People trust their doctors. This recent Rasmussen poll from the US described 79% of the population trusting their doctor. This trust, for most of us, translates into an unquestioning acceptance, at least for most common interventions, of the treatment suggested by our doctor. We take the prescription, fill it, and expect to feel better afterward. Rarely do we ask our doctor how they know that this treatment works, or what evidence they are using to recommend such an intervention. The book Taking The Medicine: A Short History of Medicine’s Beautiful Idea, and Our Difficulty Swallowing It, by Druin Burch, attempts to depict the journey from pre-scientific magic to evidence-based medicine, a journey fraught with egotistical over-confidence that doomed many millions of patients to death, even when everyone, doctors and patients, was convinced they were doing the right thing.
The first half of the book describes the largely unsuccessful and downright dangerous treatments and mistakes in thinking that comprise the majority of medicine prior to the 20th century. What is very interesting is the mistakes that we rightly chide these otherwise intelligent practitioners for are to be found in alternative or integrative medicine; the reliance on personalized individual care, the insistence of a vitalistic notion of the body, and the arrogance to think that their treatment can cure all disease and is surely better than the other charlatan down the block, are all indefensible yet indefatigable positions found in alternative medicine today.
Even the treatments that were correctly identified as being biologically active: salicylic acid from willow bark, morphine from poppy seed and quinine from the Peruvian quina quina tree, were misidentified, misconstrued and misapplied to many diseases. These, combined with the other completely ineffective and dangerous interventions and herbs were killing more people than they saved, despite cries to the opposite from the people pushing their use.
It is easy to be dismissive of these pre-scientific thinkers and their dangerous proclivities; however Burch’s strongest indictments are reserved for those in the 20th century, even in the past 30 years, who were convinced of the effectiveness of treatments they thought perfectly plausible but for which evidence was never produced. The hard truth is that most doctors and researchers, for all of their training and knowledge, had to be dragged kicking and screaming from a position that insisted that their advanced knowledge of how the body worked was all they needed to properly assign the correct treatment. When all the evidence was in, researchers stood no better chance than even odds at guessing which treatment would be effective and which would be detrimental. Flipping a coin would have been just has helpful.
The randomized controlled trial, the Bradford Hill criteria, and Cochrane reviews; they were all hard won systems of removing bias and uncovering the truth behind an intervention, and Burch charts the rise of these and other systems of ethics surrounding the running of human research. From the thalidomide disaster to the use of antiarrhythmics to prevent sudden cardiac death, Burch shows us that a single person’s opinion, let alone one that is motivated by profit, is not to be trusted, and that our current research practices are the way they are because people in the past have killed people with good intentions.
Taking the Medicine is required reading for anyone interested in the history of medicine for sure, but it is a great way to remind those of us in the field of medicine to always question our assumptions about the efficacy of our treatments. It is also a warning to those who are patients to keep informed about what our modern medical doctors and alternative practitioners are doing, because despite their best intentions, without evidence and scientific enquiry, those treatments meant to help may very well be harming us.