Medicine, Evidence, and the Grand Inquisitor

Thursday Lecture Series, Evidence

February 17, 2011 Thursday, 12:15pm EST The Heyman Center, Columbia University

For many years a professor of English at Rutgers, Terrence Holt is now a geriatrician at the University of North Carolina Medical School and an award-winning fiction writer, most recently of the short story collection In the Valley of the Kings (2009). His presentation—which comprised the reading of one of his stories and its discussion as a form of medical evidence—addressed the differing ways in which patients and doctors interpret and respond to medical statistics: for a patient, a five percent survival rate may be a cause for hope; for an oncologist, it may be a cause for anguish, knowing as she does that only one in twenty of her patients will survive, while the other nineteen will inevitably and pointlessly suffer more from her treatment than from the disease itself. Dr. Holt’s story invoked the dilemma posed by Dostoevsky’s Grand Inquisitor, suggesting that contemporary medicine, in willingly reversing Dostoevsky’s equation, is blinded by a kind of exceptionalism, in which the triumph of the one renders the suffering of the masses invisible. Stories as well as biostatistics are a form of evidence, providing a narrative context, a background against which medical data ought to be interpreted in particular instances. Understanding the meaning of such data within the case histories from which they have been extracted may point to a more rational and humane kind of medicine than currently obtains in research hospitals today.