Working as a family doctor for
more than twenty years, I feel sorry to say that quite a significant portion of
patients are so ignorant. It is not that
they are ignorant about medical knowledge or advance in medicine (as I consider
this natural, just like I am totally ignorant about car repair), but they are
so ignorant about simple logic and scientific methods, not to say
evidence-based medicine. It is only
through an open mind equipped with logic and ability to appraise scientific
evidence that the patient can learn new knowledge and take part in the
management of his medical problem. Walter
Isaacson (the author of Steve Jobs)
even writes in his book Einstein that
“an appreciation for the methods of
science is a useful asset for a responsible citizenry.” Over 2000 years ago, Hippocrates stated
that: “There are, in fact, two things,
science and opinion; the former begets knowledge, the latter ignorance.” He insightfully explained why patients became
and remained ignorant.
It is not uncommon to encounter
patients arguing with you about treatments they learn from their friends, who
in turn learn about such treatments out of nowhere traceable. When you try to explain to them, their query
is usually a reverse burden of proof. Yes,
they ask you to prove why such treatments will not work! Some knowledgeable patients rely on opinions
from authorities. However, how they look
upon authorities may depend on how frequent the subjects appear on commercials
and how confident they are when communicating the treatments they advocate.
Have we doctors done enough to
help our patients? Evidence-based
medicine was elected by BMJ in 2007 to be one of the 15 greatest medical
advances since 1840. However, we still
encounter too many advertisements, books, seminars, products and “expert
opinions” on miracles and alternative treatments. Too frequently, patients come to us (or more
sadly, leave us) because there are better but never proven methods in treating
their diabetes, alopecia, erectile dysfunction and even cancers. Advocates of such alternative treatments not
only make unsupported claims on the miraculous effects (and at the same time,
with no side-effects at all) of their products, but too often, they launch
attacks on traditional medicine. Have we
discharged our responsibilities to our patients and the public in taking time
and effort to address these scams?
Recently, I have read a book about
alternative medicine: Trick or Treatment by
Simon Singh and Edzard Ernst. In this
book, the writers dissect various alternative treatments by adopting the
evidence-based method and the appraisal of existing evidence. They skillfully introduce the importance of
clinical trials to laymen by telling the story of bloodletting and the first American
President. Bloodletting had been a
recognized method of treatment for various diseases since ancient Greece. At that time diseases were thought to be
caused by an imbalance of four bodily fluids known as the four humours. They were: blood, yellow bile, black bile and
phlegm. By removing some stagnant blood
from different parts of the body, different diseases could be treated. (This
reminds me of the “lymph plumbing” (通淋巴), which I hear from patients and
watch in the media everyday.) The former
US president, George Washington, at the age of 67, caught a cold on a Black
Friday (13 December 1799). It turned out
to be epiglottitis. Within 24 hours,
several bloodlettings were performed as treatment and about 3 liters of blood
were drained from him. Obviously, he
died the following day.
At that time, bloodletting was
the norm. There was a lawsuit in 1797
between a renowned English journalist William Cobbett and the “Pennsylvania
Hippocrates” Dr. Benjamin Rush. Dr. Rush
was the only doctor who had a statue erected in his honour in Washington DC. He was an advocate of bloodletting. Cobbett examined the local bills of mortality
and concluded that Ruth’s bloodletting had “contributed to the depopulation of
the Earth”. Rush sued him for
defamation. The verdict returned on the
day Washington died of blood loss (and/or epiglottitis). Cobbett was ordered to
pay Rush a fine of $5000, which was then the largest compensation paid in
Pennsylvania. Apparently, scientists and
doctors were not scared by the fine. In
1809, a Scottish military surgeon called Alexander Hamilton designed a clinical
trial to study bloodletting. His study
was valued because there were elements of randomization and control. He found out that among 366 soldiers of
various diseases, the death rate of those treated with bloodletting was ten
times to those treated otherwise. Various
studies were then carried out. And nowadays
our common sense that bloodletting means to kill rather than to cure has been firmly
established.
Other interesting stories in the
book include evidence-based tea (tea, or milk first?), the story of James Lind on
scurvy, the study of Florence Nightingale on the importance of hygiene, Dolls &
Hill on smoking, Bill Silverman on refuting his discovery of treating
retinopathy of prematurity with ACTH, and many others. The authors also expose plainly and cruelly the
origin of some alternative treatments. Histories review the absurd theories some
alternative treatments are built upon. Among
them is the story of Chiropractor. Chiropractic
therapy was founded by Daniel David Palmer, who was born near Toronto in 1845. He moved to Iowa at the age of twenty. In 1895, as he himself wrote, he cured a deaf
man by repositioning a displaced vertebra (as interpreted by him). The man could hear soon after his
manipulation. Another man with heart
trouble was also cured immediately after he adjusted, again, a displaced
vertebra (of course, as interpreted by him) which “pressed on nerves that
innervated the heart”. He then regarded
himself as the founder of a miracle treatment and developed a philosophical (if
not religious) theory behind it. He
believed that “ninety-five per cent of all diseases were caused by displaced
vertebrae”. Diseases were caused by
subluxation in the spine resulting in blockage of the body’s “innate intelligence”.
So replacement of the different
displaced vertebrae could allow the rectification of the flow of “innate
intelligence” and nearly all illnesses from measles, to sexual dysfunction, to asthma,
etc. could be treated. In two years
time, he opened the Palmer School of Chiropractic in Davenport, Iowa. And his son, Bartlett Joshua Palmer, was his
successor. In 1924, B.J. Palmer started
a lucrative sideline in selling “neurocalometer” invented by him for detecting
subluxations. It helped the
practitioners a lot since afterall the so-called subluxations were (with due
respect) in the minds of the chiropractors. It was sold at a price of $2200, which at that
time was enough to buy a house in Iowa. However,
the apparatus was then found to contain nothing but a thermocouple (you know
what it is!).
Too bad? Not until you read about homeopathy!
(Source: HKMA News March 2012)
