James Le Fanu

‘For every problem there is a solution: neat, plausible and wrong’. H.L.Mencken

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Unfortunately, most illness is down to sheer bad luck

AMID ALL the razzmatazz of the Oscars, the results of a very different type of award ceremony – the Darwin Awards – have been overlooked. These are not, as might be expected, bestowed on worthy biologists for pushing forward the boundaries of evolutionary theory (were that possible), but rather are a recognition of bizarre and unpredictable bad luck.

This year’s recipients included a joint award to four people involved in a string of related accidents: Sherry Moeller, admitted to hospital with a head wound caused by flying masonry; Tim Vegas, who sustained a whiplash injury and contusions to the chest and face; Bryan Corcoran, who suffered laceration of the gums; and Pamela Klesick, who sustained serious injuries to the fingers of her right hand.

The citation includes the following, possibly apocryphal, description of the events prompting the award. "Sherry Moeller had just dropped her husband off for his first day of work and, in addition to a goodbye kiss, she flashed her breasts at him. "I’m still not sure why I did it," she said later. "I was very close to the car, so I didn’t think anyone could see. It could not have been for more than two seconds."

However, taxi driver Tim Vegas did see, and as a result lost control of his cab, which crashed into the wall of the Johnstone Medical Building. Inside, a dental technician, Pamela Klesick, was cleaning the teeth of her first patient that morning, Mr Bryan Corcoran. The crash of the cab made her jump, lacerating Mr Corcoran’s gums with her dental instrument. In shock, he bit down, severely injuring two fingers of Miss Klesick’s hand.

Meanwhile, Sherry Moeller, whose flashed breasts had precipitated these chance events, was hit on the head by a piece of falling brickwork from the building. Bleakly humorous as this string of misfortune might seem, it touches on a most difficult problem of medical practice that can best be described as the "Why me?" syndrome, and which has two distinct components.

In the first place, we are privileged to live in a society where, for the first time in human history, most people can expect to live out their natural lifespan, experiencing good health most of the time, give or take the occasional bad attack of ‘flu or piles, or some other similar self-limiting condition. This, in turn, emphasises the misfortune of those whose lives are either blighted by a disabling chronic illness such as multiple sclerosis or arthritis, or prematurely threatened by cancer or heart disease.

Secondly, there is a common assumption that the therapeutic success of modern medicine must mean that doctors also know the causes of disease. Regrettably, this is not the case. Indeed, astonishing as it may seem, the causes of 95 per cent of illnesses remain unknown.

Thus, the honest, if blunt, response to the frequently posed question "Why me?" can only be "It’s just bad luck". For obvious reasons, many feel this to be too cruel a verdict, hence the appeal of pseudo explanations where illness is blamed on an "unhealthy lifestyle" or hidden pollutants in the air and water. Breast cancer is blamed on pesticides, leukaemia on the electromagnetic fields generated by overhead pylons, and so on, and so on – ad, virtually, infinitum. Indeed, so appealing are these pseudo explanations that there is a whole branch of medicine, epidemiology, that is almost exclusively committed to their fabrication on the basis of dubious statistical associations.

None the less, there is consolation of a sort in acknowledging that illness can indeed be attributed to "bad luck".

We are, in the words of the Psalms, "fearfully and wonderfully made" (You created my inmost being; you knit me together in my mother’s womb). Our physical bodies are infinitely and irreducibly complex – from the molecules of nucleic acid that make up our genes, which "pack over 100 trillion times as much information as the most sophisticated computer ever devised", to the extraordinary machinery of the cells in which the genes are located, to the aggregation of those cells into organs such as the heart and liver, to the control of the functioning of those organs by nerves and hormones, and to their integration to create a dynamic process that can grow and mature and adapt to the demands of the external world.

For most, luckily, everything works. They remain rudely healthy for years on end; but the possibility that the system may fail is inseparable from the complexity that ensures its proper function, so it is not unreasonable to attribute failures, in the form of illness, to "bad luck".

Copyright: Telegraph Group Ltd