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

Nightingale’s passion for statistics enabled her to persuade the government of the importance of a whole series of health reforms. For example, many people had argued that training nurses was a waste of time, because patients cared for by trained nurses actually had a higher mortality rate than those treated by untrained staff. Nightingale, however, pointed out that this was only because more serious cases were being sent to those wards with trained nurses. If the intention is to compare the results from two groups, then it is essential (as discussed earlier) to assign patients randomly to the two groups. Sure enough, when Nightingale set up trials in which patients were randomly assigned to trained and untrained nurses, it became clear that the cohort of patients treated by trained nurses fared much better than their counterparts in wards with untrained nurses. Furthermore, Nightingale used statistics to show that home births were safer than hospital births, presumably because British homes were cleaner than Victorian hospitals. Her interests also ranged overseas, because she also used mathematics to study the influence of sanitation on healthcare in rural India.

And throughout her long career, Nightingale’s commitment to working with soldiers never waned. In one of her later studies, she observed that soldiers based in Britain in peacetime had an annual mortality rate of 20 per 1,000, nearly twice that of civilians, which she suspected was due to poor conditions in their barracks. She calculated the death toll across the whole British army due to poor accommodation and then made a comment that highlighted how this was such a needless waste of young lives: ‘You might as well take 1,100 men every year out upon Salisbury Plain and shoot them.’

The lesson to be learned from Florence Nightingale’s medical triumphs is that scientific testing is not just the best way to establish truth in medicine, but it is also the best mechanism for having that truth recognized. The results from scientific tests are so powerful that they even enable a relative unknown such as Nightingale — a young woman, not part of the establishment, without a great reputation — to prove that she is right and that those in power are wrong. Without medical testing, lone visionaries such as Nightingale would be ignored, while doctors would continue to operate according to a corrupt body of medical knowledge based merely on tradition, dogma, fashion, politics, marketing and anecdote.

A stroke of genius

Before applying an evidence-based approach to evaluating alternative medicine, it is worth re-emphasizing that it provides extraordinarily powerful and persuasive conclusions. Indeed, it is not just the medical establishment that has to tug its forelock in the face of evidence-based medicine, because governments can also be forced to change their policies and corporations may have to alter their products according to what the scientific evidence shows. One final story illustrates exactly how scientific evidence can make the world sit up, listen and act regarding health issues — it concerns the research that dramatically revealed the previously unknown dangers of smoking.

This research was conducted by Sir Austin Bradford Hill and Sir Richard Doll, who had curiously mirrored each other in their backgrounds. Hill had wanted to follow in his father’s footsteps and become a doctor, but a bout of tuberculosis made this impossible, so instead he pursued a more mathematical career. Doll’s ambition was to study mathematics at Cambridge, but he got drunk on three pints of Trinity Audit Ale (8 per cent alcohol) the night before his entrance exam and underperformed, so instead he pursued a career in medicine. The result was a pair of men with strong interests in both healthcare and statistics.

Hill’s career had involved research into a wide variety of health issues. In the 1940s, for instance, he demonstrated a link between arsenic and cancer in chemical workers by examining death certificates, and he went on to prove that rubella during pregnancy could lead to deformities in babies. He also conducted important research into the effectiveness of antibiotics against tuberculosis, the disease that had ended his hopes of becoming a doctor. Then, in 1948, Hill’s interest turned towards lung cancer, because there had been a sixfold increase in cases of the disease in just two decades. Experts were divided as to what was behind this health crisis, with some of them dismissing it as a consequence of better diagnosis, while others suggested that lung cancer was being triggered by industrial pollution, car fumes or perhaps smoking.