Bad Science And Surgery
Doctors have an ethical imperative to ensure that their patients receive the best treatment available. From the earliest Hippocratic times we have been exhorted to “to do no harm” (επι δηλησει δε και αδικιηι ειρξειν). This requirement to use treatments that works and withhold treatments that may harm is particularly important in disciplines such as gynaecology where most interventions are aimed at alleviating non-fatal symptoms rather than heroic life-saving therapies. There is almost universal acceptance of such an approach, the problem that we have is how to know which treatments work and which do not?
Almost all of us have been trained in the classical apprenticeship manner. We learned the most effective treatments and most efficient procedures by studying the works of our distinguished teachers whom we assumed had distilled the most appropriate techniques by years of study coupled with diligent distillation of their trial and error experiences. We, in our turn applied and modified these approaches and taught them to our students. So our profession developed. But on what foundations are our speciality built and how do we know they work?
The most common justification of a procedure new or old is “that I my experience it works”. Such a justification from the famous and powerful in our profession is difficult to refute particularly if a number of our most eminent authorities come together in a society or college and re-enforce each other’s belief. Unfortunately our collective history is littered with examples of when the most widely held beliefs of the highest in the profession are subsequently shown to be in error. From the earliest days of modern gynaecology the collective wisdom of the profession has been found wanting. Take the following text on the treatment of menorrahgia from a standard medical book published in 1842 by the distinguished physician of the Royal College of Surgeons of Edinburgh Dr Thomas Andrew (1).
“It is therefore necessary to adopt preparatory measures, even when flooding is not of long standing, blood should be taken from the arm to the extent of from 10 to 14 ounces or even a pound, according to circumstances. Basquellon never omitted this precaution, even when the patient had pallid lips, small pulse, and appeared bloodless, and frequently he found the pulse and the strength of the patient re-invigorated under this treatment. This, however, is not a practice to be followed by an unprofessional attendant, as the patient might fall into a state of syncope or fainting from which she might never recover. In all circumstances of active flooding blood-letting must never be omitted”.
This passage in a widely distributed textbook and written by doctors of the highest probity reveals many of the weaknesses of our profession, now as well as then. This passage reflects the very best collective medical opinion at the time of how to manage heavy menstrual bleeding. Very authorative but completely wrong 1) First build a treatment on…
