"David J Black explores the dangers of orthodoxy in the first in a four-part medico-legal series. “Orthodoxy” wrote Bertrand Russell “is the death of intelligence”. Before placing this in a medico-legal context with specific reference to the 2009 case Fraser and another v The National Institute of Clinical Health and Excellence, consider the quandary of three anxious doctors gathered around the bed of a dangerously ill 67-year-old man fighting what appeared to be a severe attack of croup. Two of the doctors were roughly his age. The third doctor, who was in his mid-thirties, had an inspired, if unorthodox, idea. With a simple tracheotomy procedure, the inflammation blocking the windpipe could be bypassed, and the patient might be saved. The problem was that it was December 1799, and the patient was George Washington, the nearest thing the secular United States had to a deity. Cutting his throat may well have saved his life, but the outcome, had the operation gone wrong, would not have been such a good one for the three Scots-American physicians concerned. In the event Surgeon-General William Craik, the President’s brother-in-arms who had known him all his adult life, and Doctor Gustavus Brown, his neighbour from the other side of the Chesapeake, over-ruled Dr Elisha Cullen Dick of Alexandria, whom they clearly regarded as their junior. They chose instead the route of 18th century orthodoxy, bloodletting and purging, with a few extras such as molasses, vinegar and butter gargles, and throat swabs made from a preparation of dried beetles. George Washington, minus around 40 per cent of his blood, was dead within a few hours, the victim of that very same medical orthodoxy." .... "These colourful tales have very little in common with the case to be addressed, you might think, but the common theme here is that they invite us to consider the nature of orthodoxy, and to test Bertrand Russell’s dictum about it being the death of intelligence in our present era. The first question to ask of any orthodoxy is, of course, “says who?” In the following example, the answer is psychiatrists Colin McEvedy and Bill Beard, who in 1970 published “A Concept of Benign Myalgic Encephalomyelitis” in The British Medical Journal. This became the founding doctrine of what might be termed the ‘psychogenic model’ for the study and understanding of a debilitating illness widely known as Chronic Fatigue Syndrome. As an orthodoxy the psychogenic model would hold sway for half a century, until it was finally discredited in November 2020, as we shall see." Part one, https://www.scottishlegal.com/article/orthodoxy-on-trial-the-pathogenesis-of-a-diagnosis Part two, https://www.scottishlegal.com/article/orthodoxy-on-trial-ii-dominance-by-induction Parts three and four to follow.