Science begets knowledge; opinion begets ignorance.

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)