Trick or Treatment—The Undeniable Facts about Alternative Medicine (Electronic book text)

Rush was fooled by his respect for ancient ideas coupled with the ad hoc reasons that were invented to justify the use of bloodletting. For example, it would have been easy for Rush to mistake the sedation caused by bloodletting for a genuine improvement, unaware that he was draining the life out of his patients. He was also probably confused by his own memory, selectively remembering those of his patients who survived bleeding and conveniently forgetting those who died. Moreover, Rush would have been tempted to attribute any success to his treatment and to dismiss any failure as the fault of a patient who in any case was destined to die.

Although evidence-based medicine now condemns the sort of bloodletting that Rush indulged in, it is important to point out that evidence-based medicine also means remaining open to new evidence and revising conclusions. For example, thanks to the latest evidence from new trials, bloodletting is once again an acceptable treatment in very specific situations — it has now been demonstrated, for instance, that bloodletting as a last resort can ease the fluid overload caused by heart failure. Similarly, there is now a role for leeches in helping patients recover from some forms of surgery. For example, in 2007 a woman in Yorkshire had leeches placed in her mouth four times a day for a week and a half after having a cancerous tumour removed and her tongue reconstructed. This was because leeches release chemicals that increase blood flow and thus accelerate healing.

Despite being an undoubted force for good, evidence-based medicine is occasionally treated with suspicion. Some people perceive it as being a strategy for allowing the medical establishment to defend its own members and their treatments, while excluding outsiders who offer alternative treatments. In fact, as we have seen already, the opposite is often true, because evidence-based medicine actually allows outsiders to be heard — it endorses any treatment that turns out to be effective, regardless of who is behind it, and regardless of how strange it might appear to be. Lemon juice as a treatment for scurvy was an implausible remedy, but the establishment had to accept it because it was backed up by evidence from trials. Bloodletting, on the other hand, was very much a standard treatment, but the establishment eventually had to reject its own practice because it was undermined by evidence from trials.

There is one episode from the history of medicine that illustrates particularly well how an evidence-based approach forces the medical establishment to accept the conclusions that emerge when medicine is put to the test. Florence Nightingale, the Lady with the Lamp, was a woman with very little reputation, but she still managed to win a bitter argument against the male-dominated medical establishment by arming herself with solid, irrefutable data. Indeed, she can be seen as one of the earliest advocates of evidence-based medicine, and she successfully used it to transform Victorian healthcare.

Florence and her sister were born during an extended and very productive two-year-long Italian honeymoon taken by their parents William and Frances Nightingale. Florence’s older sister was born in 1819 and named Parthenope after the city of her birth — Parthenope being the Greek name for Naples. Then Florence was born in the spring of 1820, and she too was named after the city of her birth. It was expected that Florence Nightingale would grow up to live the life of a privileged English Victorian lady, but as a teenager she regularly claimed to hear God’s voice guiding her. Hence, it seems that her desire to become a nurse was the result of a ‘divine calling’. This distressed her parents, because nurses were generally viewed as being poorly educated, promiscuous and often drunk, but these were exactly the prejudices that Florence was determined to crush.

The prospect of Florence nursing in Britain was already shocking enough, so her parents would have been doubly terrified by her subsequent decision to work in the hospitals of the Crimean War. Florence had read scandalous reports in newspapers such as The Times, which highlighted the large number of soldiers who were succumbing to cholera and malaria. She volunteered her services, and by November 1854 Florence was running the Scutari Hospital in Turkey, which was notorious for its filthy wards, dirty beds, blocked sewers and rotten food. It soon became clear to her that the main cause of death was not the wounds suffered by the soldiers, but rather the diseases that ran rife under such squalid conditions. As one official report admitted, ‘The wind blew sewer air up the pipes of numerous open privies into the corridors and wards where the sick were lying.’