Quactitioners II – The mystery of medical history

The Jobbing Doctor has an excellent quote on his blog:

One reason why medical history is not much taught in medical schools is that so much of it is an embarrassment – Lewis Thomas (1992)

Thomas put his finger firmly on one of the problems with the debate between scientific medicine and alternative medicine: scientific medicine’s reluctance to face the fact that in the bad old days doctors were as ignorant and dangerous as anyone else. This is counterbalanced by the fact that alternative practitioners are reluctant to accept that modern evidence-based medicine is safe. Established orthodoxy has moved on and the rebels haven’t, and this is causing wires to be crossed.

It would assist the argument enormously if medicine owned up to its embarrassing history, and then disowned it, staking its claim to be the truly revolutionary movement and the real alternative to the dangerous practices of the past.

You’ve seen the full version of this grid before. However that was a 20th and 21st century version. This version shows the situation in the 19th century when there was little science, and practice was based on observation and experience rather than trials.

19th Century Medicine - and its Alternatives

Despite this, medics and sceptics frequently talk and write as if there have always been two separate paths – scientific medicine (good), and alternative medicine (bad), and I’m not convinced of this.

18th and early 19th century doctors were a dangerous bunch, as ignorant and hopeful as the herbalists and homoeopaths but with a fondness for powerful drugs, and frequently with an arrogant attitude. They killed millions of new mothers by giving them “child-bed fever” because they didn’t know that infection can be communicated by touch. They’d treat just about anything by drawing blood. Their favourite medicine was calomel which induced vomiting and acted as a laxative because it’s toxic. Their patients became addicted to opium in the form of laudanum. (When a showed a draft of this to a young doctor he pointed out that his predecessors used to massage women to orgasm to cure “hysteria”. It’s not called “doctors and nurses” for nothing). Dodgy sexual practices aside, it was no wonder that Samuel Hahnemann and Edward Bach devised gentler alternatives, even if the reason these alternatives did no harm was because they did no good.

So, if doctors were as ignorant as other practitioners in the 18th and early 19th centuries, what has changed? And what hasn’t?

The big change of course is that medicine now works. It cures diseases and in the main it doesn’t kill people. We now benefit from antibiotics, immunisation and increased standards of public health, not to mention treatments for everything from athlete’s foot to cancer. And all as a result of acute observation, empirical testing, double-blind clinical trials, and a widely-published and peer-reviewed evidence-base. The roll-call of conditions which are a thing of the past is awesome, and medicine has done away with these in the last 100 years or so.

By contrast, not much has changed in the practice of alternative therapies. This is partly because “traditional” is “good”, and partly because clinical trials are expensive and will either show that the interventions are not very effective (herbalism) or not effective at all (homoeopathy). Ben Goldacre rightly criticises homoeopaths for their lack of self-criticism and for treating their founder’s approach as dogma, and they most certainly aren’t the only ones. He contrasts this complacency and stasis with the continuous questioning of the scientific approach and the constantly moving medical frontier.

Another thing that hasn’t changed is the rhetoric of the alternativists. They still talk about medicine as if its practices were as dangerous and untested as they were in the 18th and 19th centuries. There are a whole bunch of reasons for this, including the difficulties the lay person has with medical science because of the poor quality of science education in our schools, the challenges in creating and interpreting drug trials (listen to R4’s excellent edition of More or Less on the subject), and the confusion that understandably arises about where and why to draw the line between things science can be certain about and things it can’t. Oh, and demonising doctors is good for business, of course.

But has the rhetoric of the doctors changed either? The science has, and the outcomes of the science most certainly have, but has the rhetoric? (I genuinely don’t know).

I’m asking because, as I said right at the beginning of this piece, if modern medicine admitted its murky past, it would make it much easier for us all to point out that the alternative practitioners are still living in it.

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4 responses to “Quactitioners II – The mystery of medical history

  1. Aphra, I think that you would be interested in this piece on the Freakonomics blog that addresses the question of progress in dealing with mental health issues in the last 100 years: http://freakonomics.blogs.nytimes.com/2008/04/08/how-much-progress-have-psychology-and-psychiatry-really-made-a-freakonomics-quorum/

  2. Well, I think my response was just eaten. Here is another go:

    There’s a GCSE option in history which involves students studying ‘Medicine Through Time’.

    Of course, the focus might not be what medics would want it to be. One of the big battles in history teaching is to stop students condemming people in the past as merely stupid or less evolved and to try to get them to see the rationality of people’s past actions and choices. ‘Ordeal by Fire’ makes no sense from a modern perspective, for example, but is easier to understand if you assume a certain viewpoint about God and His role in the universe.

    It’s not meant to imply sympathy with their ideas or decisions though, and change and the reasons for it would also be a focus, so perhaps that would have the effect you’d want.

    Of course, I do rather wonder whether doing history for GCSE is something which would be medics tend to actually do.

  3. The system keeps spitting back the link I tried to give to show some of the content of what might be taught – I haven’t had anything to do with this, so I don’t rally know where the emphasis is. Still, googling ‘medicine through time’ especial in conjunction with ‘schools history project’ should yeild something.

  4. Hmm,

    Generally agree with the post, but one thing I realised when I went to Malaysia (and stayed with a family of doctors) is that although they have many of the same drugs and supplements that we have, they use them in a different fashion, with some startling results.
    I had had a run of colds and I was just starting on the fourth one in a row. My friend gave me three pills to take for a couple of days. The cold stopped in its tracks. A few months later, another cold started. I took the combination and the cold stopped in its tracks. This has happened every time I have used this. They’re just ordinary supplements; zinc, PMSP and PMIP from Blackmores, but it cures the cold! We don’t know everything here.

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