Martin Winckler — or Marc Zaffran, his real name — is a doctor and writer of French origin who emigrated to Quebec in 2009 and became a Canadian citizen in 2019. Although he says he does not like conflict, Winckler is also a fierce critic of the medical establishment, mainly in its French version, which he accuses of elitism, sexism and even obscurantism.
Since his arrival in Quebec, Winckler has been writing full-time — mainly novels and essays — notably to criticize the pretentious members of the medical profession, whom he described, in an essay of the same title published in 2016, as “brutes in white.”
In Life is about risk (Seuil, 2024), Winckler looks back on his rich career as a caregiver, activist and writer — he says he prefers this Barthesian term to that of writer, which he says is too loaded — by answering questions from the editor Sophie Lhuillier. As I have only read some of Winckler’s essays and not his novels, several of which have been bestsellers, I mainly remember here what relates to the debate of ideas in this book.
Winckler, therefore, is not tender towards the medical profession. He denounces, among other things, the mania for overdiagnosis erected into a system, by contesting the relevance of annual examinations, of the generalized dosage of cholesterol, of screening for prostate cancer and even, in a more controversial position, of systematic mammography every two years.
This latest screening, he says, “does not increase the life expectancy of women who really have cancer” and “makes life hell for all women who are screened, especially those who do not have cancer, who are the majority.” Without a screening mammogram, he continues, a woman who discovers a cancerous nodule has as much chance of being cured as if the diagnosis had been earlier because “the treatments are much more effective than they were thirty years ago.” I will leave it to the experts to decide the question.
If Winckler were to stick to this type of questioning, he would certainly be challenged by the medical profession, but he would not be seen as a rebel in his profession. For 20 years, in fact, the issue of overdiagnosis has often been debated in medicine, as evidenced by several interventions by Quebec doctors Alain Vadeboncoeur and the late Fernand Turcotte.
However, Winckler does not stop there, while making an essential distinction. His criticisms, he specifies, are mainly aimed at the French medical institution, and not at medicine as practiced in Quebec, which is much more respectful of those being cared for and of caregivers in training. It is pleasant to hear, but not entirely convincing. Many of the criticisms that Winckler reserves for the French medical profession seem to me to apply to ours as well. Let us judge for ourselves.
In an interview with The news In 2009, Winckler already said that French medicine was elitist and violent. “Doctors,” he said, “feel like they belong to a higher class,” especially in the case of specialists. They look down on other caregivers and patients, whom they barely listen to during consultations. Quebecers know this too.
“The essence of care,” Winckler explains in Life is about riskit’s not what the doctor thinks or believes, it’s what the people being treated find important to them.” Therefore, “when you treat, you don’t just turn bodies around in all directions: you start by working with the stories that people tell,” continues the doctor for whom this narrative approach is the key to quality care.
According to Winckler, in Quebec, this holistic approach, which takes into account personal history and not just physiological indicators, would be an acquired principle, in a spirit of respect for the patient.
Reading this, I wonder if Winckler lives in the same Quebec as me. In mine, in any case, ordinary citizens often have to fight to get a simple ten-minute medical appointment, frequently feel like they are talking into a void to doctors who only look at their screens while they try to describe their situation, and are sometimes forced to travel long distances and hang around, in groups and for hours, in depressing offices to receive the care they need. There are certainly good people in all this maze, but the current Quebec system does not shine with its great respect for the sick.
The more humane medicine that Winckler defends – accessible, modest, respectful of the intelligence and autonomy of the patient, focused on reducing the suffering of all, both those being cared for and those providing care, and without any hierarchy of those involved – remains, in Quebec as elsewhere, an ideal.