Over the years the medical establishment has acquired a well-deserved reputation for ignoring good discoveries (which would make a dramatic difference to human health) and continuing with useless practices (which do more harm than good) long after they should have abandoned them. The medical profession, or, rather, perhaps I should say ‘the medical establishment’ has always been slow to accept and assimilate new ideas – and slow to see the obvious.
I have long thought that the main problem with modern medical education is that it is largely based upon learning by rote and upon eliminating all original thought. This is deliberate since the aim of an orthodox modern medical education is to help maintain the status quo (and preserve the position of the pharmaceutical industry). Right from the very beginning, young students are made to learn long lists of information. They learn the names of the bones, the arteries, the nerves and the veins in the body. They learn the names of the muscles and they learn the histology of the various organs. They then learn lists of clinical signs and symptoms. And they learn lists of drugs. At no point are students encouraged to think for themselves.
As a result it is not surprising that after graduation most doctors continue to do as they are told. The average doctor is strangely incapable of critical thought. Given the indoctrination they have undergone it is hardly surprising that doctors readily accept everything they are told by the drug companies (which more or less control post graduate education) and equally readily reject alternative medicine – something which never makes much of an appearance in the undergraduate syllabus.
There is nothing new about this.
The greatest thinkers – the ones who have, in the end, contributed most to medicine and human health – have always been scorned or ignored (or preferably both) by the medical establishment. The establishment has always manipulated the truth to suit its own political, religious or commercial purposes. Simple truths which are inconvenient have always been suppressed. It happened in the past, it will happen in the future and it is happening now.
Few medical stories illustrate the way the medical establishment works better than the story of how scurvy was discovered and how the treatment for it was ignored for centuries.
In 1535, Jacques Cartier sailed from France to Newfoundland with a crew of 110 men. Within six weeks a hundred of his men had developed scurvy. Luckily for Cartier and his men a native told them to drink the juice from the fruit of local trees. The men recovered in days. From that time on wise sea captains made sure that their men were given regular supplies of orange or lemon juice. In a book called The Surgeons Mate, published in 1636 John Woodall recommended that these juices be used to prevent scurvy. But the medical establishment was slow to accept this sensible suggestion.
It wasn’t until two centuries later, in 1747, that the idea was reintroduced by James Lind, who conducted a proper clinical trial and proved that scurvy could be prevented with the right diet. It was Lind’s work which enabled Captain Cook (he was a Lieutenant at the time) to sail around the world without a single case of scurvy.
The admiralty and the medical establishment continued to ignore all this. In the Seven Years War, from 1756 to 1763, approximately half of the 185,000 sailors involved died of scurvy. In 1779 the Channel Fleet had 2,400 cases of scurvy after a single ten week cruise.
Eventually, in 1795 the medical establishment (and the navy) succumbed to common sense and lemon juice became a compulsory part of every sailor’s diet. This breakthrough took well over two centuries to be accepted.
Then there is Paracelsus.
There is no doubt that Paracelsus (Aureolus Theophrastus Bombastus von Hohenheim to his friends) is the father of modern medicine. He tore into the precepts of established medical thinking with all the zeal of a missionary. He revolutionised medical thinking throughout Europe and scandalised the medical establishment by claiming to have learned more from his contact with witches and midwives than from his study of ancient and well-revered medical texts. No idea or theory was too bizarre to be studied and considered and no belief, no practice and no concept too sacred to be rejected. He was the first man to associate mining with chest disease, to use mercury in the treatment of syphilis, to advocate allowing wounds to drain instead of smothering them with layers of dried dung and to argue that some foods contained poisons which harmed the human body. Paracelsus scandalised the establishment by claiming that he was interested more in pleasing the sick than his own profession. He was, not surprisingly, rejected by the medical establishment and widely and persistently persecuted for his beliefs. It was years after his death that his ideas were recognised.
And there is Vesalius.
In the sixteenth century Andreas Vesalius achieved contemporary notoriety and eternal fame as the author of the first textbook of human anatomy, ‘De Humanis Corporis Fabrica’. Up until Vesalius medical students had studied anatomy using texts prepared by Galen. Since Galen used pigs not human corpses for his studies his anatomical notes were, to say the least, rather misleading.
Vesalius’s frank rejection of many of Galen’s anatomical claims earned him considerable disapproval. The medical establishment still firmly believed that Galen could do no wrong. They weren’t interested in anything as superficial and irrelevant as evidence.
Like so many original thinkers before and after him, Vesalius was unable to cope with the outcry. He burnt his remaining manuscripts, abandoned his study of anatomy and took a job as court physician to Charles V in Madrid.
Vesalius wasn’t the only anatomist whose work was rejected. In the 17th century, British doctor William Harvey spent eight years researching the circulation of the blood – and getting it right. His patience was rewarded with ridicule. He received nothing but abuse. He lost many friends and his practice shrank.
When Ambrose Pare, the great French surgeon, first started work as an army surgeon it was accepted practice to stop a haemorrhage by sealing a wound with a red hot iron. Amputations were performed with a red hot knife and the wounds which were left were sealed with boiling oil. One day Pare ran out of boiling oil and used a mild emollient to dress the wounds of the men he was treating. He worried all night about what he had done but the next day he found that his patients were not only healthy but that they were also in less pain than the men whose wounds had been sealed with boiling oil. Pare was wise enough to learn from this and from that day on he started dressing wounds with an emollient rather than boiling oil. He also introduced ligatures, artificial limbs and many surgical instruments. Inevitably, Pare met the usual fate of innovators and reformers (who get a rougher ride within the world of medicine than anywhere else). He was denounced by other surgeons as dangerous and unprofessional. Older surgeons banded together to oppose him and in their attempts to discredit him they attacked him for all sorts of things – for example, his ignorance of Latin and Greek. Pare eventually succeeded because the soldiers he treated trusted him and wanted to be treated by him. They weren’t interested in the views of the French medical establishment.
A look back at hospitals is also revealing.
When Tsar Paul came to power in Russia in 1796 he was so horrified at the state of the hospital in Moscow that he ordered it to be rebuilt. In Frankfurt in the 18th century physicians considered working in hospital to be equivalent to a sentence of death.
In 1788, Jacobus-Rene Tenon published a report on the hospitals of Paris which shocked city officials. He described how the Hotel Dieu (the magnificent looking hospital next to Notre Dame) contained 1200 beds but up to 7,000 patients – with up to six patients crammed into each bed. The stench in the hospital was so foul that people who entered would do so holding a vinegar soaked sponge to their noses. Very few patients escaped from the hospital with their lives. When reformer John Howard toured European hospitals he angrily reported that no fresh air, no sunlight, straw as bedding, no bandages and a milk and water diet supplemented with weak soup were standard. The reports of Tenon and Howard were ignored and dismissed for years and it took decades for the medical establishment to make any real changes.
In the 18th century the treatment of the mentally ill was abysmal. Daniel Defoe, best remembered for his story of the adventures of Robinson Crusoe, wrote a vicious attack on mental hospitals. ‘Is it not enough to make anyone mad,’ he asked, ‘ to be suddenly clap’d up, stripp’d, whipp’d, ill fed and worse us’d? To have no reason assigned for such treatment, no crime alleged or accusers to confront? And what is worse, no soul to appeal to but merciless creatures who answer but in laughter, surliness, contradiction and too often stripes?’
No one took much notice and medical practitioners continued to treat mentally ill patients without respect or care.
At the Bethlem Royal Hospital half naked patients were kept chained in irons. Physicians bled their patients once a year and the more troublesome patients were put on a tranquillising wheel. Until 1770 visitors could pay a penny to see the ‘fun’ at Bedlam. John Wesley, founder of the Wesleyan Church, who considered himself a benefactor of the mentally ill, suggested pouring water onto the heads of the mentally ill and forcing them to eat nothing but apples for a month. Wesley was one of the first men to use electricity in the attempted treatment of the mentally ill. Despite the protests of reformers such as Philippe Pinel (who shocked the establishment in the late 18th century by claiming that the mentally ill were sick and needed treatment) mental hospitals were, well into the 19th century, still quite unsuitable for people needing medical treatment.
There was never any evidence to show that it did any good but blood-letting was a favourite therapeutic tool for centuries. The fact that removing blood from a patient made him or her quieter was regarded as proof that it was doing some good. (This is no dafter than the rationale used to explain some modern treatments.) Blood-letting was easy to perform and it was something to do. Doctors have always felt the need to do something to their patients. (Possibly because it is difficult to explain away a big fee if all you do is give advice.) Leeches were hugely popular in the 19th century. In 1824, two million leeches were imported into France. In 1832, the figure had risen to 57 million a year.
In 1843, the American poet, novelist and anatomist, Oliver Wendell Holmes, read to the Boston Society for Medical Improvement a paper entitled ‘On The Contagiousness of Puerperal Fever’. He argued that the disease could be carried from patient to patient by doctors. He suggested that surgeons should consider changing their clothes and washing their hands after leaving a patient with puerperal fever. His lecture annoyed the medical establishment and his advice was ignored completely.
A similar fate befell Ignaz Philipp Semmelweiss who, in 1846, at the age of 28, became an assistant in an obstetric ward at the Allgemeines Krankenhaus in Vienna. Semmelweiss noticed that the number of women dying in his ward was higher than the number dying in other wards. It wasn’t difficult to notice this. Women would beg, in tears, not to be taken into Semmelweiss’s ward.
Deciding that he wasn’t that bad a doctor, Semmelweiss looked for an explanation and came to the conclusion that the major difference was that patients on his ward were looked after by medical students whereas the patients on other wards were looked after by midwives. Semmelweiss then discovered that the students came straight to the ward from the dissecting room where they had had their hands stuck into the corpses of women who had died from puerperal fever. The midwives never went near to the dissecting room. Semmelweiss instructed the medical students that they should start washing their hands in a solution of calcium chloride after coming from the dissecting room. The remedy produced a dramatic drop in the death rate on his ward.
Predictably the medical establishment was not well pleased – even though Semmelweiss had proved his point very dramatically. The unfortunate young doctor couldn’t cope with the rejection. He became an outcast and died in a mental hospital a few years later. The medical establishment had scored another hollow victory. Once again the patients were the losers.
You might have thought that the medical establishment would have welcomed anaesthesia. After all, before anaesthetics were available, surgeons had to get their patients drunk or knock them out with a blow to the head. Surgeons would often operate with the patient held down by four strong men. The first operation under anaesthesia was performed at the Massachusetts General Hospital in 1846. But the establishment was not going to accept this new-fangled nonsense lying down. The main objection was that anaesthetics were being used to help women who were in labour. And that, said the establishment, just wasn’t acceptable. It was, said the wise men, unnatural and unhealthy for women to deliver babies without suffering pain. ‘In sorrow thou shalt bring forth children,’ says the Bible. However, the religious barbarians were eventually overcome by Dr James Simpson who trumped the Bible quoters with this quote: ‘And the Good Lord caused a deep sleep to fall upon Adam and he slept; and He took one of his ribs and closed up the flesh instead thereof.’ The opposition to anaesthesia was finally quelled when Queen Victoria gave birth to Prince Leopold while under the influence of chloroform.
In 1867 Joseph Lister published a paper in The Lancet entitled ‘On the Antiseptic Principle in the Practice of Medicine’. Lister had found a solution to the age old problem of post-operative infection. But the medical establishment doesn’t like change, even if it means keeping patients alive. And Lister found himself being attacked by doctors who ignored the evidence but disapproved of his new techniques simply because they were new. It was decades before the ‘antiseptic principle’ was accepted.
One of the reasons why hospital infections are so commonplace today is that doctors and nurses seem to believe that they can use antibiotics instead of washing their hands. Incompetence, carelessness and ignorance mean that the quality of cleanliness in the average modern hospital is little better than it was in a hospital in the Middle Ages.
Until surprisingly recently, it was routine for surgery on babies to be performed without anaesthesia on the grounds that babies are incapable of feeling pain. There was no evidence for this claim (one which any mother would be able to oppose with credible if anecdotal evidence) but anaesthetists were taught that babies had immature nervous systems and so didn’t need painkillers.
Above I have described just a few of the hundreds (probably thousands) of examples I could give to illustrate the way that the medical establishment, in recent years allied with the drug industry, has always opposed original thought and has protected the status quo – regardless of the effect on patients.
The medical establishment has acted in the interests of the profession but against the interests of patients, and thoughtful and creative individuals have always had a hard time. The value of serendipity has also been ignored, of course. Both penicillin and X-rays were the result of serendipity.
The real tragedy is that absolutely nothing has changed for the better. Indeed, things have arguably got worse.
The medical establishment is still responsible for protecting and promoting medical procedures which do not work and have never worked (and which expose patients to great risk) while at the same time it opposes and suppresses treatments which do work and have been proved to work.
Today, anyone in the medical profession who dares to offer thoughts or warnings which don’t fit in with the specific requirements of the medical establishment will get the Semmelweiss treatment. They will be laughed at and suppressed.
Nothing has changed.
As I and others have discovered to our cost.