Yes, there are definitely things out there that do work as described. But the larger point being there is butt-ton of stuff out there that is passing muster as medicine that is observably no more effective than bleeding was in the past.
A third of the shelf space in my local pharmacy is dedicated to herbal, naturopathic, and homeopathic medicines. We haven’t come far.
I agree with you about the use of statistics in medicine. I’m not sure what you mean past that. Study of the chi-square and t distributions dates to about 1900. Use of modern-style hypothesis testing seems to date to the 1930s.
Strangely enough, bleeding can work to combat some bacterial infections. Bacteria need iron, and it’s usually taken from free iron (not sure if it’s free in the blood stream, in the digestive tract, or what). By removing a small amount of blood, the body is forced to use up its store of iron to create new red blood cells. In doing so, it denies iron to the bacterial infection, keeping it in check.
Of course, they kind of went overboard with the bleeding and reversed any benefits it might have had in that one instance.
Non-continuous distributions had been studied in the 18th century, Gauss’ work dates from the early 19th. And as for other fields, I keep running into people who think that the only continuous probability distribution is the Gaussian - for some reason, applying it when you have a low n or specs where your target value is on one end of your possible range works like shit. These people are working in process improvement in different industries; most of them have degrees in engineering, although I’ve also met chemists and pharmacists who had the same problem (and whose job involved process improvement). I’m an engineer, so’s one of my brothers: my thesis was a program to calculate X[sup]2[/sup], Gaussian, t, F and J - he only was told about, you guessed it, the Gaussian bell.
Others have said it in similar ways, but I thought I’d add my own wording:
Doctors really do work in a field where three things are true:
- virtually all treatments have risks and side effects
- some patients will die no matter what you do
- some patients will live no matter what you do
This is especially true outside of the modern age, when we had limited diagnostics, limited records and no formal way of conducting statistically valid double-blind experiments.
In particular, I expect you’d see a bias in samples. People without health care died more often than those with health care, even when doctors were into bleeding. The reason probably has more to do with wealth (and the improved diet and living conditions that brought) but a doctor could certainly have said that people had a higher chance of living under his care than without it.
Back in those days, too, we didn’t teach the humility of egalitarianism that is more prevalent in a democratic society. The rich, powerful, noble and educated “knew” they were better than anyone else. Therefore, a lesser fool telling them they were wrong was impertinent and presumptious, and they themselves obviously “knew” they was right.
Look at the history of Semmelweiss who dared to tell doctors that filthy hands were the causing the death of excessive mothers and babies. Since these physicians were upper class and educated, obviously they had nothing in common with the flthy pestilent lower class and could not be responsible for spreading disease…
As mentioned by others, bleeding can and does work sometimes.
In congestive heart failure (CHF) or cardiogenic pulmonary edema, bleeding would be expected to be very effective since it is a very potent way of removing the excess fluid that characterizes the condition. Nowadays, we use diuretics to remove the fluid, but bloodletting would work just as well, if not even better.
To belabour the point, I will mention that I, personally, have treated patients with CHF by using tourniquets. The tourniquets trap blood in the arms and legs thereby preventing it from returning to the heart (a very good thing to do in CHF). While obviously different from bloodletting, tourniquets wind up doing much the same thing, i.e. they remove excess blood from the circulation making the heart’s job easier, thus providing an effective, if not sophisticated, treatment for the condition.
In times past, CHF due to rheumatic heart disease must have been common. Bloodletting might have had a dramatic and beneficial effect in some individuals (e.g. mitral stenosis) and so would have made quite an impression on patient and physician (and barber).
I remember reading somewhere that many “barabaric” treatments actually worked better than you would expect…doctors are not fools and people generally note what works.
Shout out for maggot therapy!
When you’ve only got a hammer in your tool box, you’ll be amazed how many problems start to resemble nails.
What was mercury supposed to do, anyway? I remember reading Hemingway mentioning it as a treatment for syphilis as recently as World War I.
They didn’t always get worse. In The Surgion’s Mate (1617) physician John Woodall cautions others not to bleed their patients too much. He notes that that those treated by less educated village healers and midwives don’t kill their patience because they aren’t so bleed happy as the surgeons or physicians. He also advises against the practice of trepanning, admonishes young surgeons who think themselves above extracting teeth and warns that consent must be given for an amputation because the patient is likely to die and must have an opportunity to make right with God.
That’s not true. If you had impacted bowels they could provide you with an enema and if that didn’t work they would manually remove the blockage. There were plenty of physical problems that medical professionals could either fix or provide relief for. If you broke you arm they could splint it up and see that it heals properly.
I didn’t mean it like that. Obviously they would use the effective treatments first. It was used when no other solution was known, so at that point you were often (not always as noted above) in danger of dying anyway. No treatment may have been better in most cases.
Though the practice of bleeding does seem to stem from the superstitious notion of ‘humours’, the fact that its use persisted for several centuries indicates that it was somewhat palliative.
We well know that such a practice is well surpassed by modern techniques, but merely dismissing it as a ‘barbaric technique from the past’ does not do justice to the humans who were doing their level best to assist others in the throws of pain and disease. These were people who, as we all do, used the scientific method in their everyday lives. They understood cause and effect. We all do. We all experiment on a regular basis. We form hypotheses. We project models of probabilities. Everyone does all of the time. An infant does. I watched this happen this last weekend when I saw a 8 week old boy figure out where things were in his sensorium.
So, when we complain that the doctors of 3 centuries ago were hopelessly ignorant, perhaps we should recognize why we are less so.
“If I have seen further it is by standing on the shoulders of giants.” – Newton, Isaac
People got sick. They were bled. Some got better.
It’s exactly the same logic used by homeopathy.
In an anecdotal world, it’s very difficult to do double blinded studies. Without those, it’s much harder to say what works and what doesn’t.
As for George Washington, I believe the speculation is that he may have died from (bacterial) epiglottitis, or perhaps a peritonsillar or sublingual abscess.
Phlebotomy might have hastened a demise in those circumstances, but they are potentially lethal illnesses that have little to do with a “cold” and even in modern times can result in checking out in the horizontal mode (usually due to airway compromise or overwhelming sepsis).
Really, Karl?
I’d expect that making patients anemic would put additional strain on a failing heart (and other parts of the body requiring adequate oxygenation) unless there’s something I’m missing here.
Lots of practices have persisted for long periods without evidence of effectiveness (the aforementioned homeopathy being one), so longevity does not equate to usefulness.
Apart from unusual circumstances like hemochromatosis, I’d like to see evidence that bloodletting in olden times had any benefits apart from placebo effect.
*I suspect that any “benefits” in cases of infection/sepsis in terms of weakening pathogens were overshadowed by the weakening of the host.
Its remarkable that even today, there is rampant over prescription of antibiotics. A prime example is that until very recently the American Academy of Pediatrics used to recommend antibiotics as the first line of defense against ear infections. Studies have shown most of the ear infections resolve in a few days without any drugs.
And inspite of revised guidelines (from early this year), they continue to prescribe it. I had first hand experience of this with my toddler.
I think the pressure to do “something” when a person is sick is so powerful that it trumps everything else.