Tag Archives: Homeopathy

The truth, the whole truth and … wait, how many truths are there?

The Conversation

Peter Ellerton, The University of Queensland

Calling something a “scientific truth” is a double-edged sword. On the one hand it carries a kind of epistemic (how we know) credibility, a quality assurance that a truth has been arrived at in an understandable and verifiable way.

On the other, it seems to suggest science provides one of many possible categories of truth, all of which must be equal or, at least, non-comparable. Simply put, if there’s a “scientific truth” there must be other truths out there. Right?

Let me answer this by reference to the fingernail-on-the-chalkboard phrase I’ve heard a little too often:

“But whose truth?”

If somebody uses this phrase in the context of scientific knowledge, it shows me they’ve conflated several incompatible uses of “truth” with little understanding of any of them.

As is almost always the case, clarity must come before anything else. So here is the way I see truth, shot from the hip.

Venture Vancouver

While philosophers talk about the coherence or correspondence theories of truth, the rest of us have to deal with another, more immediate, division: subjective, deductive (logical) and inductive (in this case, scientific) truth.

This has to do with how we use the word and is a very practical consideration. Just about every problem a scientist or science communicator comes across in the public understanding of “truth” is a function of mixing up these three things.

Subjective truth

Subjective truth is what is true about your experience of the world. How you feel when you see the colour red, what ice-cream tastes like to you, what it’s like being with your family, all these are your experiences and yours alone.

In 1974 the philosopher Thomas Nagel published a now-famous paper about what it might be like to be a bat. He points out that even the best chiropterologist in the world, knowledgeable about the mating, eating, breeding, feeding and physiology of bats, has no more idea of what it is like to be a bat than you or me.

Similarly, I have no idea what a banana tastes like to you, because I am not you and cannot ever be in your head to feel what you feel (there are arguments regarding common physiology and hence psychology that could suggest similarities in subjective experiences, but these are presently beyond verification).

What’s more, if you tell me your favourite colour is orange, there are absolutely no grounds on which I can argue against this – even if I felt inclined. Why would I want to argue, and what would I hope to gain? What you experience is true for you, end of story.

Deductive truth

Deductive truth, on the other hand, is that contained within and defined by deductive logic. Here’s an example:

Premise 1: All Gronks are green.
Premise 2: Fred is a Gronk.
Conclusion: Fred is green.

Even if we have no idea what a Gronk is, the conclusion of this argument is true if the premises are true. If you think this isn’t the case, you’re wrong. It’s not a matter of opinion or personal taste.

PistoCasero

If you want to argue the case, you have to step out of the logical framework in which deductive logic operates, and this invalidates rational discussion. We might be better placed using the language of deduction and just call it “valid”, but “true” will do for now.

In my classes on deductive logic we talk about truth tables, truth trees, and use “true” and “false” in every second sentence and no one bats (cough) an eyelid, because we know what we mean when we use the word.

Using “true” in science, however, is problematic for much the same reason that using “prove” is problematic (and I have written about that on The Conversation before). This is a function of the nature of inductive reasoning.

Inductive truth

Induction works mostly through analogy and generalisation. Unlike deduction, it allows us to draw justified conclusions that go beyond the information contained in the premise. It is induction’s reliance on empirical observation that separates science from mathematics.

In observing one phenomenon occurring in conjunction with another – an electric current and an induced magnetic field, for instance – I generalise that this will always be so. I might even create a model, an analogy of the workings of the real world, to explain it – in this case that of particles and fields.

This then allows me to predict what future events might occur or to draw implications and create technologies, such as developing an electric motor.

And so I inductively scaffold my knowledge, using information I rely upon as a resource for further enquiry. At no stage do I arrive at deductive certainty, but I do enjoy greater degrees of confidence.

I might even speak about things being “true”, but, apart from simple observational statements about the world, I use the term as a manner of speech only to indicate my high level of confidence.

Now, there are some philosophical hairs to split here, but my point is not to define exactly what truth is, but rather to say there are differences in how the word can be used, and that ignoring or conflating these uses leads to a misunderstanding of what science is and how it works.

For instance, the lady that said to me it was true for her that ghosts exist was conflating a subjective truth with a truth about the external world.

I asked her if what she really meant was “it is true that I believe ghosts exist”. At first she was resistant, but when I asked her if it could be true for her that gravity is repulsive, she was obliging enough to accept my suggestion.

AMERICANVIRUS

Such is the nature of many “it’s true for me” statements, in which the epistemic validity of a subjective experience is misleadingly extended to facts about the world.

Put simply, it smears the meaning of truth so much that the distinctions I have outlined above disappear, as if “truth” only means one thing.

This is generally done with the intent of presenting the unassailable validity of said subject experiences as a shield for dubious claims about the external world – claiming that homeopathy works “for me”, for instance. Attacking the truth claim is then, if you accept this deceit, equivalent to questioning the genuine subject experience.

Checkmate … unless you see how the rules have been changed.

It has been a long and painful struggle for science to rise from this cognitive quagmire, separating out subjective experience from inductive methodology. Any attempt to reunite them in the public understanding of science needs immediate attention.

Operating as it should, science doesn’t spend its time just making truth claims about the world, nor does it question the validity of subject experience – it simply says it’s not enough to make object claims that anyone else should believe.

Subjective truths and scientific truths are different creatures, and while they sometimes play nicely together, their offspring are not always fertile.

So next time you are talking about truth in a deductive or scientifically inductive way and someone says “but whose truths”, tell them a hard one: it’s not all about them.

The ConversationPeter Ellerton, Lecturer in Critical Thinking, The University of Queensland

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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Four card solution

Obviously we need to turn over the D to check that there is a 3 on the back (everybody gets this one right). And equally obviously, there’s no need to turn over the K (and again, everybody realises this). The 3 card is a tricky one. Most people think that you need to turn this card over to see whether there is a D on the other side. This would be necessary had the claim been that “Every card that has a D on one side has a 3 on the other, and vice versa”. But it wasn’t. The 7 is the other tricky one. It doesn’t occur to most people that we need to turn this card over to check that the letter on the back is not D. If it is D, then the claim is false.

This trick illustrates the phenomenon of confirmation bias. Most people, being fairly charitable sorts, want to turn over the 3, find a D on the back and confirm the claim (“Well done, you’re right!”). And so it is with homeopathy (or conspiracy theories). People who want to believe that the treatment works actively search for opportunities to confirm this belief, focusing on homeopathy patients who seem to have got better (“3 cards”) and reject opportunities to disconfirm it, by ignoring research studies (“7 cards”).

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So, the NHMRC has found homeopathy doesn’t work. Now how do we get the message across?

The Conversation

By Ian Musgrave

The NHMRC has released its final statement on homeopathy. To no ones great surprise, the report concluded that there was no evidence that homeopathy was effective in treating any of 63 separate medical conditions.

I have already dealt with aspects of the interim report, and articles in The Conversation have already dealt with the report in general (see here and here), so I would like to look at it from a different angle; how do we effectively communicate the science behind the report?

Sure, the report is on the web, and has been mentioned in a variety of media and radio programs, but is this going to be effective? The need to effectively communicate these findings is highlighted by two separate occurrences, the recent debate over vaccination in the light of measles outbreaks overseas, and the recent CSIRO report that up to 40% of Australians are “disengaged” or actively distrust science.

After all, the target audience for this information is not the people who have been following the evidence, and are well aware that homeopathy is ineffective. To some degree the people who want to treat mild or self limiting conditions, for example insomnia, and who think that homeopathy is some form of herbal medicine are also not the target audience.

What we are worried about most is those people with serious conditions who abandon standard therapy for ineffective homeopathy (for example, trying to treat diabetes with homeopathic dilutions of uranium salts). We accept that adults should be able to choose (or reject) their therapies. But we also expect that people choose or reject therapies based on the best available evidence. What happens when people reject that evidence?

A recent paper looked at various ways to communicate with parents to increase vaccination rates. They found that parents accepted that the MMR vaccine did not cause significant side effects after the various communication strategies, but were not inclined to get their children vaccinated. One subset of parents, those who had the least favourable views on vaccination at the beginning of the study, were now LESS likely to vaccinate their children.

This is consistent with other studies (see also here) showing that when people with deeply entrenched beliefs are confronted with facts that disprove those beliefs, paradoxically they become firmer in their beliefs.

So how do we effectively communicate the science in the report? The NHMRC site has meticulous information on what they did, summaries and a FAQ, but we have to get people to read them. Most news articles and radio shows do not provide the information to find the report.

From a science communication point of view, most of the information on the NHMRC site is too technical for the general public. As an example of a good way to convey science around a contentious issue, the Australian Academy of Sciences has a great web accessible document that simply and clearly explains the science behind vaccines.

However, if you google “Vaccine Information Australia” you will see 4 of the top 10 results are vaccine denialist sites (and 3 of the top 5), and the AAS report is nowhere to be found.

As well as finding information in a format accessible to the general public, we need to consider that those most at risk of ignoring conventional medicine for homeopathy are also very likely to be in that 20% that the CSIRO found to be disengaged from or distrustful of science. As well, peoples perception of health and their health philosophy can make this a very emotionally charged issue.

We need to carefully consider how to approach this audience. In the light of the pediatrics paper, referenced above, where factual information led people to be less likely to vaccinate, merely giving people the facts is unlikely to be enough.

However, there are a variety of approaches that can be tried. Most of these have been developed in relation to politics or global warming, but the processes that are involved are similar.

In view of how homeopathy may be deeply linked with peoples world views, and showing homeopathy is no more than placebo may leave a gap in peoples beliefs (accounting for their reluctance to accept the facts), an approach such as replacing the gap with an alternative narrative may be the best approach.

Whatever the approach we use, the publication of the NHMRC report on homeopathy is the beginning of a long process of engagement, not the end of the matter.

The ConversationThis article was originally published on The Conversation. (Reblogged by permission). Read the original article.


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Time to stop abusing the NHMRC for ideological purposes

The Conversation

By Michael Vagg, Barwon Health

The release today of the long-awaited NHMRC Statement and Advice on Homeopathy is just the latest in a series of pointless and ideologically motivated exercises that this peak scientific body has been tasked to undertake.

We have seen this group of professional scientists sent on wild goose chases after Wind Turbine Syndrome, water fluoridation and now homeopathy on behalf of a government that clearly wants science to be done to order for its political agenda. At a time when they are holding valuable, productive and world-class research infrastructure hostage to their unpopular higher education legislation, it is simply impossible to believe that the federal government takes science seriously at all.

Thankfully, the scientists continue to do their job well even when sent on a fool’s errand. The report on homeopathy is a model of science-based enquiry. It really should put to bed the case for supporting this entirely fantastical enterprise with science or higher education dollars. The analysis of the literature was comprehensive, covering some 1800 articles published. The majority of these were of such poor quality that only a couple of hundred even met the most basic criteria for further analysis. The consensus of these acceptable studies was that there was nothing to see here, and science should move on.

If some good is to come out of such a whimsical use of public funds, it should lead to the removal of public subsidies for private health insurance to cover homeopathy services. It should be wielded mercilessly in support of a crackdown by TGA and ACCC on the spivs and hucksters who sell complete moonshine to vulnerable patients. After all, as the Prime Minister reminded us yesterday in another context,

what we can’t do is endlessly subsidise lifestyle choices

This Statement of Advice on homeopathy is reported to have cost around $800,000 to produce, and followed a similar document having been produced in the UK which arrived at the same conclusion just a couple of years earlier. I’m sure a few of Australia’s newly unemployed research scientists could have put that money to good use. The fluoridation and wind turbine fiascos add insult to injury by wasting precious science dollars on fatuous ideological stunts. One wonders whether NHMRC reports on the health effects of “superfoods” or dangers of immunisation will be next. Perhaps Senator McFarlane should just change his job title to Minister for Industry and Junk Science.

The ConversationThis article was originally published on The Conversation. (Reblogged by permission). Read the original article.


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NHMRC Statement on Homeopathy

The National Health and Medical Research Council today released a statement concluding that there is no good quality evidence to support the claim that homeopathy is effective in treating health conditions.

Its release follows a thorough review of the evidence, conducted as part of NHMRC’s responsibility to provide advice and support informed health care decisions by the Australian community. This is the final outcome from the draft information paper the NHMRC released last year.

The conclusion is based on the findings of a rigorous assessment of more than 1800 papers. Of these, 225 studies met the criteria to be included in NHMRC’s examination of the effectiveness of homeopathy.

The review found no good quality, well-designed studies with enough participants to support the idea that homeopathy works better than a placebo, or causes health improvements equal to those of another treatment.

Further information is available here.


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Dara O’Briain vs homeopathy

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2014, a Bad Year for Homoeopathy

The Conversation
By Ian Musgrave

This has been a bad year for homoeopathy, first there was the Draft Information Paper on Homoeopathy from the NHMRC, which concluded there was no reliable evidence for the use of homoeopathy in the treatment of the 61 health conditions looked at. Then a homoeopathic remedy manufacturer left the North American market due to law suites over the ineffectiveness of their products, then the Federal Court has found that Homeopathy Plus! was engaged in misleading conduct over its homoeopathic “vaccines”

Quoting from the ACCC website “…[Homeopathy Plus!] engaged in misleading and deceptive conduct and made false and misleading representations to the effect that there was an adequate foundation in medical science for the statement that homoeopathic treatments are a safe and effective alternative to the whooping cough vaccine, when in fact no such foundation exists..”

However, this is not a one-way street. Complementary Medicines Australia has claimed, 6 months after the public consultation process had closed, that the NHMRC process was flawed. In the august publication Food Navigator Asia it was claimed to be “fatally flawed”.

What coffee diluted homeopathically looks like. Ian Musgrave

Before we examine these claims, let me remind you that homoeopathy is based on two principles “like cures like” and extreme dilution, in most cases to levels so dilute that there is almost no chance of a single remaining molecule of original compound being present in the remedy. Thus caffeine diluted 1 in a hundred 30 times is used to treat insomnia and Uranium nitrate diluted 1 in a hundred 30 times is used to treat diabetes.

In the latter case it is fortunate at no uranium will actually be present, as uranium nitrate causes kidney failure. In uranium nitrate-induced kidney failure some glucose turns up in the urine, as the kidneys ability to reabsorb it is damaged. This is completely unlike what happens in diabetes, where high blood glucose overwhelms the kidneys capacity to reabsorb it (in uranium nitrate toxicity blood glucose is not elevated so it is not “like” diabetes at all). Thus the rationale for homoeopathic treatment is flawed at many levels.

But back to the draft report of the NHMRC’s review of homoeopathy. This represents the largest and most extensive recent review of homoeopathy research. The review looked at both systematic reviews of the use of homoeopathy in 61 heath conditions and submissions on behalf of interested parties, which contained a mix of systematic reviews and individual randomised controlled trials. All submissions and papers were carefully evaluated against strict criteria recognised internationally for this type of review. The Australasian Cochrane Centre independently reviewed the overview report to ensure that it was valid and high quality.

To remind you, the review found there was no good evidence that homeopathy was effective for any of the 61 medical conditions considered. In some cases, there was clear evidence that homoeopathy was ineffective; in others the evidence base was too weak to give a clear result. These findings are in concert with other large reviews of homoeopathy. Let’s look at the claimed “flaws”.

There was no adequate explanation of why randomised controlled trials (RCTs) were excluded.

They were not excluded. The main review focused on systematic reviews, which included randomised controlled trials (and other types of high level evidence). This is the best way to compare multiple studies. Randomised controlled trials are considered the highest level of evidence, but the results of a single randomised controlled trial may be misleading for many reasons.

Chance is one, if a therapy has no actual effect,by chance alone you will find some studies that appear to show an effect.

Thus it is far better to compare as many high quality trials as possible to get a clearer picture. Randomised trials were not excluded, but an integral part of the evidence through systematic reviews. Randomised controlled trials submitted by stakeholders that were not already part of systematic reviews were considered as well.

While there are limitations to this approach (specifically the most recent research may be excluded), it is widely used in making clinical decisions and in no way invalidates the findings of the report. One of the biggest limitations is that negative findings tend to be under-reported, so that systematic reviews tend to overestimate the effectiveness of a therapy. That homoeopathy cannot pass muster under these conditions is telling.

Three academics invited to comment on the review all broadly agreed there was no high quality evidence recommending homoeopathy for any disorder.

The review excluded too many studies.

Of the 1367 publications considered in the main review, only 60 were finally considered. Not because of anything sinister, but because only those met the review criteria. 374 were duplicate citations, 729 were the wrong study type (not peer-reveiwed, not systematic reviews or metaanalyses, or not looking at controlled trials or high level evidence) or were not looking at the conditions considered in the review or did not report the outcomes (etc. etc.) (see the main review for details).

Of the reports submitted by stakeholders, only a few passed the inclusion criteria or were not already included. Pro tip, if the NHMRC asks you for peer-reviewed systematic reviews and randomised controlled trials in humans, don’t submit books on the life of Hahneman and studies of frogs exposed to thyroxine (yes, I went through the papers).

The review did not consider any publication not in English.

While this excludes some studies, most high quality studies are published in the English language press. As well, the practicalities of translating foreign language papers to ensure there are no complicating errors in translation are avoided. Overall, the impact of this decision on the reliability of the report is marginal at best.

The NHMRC had not appointed a homeopathic expert to the panel.

Assoc Prof Evelin Tiralongo on the NHMRC panel is trained in homeopathic remedies.

The review did not consider animal studies.

These homoeopathic preparations are already in use in humans, so the appropriate studies are ones in humans in the first place. As well, the studies in animals suffer the same flaws as those in humans, too many are of poor quality and many are unable to be interpreted or make claims that cannot be supported. For example, one study submitted to the review that claimed to demonstrate that homoeopathic treatments kill breast cancer cells actually shows that the ethanol diluent is the lethal factor.

Summary

Overall, while there are some limitations to the study, this is a wide ranging, carefully interpreted study. While overall the broad conclusion is that there is no good evidence the homoeopathy being effective in the 61 studied conditions, in at least 13 studies there was good evidence that homoeopathy was ineffective (asthma for example). The results of this study are in broad agreement with previous studies of homoeopathy (see also this, and before you bring up the “Swiss Report” see here and here).

The NHMRC study conclusion that “…the assessment of the evidence from research in humans does not show that homeopathy is effective for treating the range of health conditions considered” cannot be ignored or dismissed.

This article was originally published on The Conversation. (Reblogged with permission). Read the original article.

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An Introduction to Homeopathy

Orginally posted on Skeptical Inquirer.

By Dr. Harriet Hall, MD.

A brief guide to a popular alternative system of remedies based on a nineteenth-century concept that has no scientific validity.

In 1800, conventional medicine was a disaster. Doctors weakened patients with bloodletting and purging, they poisoned them with mercury and other harmful substances, and they often killed more patients than they cured. Dr. Samuel Hahnemann was looking for safer, more effective ways to help his patients. He had an epiphany after he took a dose of cinchona bark and developed symptoms similar to those of malaria, the disease cinchona was supposed to treat. He extrapolated from this one observation to conclude that if any substance causes a symptom in healthy people it can be used to treat the same symptom in sick people. He formulated this as the first law of homeopathy, similia similibus curentur, usually translated as “like cures like.” He diluted his remedies so that they would no longer cause symptoms; this led to his second law of homeopathy, the law of infinitesimals, which states that dilution increases the potency of a remedy. When he observed that his remedies worked better during house calls than in his office, he attributed it to jostling in his saddle bags, so he added the requirement of “succussion,” specifying that remedies must be vigorously shaken (not stirred) by striking them against a leather surface at every step of dilution.

Homeopathic remedies are usually labeled with the notation X or C, corresponding to ten and one hundred. 15C would mean that one part of remedy was diluted in 100 parts of water, one part of the resulting solution was again diluted in 100 parts of water, and the process was repeated fifteen times. Hahnemann died before Avogadro’s number was available to calculate how many molecules are present in a volume of a chemical substance. Today we can calculate that by the thirteenth 1:100 dilution (13C), no molecules of the original substance remain. Hahnemann typically used 30C remedies. At 30C, it would take a container thirty million times the size of Earth to hold enough of the remedy to make it likely that it would contain a single molecule of the original substance. The most popular homeopathic cold and flu remedy is sold as a 200C dilution, and there are even higher dilutions. Above the 1,000C level there are remedies designated as multiples of M, where 1M=1,000C.

An example will clarify the mind- boggling implausibility of homeopathy. If coffee keeps you awake, according to homeopathy dilute coffee will put you to sleep. The more dilute, the stronger the effect. If you keep diluting it until there isn’t a single molecule of coffee left, it will be even stronger. The water will somehow remember the coffee. If you drip that water onto a sugar pill and let the water evaporate, the water’s memory will somehow be transferred to the sugar pill, and that memory of coffee will somehow enable it to function as a sleeping pill.

1857 painting by Alexander Beydeman showing historical figures and personifications of homeopathy observing the brutality of medicine of the ninetenth century.

1857 painting by Alexander Beydeman showing historical figures and personifications of homeopathy observing the brutality of medicine of the ninetenth century.

View original 1940 more words. (Reblogged with permission).

 

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That Mitchell and Webb Look: Homeopathic A&E

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December 13, 2014 · 12:12 pm

Some Origins of Western Quackery

 By Tim Harding

             (An edited version of this essay was published in The Skeptic magazine, September 2013, Vol 33 No 3 p.16. The essay is based on a talk presented to the Mordi Skeptics in April 2013 ).

‘By definition, alternative medicine has either not been proved to work or has been proved not to work. You know what they call alternative medicine that has been proved to work? Medicine.’ – Tim Minchin

A corollary of Tim Minchin’s rhetorical question might be ‘What should we call alternative medicine that has been proved not to work?’  I recently asked this question at my local Skeptics in the Pub meeting, eliciting an immediate and resounding chorus of ‘Quackery!(When you think about it, if the part of ‘alternative medicine’ that works is medicine, and the part that doesn’t work is quackery, there is nothing left in the category of ‘alternative medicine’).

On his Quackwatch web site, Dr. Stephen Barrett defines quackery as ‘the promotion of unsubstantiated methods that lack a scientifically plausible rationale’.  This definition includes questionable ideas as well as questionable products and services, regardless of the sincerity of their promoters.  In line with this definition, Barrett reserves the word ‘fraud’ only for situations in which deliberate deception is involved.

So where did quackery come from?  The word ‘quack’ derives from the archaic word ‘quacksalver’, of Dutch origin, literally meaning ‘hawker of salve’.  The quacksalvers sold their wares on the market by shouting in a loud voice.  In the Middle Ages, the word ‘quack’ meant ‘shouting’.  These days, we tend to associate quackery with dodgy products and practices from the nineteenth century such as snake oil, miracle hair tonics, magnetic bracelets and homeopathic remedies.  But the origins of western quackery actually go back much further – to the cradle of western civilisation in ancient Greece and Rome.

In those ancient times, scientific experimental methods had not yet been developed – let alone clinical trials.  Medical observations were largely confined to patients as individuals rather as a cohort or group.  Ancient physicians were not much better than naturopaths when it came to empirical evidence.  Without scientific data from treatment groups versus control groups, it was difficult to know which treatments worked and which didn’t.  As a result, there was no clear dividing line between medicine and quackery.  Ancient ‘medicine’ consisted of a mish-mash of well-meaning but misguided treatment by physicians and surgeons, faith healers, herbal remedies, aromotherapy, other superstitions – and even sorcery or magic. Sounds familiar? That’s right – many of these weird ancient beliefs have carried through to the quackery of today as a legacy of the vast Roman Empire.

Ancient Greek medicine

The first notable Greek physician may have been the poet Homer in the 7th or 8th centuries BCE.  In his Iliad, Homer describes various medical techniques such as the extraction of arrows, the treatment of wounds, the application of dressings and the dispensing of soothing drugs.  The Homeric poems provide a glimpse of ancient medical ideas and practices long before the formal documentation of medical literature.  It is significant that practical medical treatment appears to have been provided in this early period, probably as a matter of military necessity, so that wounded soldiers could be saved to fight another day.

Homer

Reliance on the gods or faith healing seems to have come later, to some extent in parallel with advances in medical treatment.  The god of healing, Asklepios, had a shrine at Epidaurus in southern Greece, where miraculous recoveries were said to have been made by the sick and lame by sleeping in the temple overnight.  A Greek lyric poet from Thebes named Pindar (c.522– c.443 BCE) wrote:

‘[Asklepios] delivered all of them from their different pains, tending some of them with gentle incantations, others with soothing potions, or by wrapping remedies all around their limbs, and others he set right with surgery.’

The following picture is of a cast showing a physician examining a patient while Asklepios stands nearby holding the symbol of medicine, a snake coiled round a staff.

Asklepios

There were also apothecaries who harvested herbs and prepared drugs, accompanying their ministrations with important rituals and incantations.  Theophrastus (c.371 – c.287 BCE), who was a student of Aristotle, described some of these weird rituals in his History of Plants:

‘They say that the peony, which some call glykyside, should be dug up at night, for, if a man does it in the day-time and is observed by a woodpecker while he is gathering the fruit, he risks the loss of his eyesight; and if he is cutting the root at the time, he gets a prolapsed anus’.

‘One should draw three circles around mandrake with a sword, and cut it with one’s face to the west; and at the cutting of the second piece one should dance around the plant and say as many things as possible about the mysteries of love’.

On the other hand, the medical literature subsequently found in Greece differs markedly from that found elsewhere.  It includes reasoned arguments and debates, reflecting an intellectual openness consistent with Greek philosophy, rather than medicine as some sort of secret mystical art.  The links between medicine and philosophy can be traced back to Parmenides, Empedocles and even Pythagoras, whose ideas on appropriate living included a ban on eating beans!

Athens was one of the first city states to employ a publicly funded physician as a more rational alternative to traditional folk medicine.  Other Greek cities also maintained a public physician as well as several private practitioners.

The Greek historian Herodotus tells the tale of the early Greek physician Democedes of Croton, who started his career in the civil service of Athens and Aegina.  In 522 BCE, Democedes was captured by the Persians and sent to Susa.  The Persian King Darius once sprained his ankle while he was hunting, and his Egyptian doctors seemed to make it worse.  Darius then summoned Democedes, who was able to heal the ankle using Greek remedies.  Democedes was richly rewarded and hired as a physician of the Persian court.  Darius’s wife, Atossa, later had a breast ulcer.  When Democedes cured her ulcer, he was allowed to visit Greece as a reward.

Schools of medicine had existed for some time in various regions of Greece, most notably on the island of Kos, associated with the famous name of Hippokrates, a younger contemporary of Herodotus.  Hippokrates’ contribution to medicine is best remembered today by the ethical oath bearing his name.  Very little is known of Hippokrates himself, or how much of the Hippokrates medical treatises he personally wrote.  Hippokrates is cited in later works by Aristotle and Plato; but the Greek habit of composing imaginary speeches or letters by famous people from the past gradually blurred the distinction between the genuine and the false.  The following references to Hippokrates are actually references to the large body of medical literature bearing his name, the Hippokratic Corpus.

Hippokrates attempted to put medical diagnosis and treatment on a rational basis.  He viewed the human body as an organism whose parts must be understand as a whole.  Hippokrates thought that human physiology was comprised of four fluids or ‘humors’: blood, phlegm, black bile and yellow bile, corresponding to the four inanimate elements of earth, air, fire and water, as shown in the diagram below.

Four humours

Disease was thought to result from an imbalance of these humors, resulting in a disturbance of the natural harmony and order of the world so important to Classical Greek thought.  Hippokrates also placed emphasis on prognosis as well as diagnosis, so that the course of an illness could be predicted.  The more familiarity a physician showed with a disease, the more confidence his patients would have in him.  Prognosis also had practical benefits in planning the medical interventions that would be needed at different times.

In the absence of the modern germ theory of infectious disease, the danger to health from overcrowding within the Long Walls of Athens was not foreseen, resulting in a devastating plague in 430BCE.  Thucydides did not attempt to explain the reasons for the plague, but in the prognostic tradition of Hippokrates, he tried to describe its symptoms and effects so that if it struck again it could be recognised.

Active medical interventions included cauterisation and blood-letting, as well as surgery, the rectification of dislocations and the setting of bone fractures.  Other therapies included cupping, special diets, herbal remedies, potions, purgatives and exercises, consistent with the idea of ‘bringing the body back into balance’.  One rather spectacular treatment often performed in public was succussion, where the patient would be tied upside down to a ladder and then repeatedly dropped from a height of several feet as illustrated below.

succussion

It is unclear what succussion was supposed to achieve, but it is worth noting that succussion is a word still used by homeopaths to describe a shaking step in the preparation of their water doses.  The founder of homeopathy, Samuel Hahnemann falsely believed that succussion activated the ‘vital energy’ of the diluted substance and made it stronger.

The rise of quackery in Rome

Traditional Roman medicine was initially an amateur activity using simple home remedies based on easily available agricultural ingredients such as wool, eggs and the humble but miraculous cabbage.  Cato the Elder wrote in his treatise On Agriculture:

‘For those who are troubled by colic, cabbage should be steeped in water…. ‘

‘Now as to patients for whom urination is painful or dribbling. Take cabbage, put in boiling water, boil briefly till half cooked…. ‘

‘If any sore or cancer develops in the breasts, apply ground cabbage …’

‘In case of dislocation, foment with hot water twice a day and apply ground cabbage: it will soon cure it…’

The Romans were a highly superstitious people.  For instance, the Roman Senate only sat on ‘auspicious days’.  In around 78 CE Pliny the Elder wrote in his Natural History:

‘I find that a bad cold in the head clears up if the sufferer kisses a mule on the nose.’

‘Some people keep a weasel’s heart in a small silver container, for swollen glands.’

The number three was regarded as a ‘lucky number’.  An anonymous Roman inscription reads:

‘To Julian who was spitting up blood and had been despaired of by all men the god revealed that he should go and from the threefold altar take the seeds of a pine cone and eat them with honey for three days. And he was saved and went and publicly offered thanks before the people’

Later Roman culture was greatly influenced by the ancient Greeks in many things, including philosophy, literature, art, science and medicine.

Galen of Pergamon (c. 129-200 CE) was a leading surgeon, physician, and philosopher of Greek origin.  In 162 CE, he established a large and successful practice in Rome, where he attended the Emperor Marcus Aurelias.  Amongst his voluminous works was a short essay entitled That the Best Physician is also a Philosopher, where he urged physicians to emulate Hippokrates and to embrace logic and rationality:

‘What reason, then, remains why the doctor, who practises the Art in a manner worthy of Hippocrates, should not be a philosopher? For since, in order to  discover the nature of the body, and the distinctions between diseases, and the indications for remedies, he must exercise his mind in rational thought, and since, so that he may persevere laboriously in the practice of these things, he must despise riches and exercise temperance,  he must already possess all the parts of philosophy: the logical, the scientific, and the ethical’.

Consistent with this approach, Galen saw the bodies of living things and their various parts as designed and operated by a craftsman-like nature with a purpose in mind; thus an important key to anatomical and physiological knowledge is an understanding of nature’s purposes.  This form of ‘intelligent design’ has been described as a teleological view of biology by modern reviewers of Galen’s writings.  Galen held that nature rules the body from three anatomical centres – the liver, the heart and the brain (in contrast to the Aristotelian view that all faculties are centred in the heart).  He claimed that human physiology can be explained by the principal activities of nature, which are genesis, growth and nutrition.

Like Hippokrates , Galen believed in the need for the ‘four humors’ to be in balance: blood, black bile, yellow bile and phlegm.  He thought that the human body had three physiological spheres: the nutritive, the vital and the logical.  According to Galen, stomach cooks food to what was called ‘chyle’ and sends it to the liver.  The liver adds ‘natural spirit’ and sends it to other organs and the heart.  The heart adds ‘vital spirit’ and sends it to the brain.  The brain adds what was called ‘pneuma’ and sends to the body through nerves.  Such views were the likely origin of the modern naturopathic belief in ‘vitalism’ that persists today.  Naturopathy posits that a special energy called ‘vital energy’ or ‘vital force’ guides bodily processes such as metabolism, reproduction, growth, and adaptation.  Such energies and forces are unknown to modern science.

For religious reasons, there was little or no dissection of human corpses in ancient Rome.  Nevertheless, Galen believed in the supreme importance of anatomy, so he regularly performed dissections on animals.  Although he was conscious of the limitations of extrapolating from animals to humans, he did express some erroneous views about human anatomy, such as the following description by Galen in his work On the Usefulness of Parts of the Body:

‘All the parts, then, that men have, women have too, the difference between them lying in only one thing, which must be kept in mind throughout the discussion, namely, that in women the parts are within [the body],   whereas in men they are outside, in the region called the perineum. Consider first whichever ones you please, turn outward the woman’s, turn inward, so to speak and fold double the man’s, and you will find them the   same in both in every respect’.

Women were treated by male physicians and the gynaecological treatises of the Hippokratic Corpus were almost certainly written by and for men.  Part of the deficiency of observational evidence stems from the failure of male medical writers to speak to women about their illnesses.  Women were traditionally presented as being incapable of knowing what was wrong with them or telling a doctor if they did know.  Galen’s teleological view of biology also appears to have influenced his attitudes towards women:

‘So too the woman is less perfect than the man in respect to the generative parts. For the parts were formed within her when she was still a foetus, but could not because of the defect in the heart emerge and project on  the outside, and this, though making the animal itself that was being formed less perfect than one that is complete in all respects, provided no small advantage for the race; for there needs must be a female. Indeed,  you ought not to think that our creator would purposely make half the whole race imperfect and, as it were, mutilated, unless there was to be some great advantage in such a mutilation’.

These biased attitudes impacted wider Greek and Roman society.  For example, it was believed, on false medical grounds, that a man’s seed was most potent when he was about 30 years of age; and a woman’s body best suited for childbirth when she was still a teenager.

The medical theories of ancient Greece and Rome formed the foundation of Western medicine for centuries, even if they were eventually rejected.  The main reasons for this rejection were the development of empirical scientific methods after the Renaissance; coupled with advances such as the invention of the microscope and the germ theory of infectious disease.  Whilst there were observations of individual patients, there is no evidence of any organised medical experiments being conducted in ancient Greece and Rome, let alone clinical trials.  In some ways, the Greek philosophical traditions of logic and reasoning held back a more empirical scientific approach to medicine.  Instead of conducting practical experiments on illnesses, ancient Greek and Roman physicians became diverted into a search for the underlying purposes of diseases – a relatively fruitless ‘search for meaning’ rather than for empirical evidence.  This mystical and unscientific approach is one of the hallmarks of quackery today.

REFERENCES

 Ancient Sources

Aristotle On the Generation of Animals excerpt translated by A.L. Peck.  Published online http://www.stoa.org/diotima/anthology/wlgr/wlgr-medicine339.shtml

(Accessed 20 September 2012)

Galen That the Best Physician is also a Philosopher translated by Brain, P., 1977, “Galen on the ideal of the physician”, South Africa Medical Journal, 52: 936–938.

Galen On the Usefulness of Parts of the Body excerpt translated by M.T. May.  Published online http://www.stoa.org/diotima/anthology/wlgr/wlgr-medicine351.shtml

(Accessed 20 September 2012)

Herodotus The Histories R.B. Strassler (ed), The Landmark Herodotus, Quercus, London, 2008.

Thucydides A Comprehensive Guide to the Peloponnesian War, R.B. Strassler (ed), The Landmark Thucydides, Free Press, New York, 1996.

Modern Sources

Brain, P., 1986    Galen on Bloodletting: A Study of the Origins, Development and Validity of his Opinions, with a Translation of the Three Works Cambridge University Press, Cambridge.

Flaceliere, R., 2002    Daily Life in Greece at the Time of Pericles. Phoenix Press, London.

King, H., 1995    ‘Medical texts as a source for women’s history ‘  in The Greek World Anton Powell (ed.) Routledge, London and New York.

Martin, T. R., 2000    Ancient Greece – From Prehistoric to Hellenistic Times, Yale University Press, New Haven and London.

Nutton, V., 2004    Ancient Medicine Routledge, London and New York.

Pagel, W., 1970    Book Review of Galen and the Usefulness of Parts of the Body in Medical History/ Volume14 / Issue04 / October 1970, 406-408.  Published online: 16 August 2012

Roberts, J.W., 1998    City of Sokrates: An Introduction to Classical Athens (2nd edition), Routledge, London.

Roebuck, C., 1966    The World of Ancient Times Charles Scribner’s Sons, New York.

Waterfield, R., 2004    Athens – A History, Macmillan, London, Basingstoke and Oxford.

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