Weird science; or, learning from the past

Here's news of an exciting medical breakthrough. Some time ago, Dr. Elisha Perkins, a Yale-trained surgeon who co-founded the Connecticut Medical Society, announced that his studies of muscle contractions had led him to the discovery of subtle electrical fields in the human body.

Dr. Perkins used metal rods—one brass and one iron—to influence these fields by drawing the rods down the body of a sick person. Pain, he said, is thereby drawn out. Thousands of grateful patients sent him testimonials, and workers could hardly make the "metallic tractors" fast enough; meanwhile, Perkins became very rich. Care to give it a try? Oops—Perkins announced his sensational ideas in 1797. Even then, his ideas sounded weird. Perkins was thrown out of the medical society he helped start, which branded him "a patentee and user of nostrums." Perkins hastened to New York City (says my source, "The Great American Medicine Show" by David and Elizabeth Armstrong) during one of the frequent epidemics of yellow fever. The Metallic Tractors failed, however, to protect Perkins or anyone else, and the doctor died of yellow fever in 1799. His son carried on for a while, salting away fifty thousand dollars, which was a heap of money in the 1790's, and eventually stating that tractors could be made of any old material, including wood. Clearly, they had more to do with suggestion and the placebo effect than electricity.

Also active in the 18th century was Benjamin Rush, a highly respected physician in New England and a signer of the American Declaration of Independence. Rush was taught the received wisdom of the day by his teacher, the noted Scot William Cullen: that all diseases were caused by "morbid excitement caused by capillary tension" and the remedy was bleeding. He also poisoned his patients with calomel (mercury) in order to purge them of "toxins".

In 1793, Philadelphia was struck by a yellow fever epidemic which killed 4,000 people. Rush leaped into the fray, taking ten or more ounces of blood at a single session. Of course, most of his patients died, including Rush's own sister and three of his assistants. Saddened, Rush said he wished he had had the nerve to bleed them even more-- perhaps he could have saved them. Blinded by his faith in the traditional doctrines he had been taught, he carried on purging, blistering and bleeding his patients. When he died in 1813, Thomas Jefferson wrote: "For classical learning, I have become a zealous advocate; and in this, as in his theory of bleeding and mercury, I was ever opposed to my friend Rush, whom I greatly loved, but who has done much harm, in the sincerest persuasion that he was preserving life and happiness all around him."

Jefferson was a clear-eyed critic of medical fads. In 1807 he wrote; "I have lived myself to see the disciples of Hoffman, Boerhave, Stahl, Cullen, Brown, succeed one another like the shifting figures of a magic lantern, and their fancies, like the dresses of the annual doll-babies from Paris, becoming, from their novelty, the vogue of the day, and yielding to the next novelty their ephemeral favor. The patient, treated on the fashionable theory, sometimes gets well in spite of the medicine. The medicine, therefore, restored him, and the young doctor receives new courage to proceed in his bold experiments on the lives of his fellow-creatures. I believe we may safely affirm, that the inexperienced and presumptuous band of medical tyros let loose upon the world, destroys more of human life in one year, than all the Robinhoods, Cartouches, and Macheaths do in a century."

Moving right along, in 1796 Samuel Hahnemann, a German doctor, published his first paper outlining his unusual views on the nature of illness. This time most disease are declared to be caused the Psora, or the Itch (which we now ascribe to the scabies mite). If the itch enters the body, it can cause every single disease from nosebleed to mental illness. Nature cannot heal much; only remedies can help, and these remedies must be diluted to the millionth power or more, each time banging the bottle or scraping the powder in a ritualistic way. And how does one choose a remedy? One takes some chemical and writes down every single little twinge, itch, headache or uneasiness that one feels for the next few days. These are the symptoms which a fantastically dilute solution of that chemical will cure. He called this system homeopathy. One can understand that, given the choice between Benjamin Rush's doses of mercury and ever-ready lancet, and Hahnemann's totally ineffective powders, many a patient would be better off with the homeopathy. That it didn't actually do anything was beside the point; it kept the patient busy while nature healed him. Two hundred years have passed, and there still isn't any evidence that homeopathy has any but a placebo effect.

Eventually, another nutbar theory arrived; iridology. This is examining the iris of the eye and comparing it to a chart linking various areas of the eye to various areas of the body. Alterations of the iris are supposed to mean problems in the body. They don't. It doesn't bother today's iridologists that there are about 19 different iris charts, all contradicting one another; nor does it bother them that one iridologist shown the same iris photos in various orders diagnosed a lot of different problems; nor does it bother them that another iridologist missed the diagnosis of the leg pain one patient came in with, while also overlooking the iritis (inflammation) in that very eye: nor does it bother them that another iridologist diagnosed kidney disease in 88% of the irises of people who had proven kidney disease, but also in 88% of the irises of people proven NOT to have kidney disease. What's going on here has nothing to do with evidence; it has to do with faith. "Hey, it works for me."

You see, all of these healers are empirics. They dream up a theory, with little or no evidence to back it, and they treat you with any old idea that happens to pop into their heads. Shown that their methods don't work, they come up with excuses. Survival of the patient counts as improvement, improvement as cure, and cure as rock-solid proof that the treatment is safe and effective. Argue, and you're an old stick in the mud, hopelessly blinkered by stuffy old science.

Actually, stuffy old science was alive and well in the eighteenth century, and even then it could cut through the babble.

Also on my bookshelf is "An Account of the Foxglove", by William Withering, first published in 1785. Withering treated cases of dropsy (swelling or edema, typically caused by heart failure) with foxglove, the source of the drug digitalis. He was given an old herbal recipe containing twenty ingredients, but says he saw immediately that the foxglove was the one that did the job.

Now, Withering was NOT an empiric. His book details every case he treated between 1775 and 1783. He writes, "It would have been an easy task to have given select cases, whose successful treatment would have spoken strongly in favour of the medicine, and perhaps have been flattering to my own reputation. (Remember these words, folks.) But Truth and Science would condemn the procedure. I have therefore mentioned every case in which I have prescribed the Foxglove, proper or improper, successful or otherwise." It is clear from his book that when he was treating heart failure, he succeeded; when he treated edema from liver cirrhosis, he failed. Digitalis works by strengthening the heart, and a synthetic version of it is still used today. (The straight herb is extremely toxic, as Withering found out.)

You see, Perkins was wrong, Rush was wrong, Hahneman was wrong, the 19 fantasists who made up iridology charts were wrong; but Withering was right, because Withering was a scientist. He studied his cases, noted the results, and published them.

The reason I criticize iridology, chelation therapy for hardening of the arteries, Laetrile for cancer, and homeopathy is that these things have been carefully studied and they don't work. They're worthless, and I can prove it.

The reason I have quite a lot of faith in radiation treatment for Hodgkin's disease, chemotherapy for acute lymphoblastic leukemia, and penicillin for pneumococcal pneumonia is that they work. They cure more people than doing nothing, or placebo, or alternative treatments, and I can prove it.

Why, then, do the things I criticize still flourish? Why has there been a vast resurgence in magnetic quackery, junk straight out of the seventeenth century? Why do people believe weird things?

There's a fine book about this, by Theodore Schick, Jr. and Lewis Vaughan. It's called "How To Think About Weird Things". There's plenty of philosophical discussion about how we humans come to a consensus about what's true and what isn't. The trouble is that we put way too much faith in single episodes, if they happen to us. Particularly when it comes to healing, people are amazingly willing to draw conclusions from a large series of one. "I tried x, and now I'm better." Well, perhaps you would have done well with y, or z, or no treatment at all. Maybe x actually made you worse than you would have otherwise been. People are amazingly willing to believe totally false statements put forward by quacks. "Chromium picolinate makes you stronger." No, it doesn't. "Herbal treatments for leukemia work as well as chemotherapy." No, they don't. "Chiropractors can cure diabetes." No, they can't. ""Dr. Rife could see things with a light microscope that are actually smaller than the wavelength of light." No, he couldn't. "I can diagnose your vitamin deficiencies if you mail me your saliva." No, he can't.

There are ways to decide if something actually works; you test it, many times, and see if the results differ from chance. This is called the scientific method, and it's what a baby is doing when he figures out which box consistently contains the cookies.

My favourite summing up is this quote from Dr. Robert Buckman: "...the scientific method is something that we ignore at our peril. It is the scientific method that leads us to decide whether to take an umbrella on a rainy day, walk across eight lanes of a busy motorway in rush hour, or practice unsafe sex. To say that there are other paths to knowledge than science is like saying to your bank manager that you may appear to have an overdraft by his stuffy, narrow methods of calculating but with your rainbow coloured yin-yang 'natural' sort of arithmetic, you believe that you are vastly in credit. You may be allowed to believe it, but you'll be asked to take your account to a less scientific bank, if you can find one."

Sheila Kitzinger put it this way; "For many people who have little control over the forces of nature and who feel at the mercy of powers which are not susceptible to the technological manoeuvres at their disposal, magic and witchcraft help to give some semblance of control over those processes and incidents in life which involve most risk and danger. There is in magic a careful and internal logic which can be entirely consistent, given the premises upon which the magical system of belief is based." And for those folks, no evidence is needed; only faith.

Now, faith has its place in organizing and supporting the body's innate power to heal. But it's no way to assess a theory, a drug, or a course of treatment. In 1842 Oliver Wendell Holmes, the poet and obstetrician, wrote a truly hilarious essay on homeopathy, (you can find it on the Internet, and in the book (Examining Holistic Medicine, edited by Douglas Stalker and Clark Gylmour) and Holmes has this to say;

"I think, after what we have seen of medical facts, as they are represented by incompetent persons, we are disposed to attribute little value to all statements of wonderful cures, coming from those who have never been accustomed to watch the caprices of disease, and have not cooled down their young enthusiasm by the habit of tranquil observation. Those who know nothing of the natural progress of a malady, of its ordinary duration, of its various modes of terminating, of its liability to accidental complications, of the signs which mark its insignificance or severity, of what is to be expected of it when left to itself, or who much or how little is to be anticipated from remedies, those who know nothing or next to nothing of all these things, and who are in a great state of excitement from benevolence, sympathy, or zeal for a new medical discovery, can hardly be expected to be sound judges of facts which have misled so many sagacious men, who have spent their lives in the daily study and observation of them. I believe that, after having drawn the portrait of defunct Perkinism, with its five thousand printed cures, and its million and a half computed ones, its miracles blazoned about through America, Denmark, and England; after relating that forty years ago women carried the Tractors about in their pockets, and workmen could not make them fast enough for the public demand; and then showing you, as a curiosity, a single one of these instruments, an odd one of a pair, which I obtained only by a lucky accident, so utterly lost is the memory of all their wonderful achievements; I believe, after all this, I need not waste time in showing that medical accuracy is not to be looked for in the florid reports of benevolent associations, the assertions of illustrious patrons, the lax effusions of daily journals, or the effervescent gossip of the tea-table."

Gee, I wish I'd said that.