Saturday, August 17, 2013

Scientific Medicine

Arun has lately been posting on Richard Lewontin's reflections on scientific medicine. Here is a quote that exemplifies my objection to Lewontin's argument:

The causes of the tremendous decline of mortality from infectious diseases in the last 100 years are not certain. All that is certain is that “scientific medicine” played no significant part.

Evaluating his argument depends on exactly how one defines "scientific medicine," but I'm going to argue that scientific medicine began with the statistical evaluation of treatment effectiveness. Alan Taylor:

In 1809, on a battlefield in Portugal, the first recognisable medical trial evaluated bloodletting on a sample of 366 soldiers allocated into treatment and control groups. The cure was shown to be bogus. It was the beginning of the end of pre-modern medicine.

Here is another Lewontin Fragment:

In 1828, when causes of death were first systematically recorded in Britain, the death rate from tuberculosis was nearly 4,000 per million. The rate can only be appreciated in contrast to the present death rate in the US and Britain from all causes of only 9,000 per million. By 1855 the death rate from tuberculosis had fallen to about 2,700 and continued to fall steadily so that by the turn of the century it had reached about 1,200 per million. Koch’s discovery of the causal bacillus in the 1880s had no effect whatsoever on the rate of decline, and by 1925, after the Flexner revolution in medical schools, the rate was about 800, only 20 percent of its value in 1838. Totally unaffected by the arrival of modern medicine, the death rate continued its steady drop to 400 per million until 1948 when the introduction of chemotherapy on a broad scale did indeed accelerate the decline to its present negligible level.

Note first that the collection of systematic records on causes of death is exactly the sort of thing that corresponds to what I call "scientific medicine", and that the date is quite in line with the Taylor quote. That kind of statistical data has been central to medicine ever since, and that kind of data is even more valuable than the identification of a specific causal agent to prevention and treatment. Even the modern plague of AIDS followed the familiar pattern - the Center for Disease Control and others knew a great deal about epidemiology long before the identification of the virus responsible.

Dr. Lewontin, your diagnosis is bogus.