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Wednesday, December 18, 2013

Medicine slow to accept science

Medicine is the only profession based on science to be slow to accept science.  That's because it's easy for a physician believe in something, or prescribe something, because "it sounds good" as opposed to "it is proven good."

Hippocrates observed this over 2,000 years ago when he said:
Instruction, to be beneficial, should be founded on facts. Arts are deduced from reflection; but any reflections or reasoning, not accompanied by facts, evince that fault somewhere exists. To think merely, and produce nothing, is a proof of error, or of ignorance especially in medicine. Here, opinion alone is criminal, and becomes injurious to the sick. Confidence in self-opinion is delusive, since fact too often proves its falsehood, as impure gold is tried in the furnace. The common remark, that “finis coronat opus (the end crowns the work),” is lost on such persons as I have pointed out, although the true method of attaining the science is daily manifested to all who desire its acquirement.
He then adds:
It may be concluded then, admitting the truth of the preceding remarks, that knowledge and medicine must go hand in hand. The physician who is truly a philosopher is a demigod. Medicine and philosophy are closely allied. That which is taught by the latter, is practised by the former,—contempt of riches, moderation, decency, modesty, honour, justice, affability, cleanliness, gravity, a just appreciation of all the wants of life, courage in adversity—opposition to fraud and superstition, and due consideration of the Divine power. The physician is perpetually exposed to the hazards of incontinence, turpitude, avarice, intemperance, detraction, and insolence. How far these may influence his character, may be estimated by his conduct towards his patients, his friends, and families.
Keep in mind here that philosophy was (is) the quest for wisdom, so physicians were not just educated in medicine, but all wisdom.  They were also knowledgeable in algebra, geometry, chemistry, astronomy, astrology, etc.  They were very well rounded in their education.

Yet  still, through it all, there was a tendency to theorize in medicine.  And even while there was always an attempt to use empirical evidence and science, the medical profession never quite made it all the way there.  Much of what we still do in the hospital is based on speculation.

Examples include oxygenating patient's who complain of symptoms even though their SpO2 is normal, or not oxygenating COPD patients based on the hypoxic drive myth.  Another example is giving Tylenol and Ventolin for the placebo affect.

  1. Hippocrates, "On decency in manner and dress," epitomised from the original Latin translations by John Redman Coxe, "The writings of Hippocrates and Galen," 1846, Philadelphia, Lindsay and Blakiston
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1 comment:

Anonymous said...

You can have a normal SpO2 displayed on the pulse ox and still require oxygen.

Case in point: Carbon monoxide poisoning