Doctor's orders in a time of pandemic

As we’re repeatedly and rightly told, in this time of pandemic we need to be guided by scientific and medical experts basing themselves on solid evidence. Not by a series of bigoted views based on no more than gut feel.

On the right, Dr Fauci, a medical expert to follow
With him, a buffoon it might be wiser to shun

Unfortunately, the evidence is patchy and experts don’t always agree on how to interpret it.

• Does recovery from Covid-19 leave you immune to the disease or could you be infected again? It’s not clear.
• Are masks worth wearing or do they provide little real benefit? Views differ. 
• How quickly will an effective vaccine be available? No one really knows.

None of this is a cause for worry. It’s in the nature of science. Scientific principles are never proved, they’re merely accepted as good working theories for just as long as they’re not disproved.

To believe that science offers certainty is to misunderstand its fundamental nature.

Now I’m going to step into an intellectual minefield. Doctors tend to have a fairly favourable view of the extent of their knowledge. Whereas my view is that uncertainty is even greater in medical science than in most of the others, because medical science is still in its infancy.

A recent study of 3000 Randomised Control Trials, the most powerful type of clinical trial, showed that 396 of them (13%) led to what are known as ‘medical reversals’. That’s when a new finding leads to what was previously regarded as good practice being found to produce no benefit or, even, to do positive harm.

What that says is that medicine is still a long way from reaching the kind of stability of a field such as physics.

This all came to mind just the other day, as I was working on a project of mine that has lasted too many years, but which I can now focus on more completely, following my retirement. It’s a novel based on the life of Emilie du Châtelet, a remarkable intellectual of the eighteenth century, a time when it was more difficult even than today for a woman to be taken seriously as an authority.

A fairly large collection of her correspondence has survived, and I’ve been reading it as a way of getting as close as I can to her voice and, even more important, to her feelings. I’m now into the last few of her letters, when she was already carrying the baby of the entirely unworthy man for whom she developed a terrible, and ultimately fatal infatuation (yes, her life really is that surprisingly interesting).

In one of her letters to him she writes:

It’s true that I have been feeling so unwell for the last week that I was obliged to submit to bleeding, to avoid the same accident as happened at Commercy. So I came here to be bled… Since the bloodletting I’ve been feeling even worse, but at least I’ve done what I had to do to avoid the danger which worried me more in my current state than in any other. I’ve felt sick and had a headache ever since the blood was taken.

Bloodletting. This was a standard practice, and perhaps the most common surgical procedure in Western medicine for something like 2000 years. Emilie du Châtelet obviously hated and dreaded it. But she went through it, because in her “current state” – i.e. pregnant – it was clearly something that she “had to do”.

She “had to do” it? That was only because that’s what physicians of the time would have told her to do.

Today, we know that, except for the treatment of a small number of specific blood disorders, this kind of intervention isn’t just useless, it’s harmful to the patient. But, back in 1749, it was regarded as an absolute must. Practically all doctors agreed.

It’s often said that the difference between a doctor and God is that God doesn’t think he’s a doctor.

Well, the information that doctors have isn’t handed down from on high, carved on tablets of stone. The sheer number of medical reversals proves that. What’s believed today is the best available working hypothesis but no more.

Still, a good working hypothesis is as good as it gets while we await further evidence. So it’s best to follow it. In other words, we do, as I said, need to respect medical experts’ views, because they have the best information available in the state of knowledge today. Though we should remember that it could change tomorrow.

Respect isn’t quite the same as reverence. In particular, it allows us to indulge in a measure of scepticism. Always, I feel, a good approach when it comes to protecting our health.

After all, look what happened to Emilie.