores the cold, mechanical, and robotic ways in which medicine is practiced today. Much of this results from productivity demands, administrative overload, and medical education that prioritizes technology over communication and compassion.  In essence, he claims that we already have thinly disguised robotic medicine. If AI takes over most notetaking, diagnostic, therapeutic, and “busy-work” functions, then physicians will be free to establish human connection with their patients. I believe Topol has made the correct diagnosis of contemporary medical practice, but is his solution viable? 

Madan supports his humanization claim with a discussion of an AI system’s potential to replicate empathy. “Empathy at its core,” he writes, “is a set of verbal and body language signals.^{2, p. 65} Already, large language models can modulate the tone and pace of their speech to replicate various human styles, concerns and moods. They can generate empathic responses, like, “That must be difficult” or “I’m sorry you’re experiencing so much pain.” He claims that the newest generative AI models “score high on empathy.”^{2, p. 72} Would such features be experienced by patients as genuine concern? Would they learn to trust a machine in the same way they trust their doctor? 

In today’s fragmented health care settings, physicians are harried by time pressures and multitasking, which often compromise empathic behavior. Given Madan’s background, it is understandable that he proposes an AI solution to the problem, but Topol understands that empathy is not merely the production of appropriate verbal responses, but rather it involves shared human presence, attention, reassurance, and understanding. Machines cannot vicariously participate in pain and suffering, as fellow humans can. Patients will not trust, or be comforted by, their AI providers_.. Although we commonly “trust” test results or interpretations produced by a machine, this “trust” is phenomenologically different from the trust involved in a human relationship.  

Thus, while Madan claims that AI will directly contribute to humanization by offering surrogate empathic behavior, Topol believes that physicians, relieved of time constraints and harried multitasking, will be free to engage in genuine empathic patient encounters. To be fair, Madan does refer to physicians’ having time for other activities when they are relieved of diagnosis and treatment decisions, but his goal of almost completely replacing physicians in many areas, except for very complex cases, makes you wonder whether the activities mentioned might include visiting the unemployment office.  

Shannon Vallor, a philosopher at the University of Edinburgh, takes a step back and questions the assumptions on which either one of these “health care more humane with AI” projections are based. In The AI Mirror, she states the obvious, but rarely discussed, fact that human technologists “train” generative AI systems with algorithms and immense amounts of data. Sometimes the algorithms may reflect human bias, or the training data may include errors. She describes an egregious case of racial bias discovered in 2019 in an AI risk prediction algorithm widely used in American hospitals. The algorithm “diverted medical care away from high-risk Black patients, even though these patients were, in fact, sicker than the white patients the tool prioritized for care.”^{4, p. 42} Race had been explicitly excluded from the training data, but .the AI system was able to reconstruct the same bias by integrating other forms of data, like residence and income, into its decision making,  

Vallor’s point is that generative AI mirrors the values and aspirations of the culture that created it. When we look at a powerful Large Language Model system, like ChatGPT, we see our own priorities, both healthy and flawed, writ large. In medicine, AI should not be understood primarily as a technological revolution but as a moral and cultural mirror revealing what modern medicine values, what it neglects, and what aspects of healing can and cannot be mechanized. From this perspective, whether AI will make medicine more humane depends less on the technology itself than on the vision of healing that clinicians, patients, and health care institutions bring to it. 

There is almost universal agreement that American health care needs major reform. In 1977, John Knowles edited a collection of essays entitled Doing Better and Feeling Worse: Health in the United States, which was severely critical of the fragmented, expensive, mechanistic, and inequitable health care system at the time, despite its many technological advances.⁶ Today, fifty years later, despite remarkable technological developments since then, we are in an even more critical situation. We are both doing worse and feeling worse. In this context, how is the future of AI-automated health care likely to look?  

Currently the U.S. health care sector employs nearly 18 million people, among them over 860,000 physicians.⁷ Millions of these are engaged in clerical and administrative jobs that will likely be handled more efficiently by AI systems. If any scenario even approximating Madan’s Level 3 or 4 occurs, tens of thousands of physicians may also be made redundant. Thus, full implementation of AI will probably lead to a considerable reduction in the health care workforce. This negative economic consequence could only be avoided by significant health care reform involving professional development and the creation of new openings for genuine caregiving. 

Modern health policy often treats “care” as the aggregate of services delivered, procedures performed, and outcomes measured. Yet the word “care” refers not primarily to a service but to a disposition or motivation to respond to human suffering. If humanity in medicine comes from caring relationships, then technology is beneficial only insofar as it enables, rather than replaces, those relationships. If medicine is a moral practice involving trust, suffering, mortality, uncertainty, and compassion, then AI can assist but never replace the physician’s role.^8,9 Contemporary health care fosters ambiguity between the two definitions of “care.” While in practice the quantitative definition prevails, in theory (e.g., hospital commercials, mission statements), institutions tout the qualitative definition. It is reasonable, then. to expect the same ambiguity to continue with AI enhanced medicine, unless major reform results in prioritizing genuine caring 

From this perspective, if AI saves physicians two hours of clerical work per day, will those hours be returned to more productive encounters with patients, or will they be absorbed by institutions seeking greater productivity? Indeed, physicians currently spend increasing amounts of time on various forms of documentation, chart review, data management, and other forms of drudgery, from which AI will be able to relieve them. But will this leave them more time for listening to, examining, reassuring, and teaching patients, as Topol believes? A hopeful scenario, but unlikely under current institutional demands. It seems more likely that the extra hours will be absorbed into the hospital’s or clinic’s demand for income and efficiency. Every major medical technology has been accompanied by promises that efficiency would create more time for the patient. Yet the history of medicine shows the opposite outcome: efficiencies become opportunities for greater productivity. 

And so I return to Simone Weil’s metaphor. We once again find ourselves “in a motorcar launched at full speed and driverless across a broken country.”¹ Health care automated by AI will surely be able to drive the car even faster, but I don’t believe that AI in itself will take us to a more humane destination. At present, AI mirrors the values of a system that values technology, productivity, and income over equity and caregiving. If we want our car to arrive at universal and compassionate health care, radical reform – not generative AI – must become its driver. 

References 

1. Simone Weil, Oppression and Liberty, Routledge,2001 (1st edition, 1955) 

2. Anmol Madan, The Machines Will See You Now, Baltimore, Johns Hopkins University Press, 2026 

3. Eric Topol. Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again, New York, Basic Books, 2019 

4. Shannon Vallor, The AI Mirror, New York, Oxford University Press, 2024 

5. Maxim Tokas, Laura Marie Peltomen, Zhihong Zang et al, The deskilling effect: is artificial intelligence eroding clinical competence? Ann Intern Med. 2026; 179: 1048-1054 

6. John Knowles (Ed.) Doing Better and Feeling Worse: Health in the United States, New York, Norton, 1977 

7. Health Resources and Services Administration. State of the U.S. Health Care Workforce, 2025. National Center for Health Workforce Analysis, December 2025,  

8. Eric J. Cassell, The Nature of Suffering and the Goals of Medicine. New York, Oxford University Press, 2004 

9. Arthur Kleinman, The Soul of Care, New York, Penguin Books, 2020 

Web image generated by Medhum.org

A song can make a claim before its writer notices that it has done so. A number fits the beat, a sentence sounds convincing, and the chorus returns often enough for the wording to feel settled. Writing Dying for a Diagnosis, about waiting for psychiatric and neurodevelopmental care, made me look more closely at that process. Research was useful, but not because it could certify everything I felt. It was useful because it could tell me where the song needed to stop claiming more than it knew. 

My own experience was part of the starting point. It gave the subject its urgency, but it could not tell me how common that experience was, or explain somebody else’s history. I needed to keep those questions separate. A personal account can describe what happened to one person. A published study can investigate a defined population. Neither becomes the other simply because they appear in the same verse. 

I kept a research dossier behind the song, separating official data, academic research, charity surveys, reporting and personal testimony. That sounds rather dry beside a track about frustration and exhaustion. In practice, it helped with the writing. A line had to answer two different questions: does it convey the experience, and does its factual claim survive outside the music? Getting the first answer right did not excuse getting the second wrong. 

Take the waiting-list number. NHS England’s May 2025 publication said that up to 549,000 people might have been waiting for an ADHD assessment in England in March that year. It was an estimate, not a precise count of everyone needing care today. That distinction does important work. The lyric’s compressed number needs its accompanying research context: otherwise, a memorable rhythmic phrase can turn a qualified historical finding into an apparently certain statement about the present. 

There is a similar problem with dramatic comparisons. A figure from a survey is not automatically a national rate. An account of a very long local wait does not establish the average wait everywhere. Research can support concern while refusing the strongest possible version of a sentence. That refusal need not weaken the song. It can make the anger more specific: this is the barrier being described, this is where the evidence comes from, and this is what it does not establish. 

The hardest boundary concerned mortality. A Swedish observational study published in JAMA found an association between starting ADHD medication and lower mortality during follow-up. It did not establish that a particular delay caused a particular death, or that its findings predict an individual’s future. The lyric says “Association, not causality”. I wanted the qualification to be part of the language, rather than a correction waiting somewhere the listener might never see. 

That does not make a song a research paper. A lyric cannot carry a study’s entire design, exclusions and limitations. The accompanying sources matter because somebody should be able to leave the song, read the finding and discover what was compressed. The musical phrase can point towards evidence. It should not make the evidence inaccessible behind its own confidence. 

Personal testimony needs a different kind of care. Two anonymous accounts do not become a single representative patient because combining them would make a smoother story. Their details may be vivid, but vividness is not verification. Keeping separate accounts separate was a writing decision as well as an ethical one. It left room for the people behind them to have lives larger than the details useful to my argument. 

The same restraint applies to people I know. Concern does not give me unrestricted access to somebody else’s story. Removing a name would not be enough if the remaining details identified them. There are things a song can leave out without becoming dishonest. It can describe the pressure of a system without offering an intimate life as proof. 

Administrative language gave the work another way to make its point. A referral can be acknowledged while help remains unavailable. The song places that orderly vocabulary beside a life that does not pause for the next message. In that contrast, research and experience have different jobs. Research helps identify the limits of the factual claim; the song explores what the interval between an acknowledgement and usable care can feel like. 

I don’t think the track can diagnose anyone, demonstrate a treatment effect or establish how every patient experiences waiting. What it can do is offer a particular way into the subject. A listener may recognise something; another may disagree with the interpretation. Neither response turns the song into clinical evidence. 

Checking the sources did not remove the feeling from the writing. It gave that feeling boundaries. A strong statement can still make room for uncertainty, and a qualification can belong inside a line rather than outside the conversation. For me, that is the useful relationship between research and a song about illness: not permission to speak for everyone, but help in knowing what I can responsibly say. 

Sources and song 
NHS England. ADHD Management Information — May 2025. 29 May 2025.
https://digital.nhs.uk/data-and-information/publications/statistical/mi-adhd/may-2025 

Li L, Zhu N, Zhang L, et al. ADHD pharmacotherapy and mortality in individuals with ADHD. JAMA. 2024;331(10):850–860.
https://doi.org/10.1001/jama.2024.0851 

Song and public background: https://kieransimkin.co.uk/dying-for-a-diagnosis/ 

Verified research dossier: 
https://kieransimkin.co.uk/wp-content/uploads/2026/08/Dying_for_a_Diagnosis_Research_Dossier_Verified.pdf 

Photos
©2026 Kieran Simkin

Källén opens with some background. In late 1989, Erika Hagelberg and colleagues established something once considered impossible: the extraction and analysis of DNA from dry bone (pig). Their feat promised tremendous potential for archeology; however, the expense and complexity of sequencing ancient DNA (aDNA) meant that the field of archeogenetics had to wait until computerized techniques allowed for high throughput methods.

Next Källén offers a lucid description of DNA, and its various forms used in the context of tracing ancestry and understanding inheritance–Y chromosome (from fathers) and mitochondrial (from mothers)—and how it contributes well to forensic science today. But, she points out, the molecule deteriorates with time and only fragments remain to be recovered with difficulty. Scientists must turn to computerized probabilities that rely on similar aDNA examples to select likely genetic candidates for filling in the gaps.

Källén’s beef is mostly with what popular media makes of the aDNA results that are expressed more cautiously by the scientists themselves. She skewers the ecstatic 2017 reporting that a Viking warrior, buried with armour and weapons, had been proven by aDNA to be a woman–something that was already known through anatomical examination when her grave was uncovered in 1878. But she also challenges the interpretive biases of researchers who inevitably perceive their findings through a contemporary lens, one that contends with the population biases of present-day genomics.

Among the interpretive leaps can be found the desire to turn aDNA similarities in scant, disparate material into a new and separate “people.” For example, aDNA similarities in a few teeth and a piece of finger, found in only two widely separated places, have become the Denisovian “people.” A newfound furor for facial reconstruction has recruited aDNA to serve “the look” of this almost imaginary Denisovian “species.” Likewise, for the 10,000 year-old Cheddar man whose skull offered architecture, aDNA was to provide his (blue) eyes and (dark) skin colour.

Geographic variations of comparable aDNA findings with differing chronological tags become mass migrations, displayed by arrows crossing vast swaths of territory. When aDNA results are picked up by ethno-nationalist agendas, these pressures revive long-discredited forms of entitlement and racism.

In some examples, DNA findings must be contorted to match what was already settled from documentary and oral traditions: for example, the effort to match the DNA extracted from the braid of the leader Sitting Bull to that of his great-grandson. In a few generations, so much mixing has occurred that the common elements were few. In the end, the relationship was not being tested; it was aDNA’s ability to confirm it that wobbled.

Perhaps Källén’s greatest caution comes in her warning that the molecular signature of DNA is not identity as much as we would like it to be, nor does it reveal culture and “paleopersonalities.” She describes how commercial entities promising to uncover our origins do so on probabilities based on frequencies of myriad DNA variations. She also wonders about our insecurities that foster such a market.

In the end, aDNA is not a revolution. It is just a molecule and a useful adjunct to the methods we already possess, not the least of which is its ability to give us new questions.

The Trouble with Ancient DNA: Telling Stories of the Past with Genomic Science
Anna Källén
University of Chicago Press, 2025. 160 pages

Image of Cheddar Man from Wikicommons

I think of Susan Sontag when I’m in the bathroom. The mirror is high enough that I have to tiptoe to see my lower belly, which is where the cannula goes; the river mouth of my insulin pump, that has kept me alive for the wondrously long time of exactly three days. I need to change it now, to rip it out of my left side and shoot a new one into my right; every three days there’s a new cartridge, a new tube, a new cannula, a new spot in my abdomen that takes the hit. And when the needle makes its way into me and leaves a hole, and when the tube clicks and the slow stream of insulin is forced inside, I think of Susan. I think of Susan and her essay, “Illness as Metaphor”; I think of how she describes illness as “ the night-side of life, a more onerous citizenship ” . The kingdom of the well, the realm of the sick: a double passport situation. And sometimes, unfortunately, we’re obliged, at least for a while, to travel to the underworld and identify ourselves as citizens of that “other” place. Say, then: what if that other place came to you? What if you had to live there? It’s tricky to talk about chronicity in illness, because it’s not a generalized, shared human experience. Almost all of us can revel in our feelings of love, longing, loneliness; we can wonder at the natural world and share in our curiosity for it. We can whisper about our fear of death. But how can someone with rheumatoid arthritis explain to you what it is to live in constant, searing joint pain? My mother cannot clap: her hands, now deformed, cannot be straightened enough to be put together. I don’t know how that feels. Chronicity is tricky.

Every single waking moment of my life I’m thinking about my glucose levels. It’s an open tab on the browser of my brain, forever. It doesn’t rest. Even my sleep is thin, vaporous, like a white sheet caught in a breeze; my ears are primed and alert for the beeping of my glucose monitor, which would mean a drop in my sugar levels; I’d need to get up quickly and drink some orange juice or take a glucose pill. If I don’t, sleep can turn into a coma. I sleep with my insulin pump connected to my body; the tube is only 40 cm long, so there’s a lot of tugging and tangling around. The first thing I do when I wake up is inject insulin, because my metabolism, like everybody else’s, is waking up too, which includes secreting glucocorticoids: emphasis on gluco. This is why breakfast is generally not recommended for diabetics, especially the classic and insidious high-sugary ones, with juices and pancakes and cereal. Here comes chronicity again: I analyze every single thing I put in my mouth, because I need to know how many carbohydrates it has. I benefit immensely from planning my days, from knowing exactly what and when I’m eating; the when is crucial too. My insulin pump is programmed, by me and my endocrinologist, based on the time of day and the number of insulin units needed to compensate for the grams of carbohydrate I’m taking in . I need less insulin at noon, my ratio is higher in the evening. My body changes every hour, my mind does too; my emotional state will impact my glucose levels. Long hours of work mean more insulin. Have I woken up too early? More insulin. Am I stressed this week? That’s cortisol, that’s a glucocorticoid: more insulin. The inverse is true too: what if I’m suddenly scared or taken aback? My mother calls me, her pain is worse; my friend argues with me; my partner leaves me: panicking makes my glucose levels drop. An overthinking brain uses up too much fuel: cut the insulin, please. These ups and downs happen all the time, often on top of each other, simultaneously. That’s chronicity. Our organisms are in constant communication with our environment and our fellow human beings: if your organism happens to be chronically ill, you’re going to have to add that factor to absolutely everything.

That makes me think of Susan again. Am I a permanent resident of sick-city? Do I even have a “ healthy ” passport anymore? Can I cross the border? It doesn’t seem like I can. But then again, Susan, I’m also immediately suspicious of binary responses to questions: you’re either healthy or sick, sick for a time, then back to healthy? I like Lina Meruane’s approach better: she’s a brilliant Chilean author who also happens to be diabetic, and she talks about illness as “normality”. She turns the binary to a spectrum, and builds a huge space for all the little shades of grey to live in. There are degrees of illness, degrees of health. One traverses the spectrum constantly; one doesn’t just stand around a pole forever. I’m healthier than a lot of people I know, in a lot of ways. You can be emotionally healthier, for example. Would you rather a toxic, chronic marriage or an insulin pump? Both can kill you. Comparisons like this are silly, which is exactly my point; illness, health and human beings are extremely complex and varied, very difficult to categorize. There’s a lot of normality in my diabetes. If I look at it that way, it helps me communicate and connect with other people’s varying degrees of health and sickness. It opens up a space; it allows me to identify as something other than just “chronically ill”.

And then again, these are just words.

And then again, the way we speak to ourselves is important. The way we narrate the situations we’re in ends up changing them, and us. We attach meanings to reality, and reality is transformed accordingly. So hey, use your words but use them wisely.

The British author, Eve Garnett (1900-1991) was born in Worcestershire, England, and had a comfortable, middle-class upbringing. She became inspired to write children’s literature after moving to London in the 1920s for art school and witnessing the stark social division and living conditions of London’s poor.[1] These experiences fueled a lifelong mission to bring attention to poverty and to give children from urban, working-class backgrounds stories that reflected their own lives. Her first book, The Family from One End Street, was published in 1937. It is the first of three books about the Ruggles family, consisting of Mr. Ruggles, a town dustman¹, Mrs. Ruggles, a washerwoman, and their seven children, from teenage Lily Rose to infant William. The subsequent books, Further Adventures of the Family from One End Street (1956) and Holiday at the Dew Drop Inn (1962), take place immediately after the first. Set in the fictional English town of Otwell between WWI and WWII, the series describes the adventures and hardships of the Ruggles family with humor and poignancy. 

In the second book, Further Adventures of the Family from One End Street, a measles outbreak is the inciting event that sets the plot into motion. The eldest, Lily Rose, is the first to be stricken as “her head ached, she felt hot and cold by turns” and then she looks in the mirror to find her face is “bright pink, and covered all over with small red spots!” The doctor is called to their small and crowded home, and he advises Mrs. Ruggles, “You can’t keep her here, you know – nowhere to isolate her and no time to look after her if you had; it’s the isolation hospital for measles these days. I’ll have the ambulance round in half an hour and someone to disinfect that room for you. ‘The others?’ no, they certainly can’t go to school, but don’t you worry, they’ll probably all have it in a few days and be off your hands in the hospital too!” 

Management of measles and other infectious diseases was particularly challenging among the urban poor, who lived in crowded conditions. Because the nine Ruggles live in tight quarters in a “very old and very small” house, the remaining six Ruggles children are at risk for catching measles from Lily Rose.² Infection can also easily spread beyond the Ruggles household to the rest of the neighborhood. To help contain the infection, patients were sent to isolation hospitals, which were standalone institutions dedicated to treating infectious diseases in the pre-antibiotic and pre-vaccine era.  

The evolution of isolation hospitals was shaped by public health efforts throughout the 1800s and the medical acceptance of germ theory by the 1880s. The first fever hospital in England opened in 1801.[2] Early fever hospitals were run as private charities for the poor and featured open-planned rooms where patients suffering from different infections were packed side-by-side. These places were mocked as houses of death because someone admitted with a mild case of one fever could catch an entirely different, fatal infection from the patient in the next bed. Over time, laws established public health funding and regulation for isolation hospitals. The Sanitary Act of 1866 gave local authorities explicit power to provide hospital accommodation for infectious disease, a power consolidated by the Public Health Act of 1875.[3-5] Later, the Isolation Hospitals Act of 1893 empowered county councils to build new isolation hospitals where needed, leading to a national network of specialized isolation hospitals designed in accordance with modern germ theory.[3,6] By WWI, there were more than 750 isolation hospitals in England and Wales.[7] These new isolation hospitals emphasized cleanliness and good ventilation, and featured separate wards for different infections.[7] Thus, when Lily Rose develops measles in the 1930s, the doctor recommends she be admitted to a dedicated measles ward of a modern isolation hospital for quarantine and care.³ 

Hypothetically, if Mrs. Ruggles objected to Lily Rose’s hospital stay, the doctor may not have had a pathway to mandate her admission in the 1930s. The Public Health Act of 1936 gave local health authorities a legal mechanism to apply to a justice of peace, who could then mandate the admission of a patient to an isolation hospital if they had a notifiable disease, home isolation was not possible, and they posed a serious risk of infection to other persons.[8] However, measles did not become a nationally notifiable disease in England and Wales until 1940.[9] Before 1940, it was up to individual towns to make measles notifiable and enforce isolation, and Eve Garnett does not specify if such laws existed in Otwell. 

Despite Lily Rose’s prompt quarantine, her younger siblings Jo and Peg also develop measles and are sent to the isolation hospital. Mrs. Ruggles may have been particularly grateful for the supportive care of isolation hospitals in Jo’s case as “the doctor said Jo was a very sick boy, and told Mrs. Ruggles downstairs it was always worse if the spots stayed in, and the sooner Jo was in the hospital the better!” What the doctor is referring to is that the measles rash typically appears 3-5 days after the first symptoms of fever, cough, coryza⁴, and conjunctivitis; if the rash onset is delayed or “the spots stayed in”, it is a signal that the body is struggling to fight the virus. A late, absent, or weak rash is common in immunocompromised, malnourished, and very young children whose immune systems are not fully developed; these patients are at increased risk for severe systemic complications.[10, 11] While Lily Rose is described as a robust 13-year-old girl who only has a “mild attack”, 7-year-old Jo and 5-year-old Peg suffer more serious attacks and have a longer road to recovery. This is especially true as measles is now known to cause immune amnesia, a condition where the virus depletes patients’ pre-existing antibody repertoire, leaving them vulnerable to other infections for two to three years afterward.[12]  

Upon discharge from the hospital, Peg and Jo have clearly lost weight, are still quite weak, and need further treatment. After a conversation with the doctor, worried Mrs. Ruggles updates her husband, “Peg and Jo’s got to be fed up with malt-and-oil when they comes out, and Jo’s that pulled down, the doctor says as six weeks in the country’ll barely set him up”. The oil the doctor recommends to Mrs. Ruggles is cod liver oil, which transitioned from a folk remedy to a mainstream, multi-purpose medical treatment in the 1800s. However, doctors did not know why some patients benefited from cod liver oil until medical research in the early 1900s discovered vitamins and diseases of vitamin deficiency. Cod liver oil was discovered to contain vitamin A in 1913 and vitamin D in 1922.[13,14] And, as discussed in the first part of this MedHum series, the therapeutic value of treating measles patients with vitamin A was demonstrated in 1932.[15] The high caloric content of cod liver oil also helped with malnourishment. Unsurprisingly, children hated the taste of cod liver oil, so malt-and-oil was developed as a commercial pharmaceutical product in the late 1800s, whereby the fishy oil was mixed with thick, sweet malt extract to make it more palatable. Mrs. Ruggles, who has not tasted the malt-and-oil, puts this mixture to the test when she “hold[s] a spoonful out to” suspicious Jo and coaxes him with hopeful reassurances, “It’s not medicine, nor yet oily – more like soft toffee”. She heaves a sigh a relief when he swallows it without resistance, “Thank Heaven he liked it!” 

By sacrificing their meager savings, Mr. and Mrs. Ruggles are able to follow the doctor’s other recommendation to send Jo and Peg (along with their 12-year-old sister Kate) to stay with Mrs. Wildgoose in countryside for recovery. Throughout the 19^th and early 20^th centuries, sending urban children to the countryside to recover from illness was standard practice; the rationale was plausible in cities plagued by industrial smog, poor sanitation, and overcrowding. When Mrs. Wildgoose meets the children, she says “she could see from the look of Peg and Jo how important [malt-and-oil] was, but mark her words, before the three children had been a week at the Dew Drop Inn, eating the eggs from her ducks and hens, good farm butter, and drinking milk from Mr. Digweed’s cows, they wouldn’t know themselves!” It may be universally agreed upon that eggs and dairy are a more palatable way to consume calories and fat-soluble vitamins than cod liver oil. The children do indeed have a marvelous time at the Dew Drop Inn – their countryside explorations and misadventures make up the core of the book – and they make a full recovery attributed to fresh air, sunshine, exercise, and good food. And when they return home, “How [Mrs. Ruggles] hugged and kissed them all, exclaiming again and again at Peg and Jo’s bright eyes and round, fat, sunburnt faces – so different from the pale, skinny little creatures she had seen off six long weeks ago!” 

Although the book focuses on the children’s perspectives, Mrs. Ruggles’ measles experience is worth acknowledging. She is separated from her children for two stressful months because of measles. She is not allowed to visit them during their weeks in the hospital, as isolation hospitals of the time followed strict quarantine protocols. In fact, the doctor warns Mrs. Ruggles when Lily Rose is first diagnosed, “go down to the hospital this evening if you like but they won’t let you see her.” After Peg and Jo are discharged from the hospital, she sends them to recuperate with Mrs. Wildgoose for six weeks because she cannot afford to take time off of work and she needs to tend to her other four children. No wonder those six weeks felt long, and no wonder she is relieved and overjoyed to see her children healthy again when they return from Dew Drop Inn.  

While the isolation hospital and measles recuperation experience would have been familiar to contemporary readers, it likely feels foreign to readers today. The development of a measles vaccine in 1963 and its implementation in Britain in 1968 – about thirty years after this book is set – dramatically reduced the incidence of measles and contributed to the obsolescence of isolation hospitals.[16] Following the development of highly effective vaccines and antibiotics in the mid-1900s, isolation hospitals were systemically closed or repurposed. Measles was declared eliminated by the World Health Organization in the US in 2000 and in the UK in 2017.[17,18] For a period of time, measles was relegated to a bygone era, just like doctors’ prescriptions for malt-and-oil and country air. However, as vaccination coverage has fallen, measles has returned. The UK lost its measles elimination status for a second time on January 26, 2026, and the US is predicted to follow.[18,19] As a result, Further Adventures of the Family from One End Street is somehow pertinent again in its depiction of measles as a contemporary childhood malady.  

¹ Dustman is a traditional British term for garbage collector, which is considered old-fashioned today. 

² This quote is taken from the first book, The Family from One End Street. 

³ The development of isolation hospitals in the US followed a similar timeframe. In the US, the first isolation hospital was opened in Philadelphia in 1801 following a series of yellow fever epidemics. During the late 19th and early 20th centuries, state statutes across the US codified the mandatory construction of municipal isolation hospitals to control epidemics. Because public health powers are granted to states under the U.S. Constitution’s 10th Amendment, individual towns and state boards of health passed the earliest mandatory measles isolation laws in the late 1800s, and measles became a nationally notifiable disease in 1912. 

⁴ Coryza is the medical term for acute inflammation of the mucous membranes inside the nose, commonly known as a runny nose. It is one of the “three C’s of measles”, a traditional medical mnemonic used to teach medical students the standard early clinical presentation of measles – cough, coryza, and conjunctivitis.  

References 

1. Eve Garnett. Penguin Random House. Accessed September 7, 2026. https://www.penguinrandomhouse.com/authors/9731/eve-garnett/ 
2. Currie MR. Fever Hospitals and Fever Nurses: A British Social History of Fever Nursing: A National Service. Routledge; 2005. Accessed September 7, 2026. https://ndl.ethernet.edu.et/bitstream/123456789/9881/1/1072.pdf 
3. Parsons HF. The Hospital Isolation of Infectious Diseases: I. The History of Isolation. Hospital (Lond 1886). 1913;54(1408):357-358. 
4. Great Britain. The Sanitary Act 1866. legislation.gov.uk. Enacted 1866. Accessed September 7, 2026. https://www.legislation.gov.uk/ukpga/Vict/29-30/90/contents/enacted 
5. Great Britain. Public Health Act 1875. legislation.gov.uk. Enacted 1875. Accessed September 7, 2026. https://www.legislation.gov.uk/ukpga/Vict/38-39/55/contents 
6. Great Britain. Isolation Hospitals Act 1893. legislation.gov.uk. Enacted 1893. Accessed September 7, 2026. https://www.legislation.gov.uk/ukpga/Vict/56-57/68/enacted 
7. Currie MR. Fever Hospitals and Fever Nurses: A British Social History of Fever Nursing: A National Service. Routledge; 2005. Accessed September 7, 2026. https://ndl.ethernet.edu.et/bitstream/123456789/9881/1/1072.pdf 
8. Great Britain. Public Health Act 1936, section 169. legislation.gov.uk. Enacted 1936. Accessed September 7, 2026. https://www.legislation.gov.uk/ukpga/Geo5and1Edw8/26/49/section/169/enacted 
9. Public Health Wales. Measles surveillance and epidemiology. Accessed September 7, 2026. https://phw.nhs.wales/reports/measles-surveillance-and-epidemiology/ 
10. Burrell CJ, Howard CR, Murphy FA. Pathogenesis of virus infections. In: Fenner and White’s Medical Virology. 5th ed. Academic Press; 2017:77-104. doi:10.1016/B978-0-12-375156-0.00007-2 
11. Permar SR, Griffin DE, Letvin NL. Immune containment and consequences of measles virus infection in healthy and immunocompromised individuals. Clin Vaccine Immunol. 2006;13(4):437-443. doi:10.1128/CVI.13.4.437-443.2006 
12. Mina MJ, Kula T, Leng Y, et al. Measles virus infection diminishes preexisting antibodies that offer protection from other pathogens. Science. 2019;366(6465):599-606. doi:10.1126/science.aay6450. 
13. McCollum EV, Davis M. Nutrition classics from The Journal of Biological Chemistry 15:167-175, 1913. The necessity of certain lipins in the diet during growth. Nutr Rev. 1973;31(9):280-281. doi:10.1111/j.1753-4887.1973.tb07065.x 
14. McCollum EV, Simmonds N, Becker JE, Shipley PG. Nutrition classics. The Journal of Biological Chemistry 53:293-312, 1922. Studies on experimental rickets. XXI. An experimental demonstration of the existence of a vitamin which promotes calcium deposition. Nutr Rev. 1973;31(5):158-161. doi:10.1111/j.1753-4887.1973.tb05090.x 
15. Ellison JB. Intensive vitamin therapy in measles. Br Med J. 1932;2(3745):708-711. doi:10.1136/bmj.2.3745.708 
16. Sutherland I, Fayers PM. Effect of measles vaccination on incidence of measles in the community. Br Med J. 1971;1(5751):698-702. doi:10.1136/bmj.1.5751.698 
17. Centers for Disease Control and Prevention. History of measles. Updated April 29, 2026. Accessed September 7, 2026. https://www.cdc.gov/measles/about/history.html 
18. Taylor L. UK loses its measles elimination status. BMJ. 2026;392:s172. doi:10.1136/bmj.s172 
19. Bischops AC, Hulland EN, Patzakis M, Majumder MS. Will the USA lose its measles elimination status? Lancet. 2026;407(10540):1679-1681. doi:10.1016/S0140-6736(26)00466-6

Further Adventures of the Family from One End Street 
Eve Garnett 
Puffin Books, 1993. Paperback. 256 pages 
Originally published 1956 

Web image generated by Medhum.org based on the original book cover.

At the height of the HIV/AIDS epidemic, on Nov. 30, 1993, Larry Kramer, the late writer and gay rights activist, sparred with Anthony Fauci, then director of the National Institute of Allergy and Infectious Diseases, on a C-SPAN call-in program over the Clinton administration’s response to the crisis. Journalist Steve Scully moderated the conversation, also taking calls from civilians whose questions and comments revealed varying levels of understanding of the disease and compassion for those living with it and their loved ones. 

Daniel Fish’s Kramer/Fauci offers a verbatim staging of this conversation, starring Thomas Jay Ryan as Kramer, Will Brill as Fauci, Greig Sargeant as Scully, and Jennifer Seastone as the various callers. All four listen to the C-SPAN recording through in-ear speakers. 

Kramer casts Fauci as the face of an indifferent bureaucracy committing a genocide by inaction. “Tony, if you start that business about, ‘Science isn’t done that way,’” he says, “I’m going to come down there and slap your face.” 

“All right, Larry, hang on for a sec,” replies the career public servant. “I love you, Larry.” 

They are equal parts allies and antagonists, their genuine affection bubbling through their disagreements and making their complicated relationship [1] especially compelling to watch. What I found less compelling was the machine that releases a tidal wave of bubbles, enveloping Kramer. At one point, Fauci lies near the foam in a Titanic-style “draw me like one of your French girls” pose. If the suds are meant to represent lives lost to AIDS, this image risks reducing an enormous human toll to a theatrical flourish; the absurdism does little to illuminate the government’s inadequate response. Seastone dons roller skates at one point and an inflatable chicken suit at another. Are these props meant to suggest that the titular characters are skating past each other? Playing some game of chicken? 

I am still glad I saw the hour-long production. It offers a different experience from watching Fauci sit in a studio or Kramer appear via video screen. The actors roam in the cavernous venue, putting the audience physically inside the conversation. But there is more to theater than the theater itself or theatricality for its own sake—than paltry props and a bevy of bubbles. 

Kramer indicates that, despite Fauci’s diplomatic, controlled persona, he is privately frustrated by the political and bureaucratic constraints holding back AIDS research. What if we had seen imaginings of Fauci’s anger behind closed doors? What if we had witnessed how the men’s relationship evolved—how Fauci began working with AIDS Coalition to Unleash Power, co-founded by Kramer, to expand access to life-saving experimental treatments, or how Kramer later shouted at a government hearing, “Tony, I have called you a murderer in the past, but you are now my hero”? 

What if the production had used its visual language to evoke the toll of the epidemic rather than providing sporadic spectacle? Panels from the AIDS Memorial Quilt. Stories of the 700,000 Americans who died. The more than 1 million Americans living with HIV today, with Black and Hispanic/Latino Americans and men who have sex with men among those disproportionately affected. 

Otherwise, Fish risks reducing AIDS to a metaphor for COVID-19 and its fallout. Kramer/Fauci should not be relevant only because COVID-19 has reshaped the public’s relationship with science, or because Fauci, three decades later, has once again been called on to defend his work during a plague. It should be relevant because the history it depicts remains unfinished. 

C-SPAN recording of the Kramer/Fauci call-in show  

Fauci remembers Kramer 

[1] Fauci, Anthony. “Anthony Fauci on Larry Kramer and Loving Difficult People.” The New York Times, 4 July 2023, https://www.nytimes.com/2023/07/04/opinion/anthony-fauci-larry-kramer.html.  

Web image generated by Medhum.org

The book has a Biblical quality. The story unfolds in present day Australia, but the atmosphere is ancient and premodern. Wood incorporates a frightening plague of mice who infiltrate every element of the women’s home and terrify the nuns. Also, a woman who knew the narrator in high school and who was the victim of a horrifying adolescent gang attack surfaces unexpectedly. She is now a famous nun charged with returning the bones of a murdered sister to the community for burial. Her sudden appearance unsettles everyone. It all sounds like “A Children’s Bible” by Lydia Millet. But it is unmistakably a tale of adults living today in a world that we recognize. These mythical events play out in the setting of grounded people caught up in regular everyday challenges and missteps – miscommunication between couples, adolescent conflicts, failing to realize unintended slights, evenings spent comforting ill friends. The narrator is surrounded by nuns, neighbors, and friends whose activities and conversation are routine. Against this backdrop, her voice sounds timeless and prophetic.

This is an extraordinary book. It is not an easy read but a rewarding one that would be meaningful to any doctor trying to become a better care provider. For example, there is an intense effort underway to incorporate quantitative rigor into medical practice. With that as the point of departure, absent evidence to support one treatment over another, it might seem that restraint would be the best path for a doctor to follow. But illness calls for action. And if doctors are honest, they will acknowledge that errors are made in the course of action that they choose. Patients can be injured and their deepest hopes may be ignored. There is plenty of room for misunderstanding and hurt in both directions — patient to doctor, doctor to patient. How does a thoughtful, mature doctor manage this inescapable burden?

Wood’s novel speaks to doctors who have to address mistakes and conflicts every day in their practice. The setting is religious, but the scope is human. She does not offer an evidence-based one-size-fits-all solution to the chaos of life. The interdependency of people and the connectedness of people and nature are central features of the book and key to its emotional integrity. With that backdrop, she has created a narrative that sensitively details the burden of pain and despair when people cannot get past these challenges. This is balanced by the serenity that is achieved when people honestly confront their mistakes and receive forgiveness for misdeeds. The individual stories in the novel vary and the outcomes differ. The endings are often imperfect and reflect our human limitations. But there are moments of deep connection between characters, a willingness to accept how life played out. The feelings that are created are real and genuine. And they speak to doctors.

This is the season in the Jewish annual calendar when one is commanded to take stock of one’s life and conduct. The underlying theme is atonement, to frankly acknowledge personal flaws and misdeeds and seek forgiveness from that one has hurt. The religious framework is an opportunity to address mistakes of the past and map a path to a healthier more moral future. Ideally, it builds on true memory to create a new future history for our personhood. I would recommend Wood’s book as a human companion text to traditional Jewish prayer books. It is a challenging read, unsettling in its directness, and implacable in its honesty. It is an irreplaceable guide to genuine forgiveness, acceptance, and compassion, whether or not you are a doctor, regardless of your faith.

Stone Yard Devotional
Charlotte Wood 
Riverhead Books, 2023, 293 pp 

Web image generated using the original book cover.

In Christopher Nolan’s adaptation of The Odyssey (2026), this entire sequence is conspicuously absent. Waking up on the beach, Matt Damon’s Odysseus only sees Athena, played by Zendaya. Zendaya’s Athena reappears at times in the story, watchful and from afar, such as during conversations. On the beach, Athena is seen in the distance, and Odysseus is stoic. There is no court of Alcinous. Athena’s inclusion also stands out against the rest of the film in that she is the only god personified. As has been criticized by Emily Wilson, the translator of the popular 2020 translation of The Odyssey that Nolan took inspiration from, it is a godless film ¹. Rather, the gods are often vaguely referenced in terms of evoking natural phenomena (e.g., the storms in the distance representing Zeus). So why then does Athena appear time and time again, wordlessly watching?

To understand Athena’s role in the film, it is useful to return to earlier interpretations of the poem. The story of The Odyssey is many things, not the least of which is a story of post-traumatic stress disorder (PTSD). Jonathan Shay’s (2002) Odysseus in America: Combat Trauma and the Trials of Homecoming has most authoritatively used the original text as a framework to understand the poem through the lens of PTSD. Shay argues that Odysseus’ mistrust, lying, explosive violence, and emotional concealment mirror the real-world symptoms seen in combat veterans. He further argues that unlike Odysseus, for whom the titular odyssey of 10 years acts to process his trauma, modern soldiers go from the battlefield to civilian life via a quick plane ride, removing the ability to process trauma. Yet, Nolan’s film refines this allegorical parallel to PTSD beyond the original poem. Many of these qualities Shay touches upon, including the mistrust, lying, and emotional concealment, have been stripped from Odysseus in Nolan’s version, rendering him an “uncomplicated man,” per Emily Wilson. Yet, a new trait, core to PTSD, is introduced: avoidance.

Understanding Nolan’s The Odyssey as allegorical for PTSD fundamentally alters how several scenes are read. For much of its runtime, it feels far removed from the commentary on PTSD of the original poem; Odysseus seems unbothered by the passage of time. Contrarily, it also diverges from the poem in directly calling attention to Odysseus’ role in the Trojan War, which remains relatively implicit in the original poem. The film’s third act reconciles this contradiction by rendering the film’s past events as an exercise in avoidance of trauma. It is only in the finale of the film that the function of these visions of Athena is revealed. Odysseus finally tells the story of his sacking of Troy, and in it, the desecration of a statue of Athena is juxtaposed with the execution of an innocent Trojan, played by Zendaya. This parallel invokes Quran 5:32 (“Whoever kills a soul unless for a soul or for corruption . . . he had slain mankind entirely”) and other religious traditions holding that to kill an innocent is equivalent to killing a god. Simultaneously, it recontextualizes the recurrent appearances of Athena across the film as a type of living embodiment of the guilt that Odysseus holds with him. Athena never intervenes in the film as gods do in Homer’s original poem; rather, she watches, materializing at exactly the moments Odysseus would otherwise be flooded by memory of Troy. This parallels the sense of being watched that trauma survivors describe (Sims & Sims, 1998). While in Homer’s original poem Odysseus breaks down in recounting his journey, in Nolan’s film, instead, he remains stoic while seeing Athena in the distance, avoiding the memories of the war.

So, returning to Book 6 of The Odyssey, Odysseus cries on the beach, overcome by trauma. But in the film, something just as characteristic of PTSD occurs. Odysseus sees Athena, analogous to the innocents he killed in the Trojan War, and he looks away. He avoids reckoning with the regret that comes with such a vision. In Nolan’s The Odyssey, no gods remain to offer Odysseus solace from PTSD. Rather, Athena, the only god that remains, serves only as a reminder for him of his combat trauma.

Footnote:
1, https://www.lrb.co.uk/the-paper/v48/n14/emily-wilson/an-uncomplicated-man

References:
Shay, J. (with Internet Archive). (2002). Odysseus in America: Combat trauma and the trials of homecoming. New York : Scribner. http://archive.org/details/odysseusinameric0000shay

Sims, A., & Sims, D. (1998). The Phenomenology of Post-Traumatic Stress Disorder: A Symptomatic Study of 70 Victims of Psychological Trauma. Psychopathology, 31(2), 96–112. https://doi.org/10.1159/000029029

The Odyssey
Director: Christopher Nolan
Universal Pictures, 2026: RT 2hr 52 min
Web photo courteous of Universal Pictures

Felix is a gifted director at an Ontario theatre festival. He plans an exciting new interpretation of The Tempest but is unfairly ousted from his beloved position by a jealous and inadequate rival. Worse, he is haunted by grief over the loss of his daughter, Miranda who died twelve years ago. 

Struggling financially, he accepts a low-paying position to promote literacy in a local prison—and hits upon the idea of using his newfound but incarcerated protégés to mount his long-planned Tempest. The project encounters financial difficulties that begin to seem insurmountable, as his hostile rival assumes an influential government position. 

Moments of hilarity abound. For example, Felix convinces hardened criminals that they might crave and compete to portray such unlikely roles as the ethereal sprite, Ariel, or even the enslaved, monster, Caliban (Hag-seed), with whom the prisoners feel a special connection. Felix forbids swearing, except those oaths used by Shakespeare and the prisoners delight in creating a glossary of antiquated expletives, which they apply to everyday life. The “Correctional Players” embrace digital technologies, and choreography and plan to video their performance. Bringing a meaningful project to his initially uncomprehending, new friends becomes a reward in itself, inviting him to reconsider and move beyond his previous losses.

The result exceeds all expectations, helps to heal his grief, and with its unorthodox staging provides a delicious revenge. 

Hag-Seed
Margaret Atwood 
Penguin Random House, 2017: 320 pages 

AI image created with prompts by MedHum.

For thousands of years, the value of medical treatments of the day was disparaged with some frequency mostly in the form of quips from prominent people in health care, the arts, government, and social commentary. More recently, the quips evolved into formal philosophical arguments conveying a view that the likelihood of any new medical treatment becoming a major breakthrough is low. The term “medical nihilism” is now associated with this view. 

In this episode, with the physician and philosopher Dr. Ross Upshur, we cover medical nihilism conceptually and assess how well the term fits the arguments underlying it. We discuss some of the components comprising the arguments, which are generally real, and how they can contribute to medical nihilism, and validate the uncertainty existing in medicine for some. We talk further about how to accept this uncertainty and manage our health care decisions as providers, educators, and consumers without falling into the despair of medical nihilism. 

Note that throughout the episode, we mention Jacob Stegenga and his book, Medical Nihilism, and also Jonathan Fuller and his book, The New Modern Medicine. We mention Ross Upshur and Maya Goldenberg’s article, Countering Medical Nihilism by Reconnecting Facts and Values in Studies in History and Philosophy of Science. Citations for each are listed below.

Primary Sources
Upshur, Ross, and Maya J. Goldenberg. “Countering Medical Nihilism by Reconnecting Facts and Values.” Studies in History and Philosophy of Science Part A, vol. 84, Dec. 2020, pp. 75–83. (Available as pdf at Maya Goldenberg’s website.)
Stegenga, Jacob. Medical Nihilism. Oxford University Press, 2020.

Fuller, Jonathan. The New Modern Medicine: Disease, Evidence, and Epidemiological Medicine. Oxford University Press, 2025, academic.oup.com/book/61541. (Available as open access at Oxford University Press.)

Links
Biosketch for our guest Dr. Ross Upshur 
FDA list of recalls, market withdrawals, and safety alerts.

Attributions
For audio clip: From Atonement by Ian McEwan, read by Jill Tanner. Audiobook. [Recorded Books, 2002]. Accessed via Spotify.

Episode image: 
Oliver Wendell Holmes, Sr 
Credit: Oliver Wendell Holmes. Colour lithograph by Sir L. Ward [Spy], 1886. Wellcome Collection. Source: Wellcome Collection. License: Public Domain Mark.

Thanks to Dr. Ross Upshur for his interesting and insightful contributions to this episode. 

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