1. Richard Asher:
Some words of
wisdom
Jonathan McFarland
February 2013

2. Short Biography
 He was an eminent British endocrinologist
and haematologist.
 Asher himself described the modern
haematologist as an individual who
“instead of describing in English what he
can see, prefers to describe in Greek
what he can’t”(1)

3.  Asthe senior physician responsible for the
mental observation ward at the Central
Middlesex Hospital he described and
named Munchausen syndrome in a 1951
article in The Lancet.[2]

4. The Beatle Connection
 The Asher family home above his private
consulting rooms at 57 Wimpole Street
was briefly notable when Paul McCartney
lived there in 1964-1966 during his
relationship with Jane Asher

5.  In1964 Asher suddenly gave up his
hospital post and perhaps all medical
activities.
 He suffered from depression in later life
and reportedly died by his own hand at
the age of 57.

6. Medical Writing
 Asher was regarded as "one of the
foremost medical thinkers of our times“.(3)
 He emphasised the need "to be
increasingly critical of our own and other
people's thinking".(4)

7. Medical Writing
 Asher was particularly concerned that
"many clinical notions are accepted
because they are comforting rather than
because there is any evidence to support
them.”(5)
 Asher is remembered today mostly for his
"refreshingly provoking"[articles(6)

8. Medical Writing
 He thought that medical writing should
provide "useful, understandable, and
practical knowledge instead of allotov-
words-2-obscure-4-any-1,2-succidin-
understanding-them.(7)
 Anthologies of his articles were well-
received,with the Talking Sense collection
being described as still the best advice on
medical writing

9. Medical Writing
 Many of his papers have a timeless quality, and
like some medical classics deserve to be reread
from time to time.
 They include, among others, the following:
 “Why are medical journals so dull”(8)
 “Straight and crooked thinking in medicine”(9)
 “The dangers of going to bed”(10)
 “Clinical sense: the use of the five senses”(11)
 “Six honest serving men for medical writers”(12)

10. Medical Writing
 In the first he states in the concluding
paragraph, “Medical articles should, like
after-dinner speeches, finish before the
audience’s interest has started to wane”
 “The dangers of going to bed” was an
influential paper at a time when the
hospital stay for patients was
considerable.

11. Medical Writing
 In the “Clinical Sense” he begins,
 “ Clinical knowledge depends upon three
processes-observing, recording, and
thinking.”
 And proceeds to talk about the
importance of each of the 5 senses

12. Medical writing
 “Sixhonest serving men for medical
writers” is taken from Rudyard Kipling who
wrote:
(13)

13. The seven sins of medicine
 But today I wish to concentrate on one
article.
 “Seven sins of medicine”, published in the
Lancet in 1949.

14. The Seven Cardinal Sins
What are the seven sins?

15. GLUTTONY

16. LUST

17. ENVY

18. SLOTH

20. WRATH

21. GREED

22. And in Medicine?
 And what are the “Seven Sins of
Medicine”?(14)
 Please write down what you consider to
be the 7 sins that a doctor must NOT
commit
 And why?

23. Asher considered the seven
sins to be:
 OBSCURITY-
 “Obscurity is bad, not only because it is
difficult to understand but also because it
is confused with profundity.”

24. Bad Manners
 Often overlooked, rudeness or poor taste
in humour is condoned with hospitals
 Asher states” If students do not learn
good manners while they are learning
medicine they will be at a great
disadvantage in dealing with patients,
nurses and colleagues”

25.  CRUELTY-
 He states that mental cruelty is common,
and there are 3 ways:
 1) by saying too much
 2) by saying too little
 3) and by the patient being forgotten

26.  OVER-SPECIALISATION
 “It is right that a doctor should have
special interest and knowledge about
one subject. It is wrong for him to show
special indifference and ignorance about
all other subjects”

27.  SPANOPHILIA Or “Love of the rare”
 He says that this is common in medical
students

28.  COMMON STUPIDITY
 Or the “opposite” of common sense, “ but
I think the commonest type is what might
be called therapeutic automatism”
 “ …patients should never be treated by
rote and rule, for there may be special
circumstances”

29.  SLOTH
 He says that mental sloth
 “..is commoner and more important.
Especially in history-taking is sloth the
great danger. If the day is hot, the patient
deaf, the doctor in a hurry, and the history
garnished with reminiscences and
irrelevances, it requires enormous
patience and concentration to distil the
essence from it.”

30. And never forget –
 “Lastly,beware of sloth of thinking.”
 He reiterates the importance of:
 Healthy Doubt ( without being unduly
sceptical)
 And ends ( in his true, witty style)
 “Please adopt this attitude with
everything I have said, and realise that
much of it may be nonsense”

31. Take home message
 Modern society is fast and furious; no time
to stop and think.
 With an emphasis on change, on the
new, the young.
 Once in a while read something from the
past; it can still be useful.
 “Study the past if you would define the
future” (15)

32. Bibliography
1)“Making sense”, Asher,R, The Lancet, 1959
2)“Munchausen’s syndrome”, Asher,R, Lancet, 1951
3)“Richard Asher talking sense by Avery
Jones(review),Drew,R,Proc R Society,1973.
4)“Straight and crooked thinking”, Asher,R,BMJ,1954
5)“Talking sense”,Asher,R,University Park Press,1972.
6)“Richard Asher and the seven sins of Medicine”,
Rowat,B, Humane Health Care,1985
7)“All the vitamins”, Asher,R,BMJ,1947
8) BMJ,1958
9) BMJ,1954
10) BMJ, 1947
11) BMJ, 1960
12) JAMA, 1969
13) “The Elephant’s child”, Kipling,R, 1902
14) The Lancet, 1949
15) Confucius