Is Medicine really a Science?

“If your physician does not think it good for you to sleep, to drink wine, or to eat such and such meats, never trouble yourself; I will find you another that shall not be of his opinion; the diversity of medical arguments and opinions embraces all sorts and forms.”

So wrote Michel de Montaigne over four centuries ago.

Well, things have changed. Today, a growing body of information is attracting a consensus within the medical profession. However, the information is by no means stable. A journal of the Mayo Clinic in the US (its Proceedings) published a study in August 2013 of all the original research articles from the prestigious New England Journal of Medicine over a decade. It found that:

• 1344 articles examined a new or existing medical practice
• Over half of them (56.3%) suggested a new practice superior to an existing practice. This is known as ‘replacement’, where a new treatment is to be preferred to an old one
• Far more worrying, nearly one in nine (10.9%) found that a treatment in common use was inferior to what had preceded it and should be stopped. This is known as a ‘reversal’, where a new treatment is found to be inadequate and practice reverts to an older approach

That’s just one decade and just one journal, even if it is one of the publications with the most impact in medicine.

Maybe that means that Montaigne, if he were living today, would have to change his advice slightly: if you don’t like the advice your doctor’s giving you, you don’t so much have to find another doctor, just wait a bit – before long there’ll be some new advice coming along.

Of course, you do have to survive for as long as it takes to get that new advice.

Bloodletting: once one of the most common of medical practices
Now regarded as not generally beneficial...

What prompted me to think about all this? Why, the new advice from the Lancet, another of the most prestigious medical journals, that salt, against which we’ve been warned for so long and so loudly, for the harm it does to the heart, might actually be beneficial for cardiovascular disease if consumed in moderation.

Doesn’t this remind you of attitudes towards, say, aspirin? It was perceived as a panacea, a cure for practically any disease, when it was first discovered. Then the profession turned sharply against it, above all for its effect on the digestive system. But now the pendulum has swung back and aspirin, in moderation, is recommended for many conditions, and in particular as a preventative for certain heart problems.

As for red wine, I’ve lost track of where we stand now. Is it good for you? Is it bad for you? Maybe I should just take a leaf out of Montaigne’s book and just do what I like and, since I like red wine, keep drinking it.

In moderation, of course.

Naturally, all this progress is based on scientific work. Highly effective, intelligent research is slowly moving us forward. It’s causing us to question old remedies, and sometimes – maybe as often as one time in nine – even new remedies. Which means that medicine is becoming more scientific.

Gone are the days of bleeding patients, as in the eighteenth century, just because that’s what a physician does. After all a scientist might well come along and question the practice. But it seems that could also happen for many of the practices we still use, unlike bleeding. With so much of medicine subject to questioning, I’m not convinced that it’s reasonable to call it a science.

Perhaps it’s just a practice on the way to becoming more scientific…

There’s a great quote attributed to Mahatma Gandhi, though he probably never said it. Asked by a journalist what he thought of Western Civilisation, the story says Gandhi replied that he thought ‘it would be a good idea’.

Medical science? I don’t know what Gandhi would have thought. But to me it seems like it would be another good idea.