Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Ken Fisher, MD, who is an internist/nephrologist in Kalamazoo, Michigan, a teacher, author ("Understanding Healthcare: A Historical Perpsective") and co-founder of Michigan Chapter Free Market Medicine Association. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.
Dr. FisherFor over a thousand years, Europe was intellectually in the doldrums, caused by the fall of the Roman Empire, plagues, wars, a lack of commerce and religious doctrine.
In the disciplines of Astronomy and Medicine dogma reigned. Ancient Greek teaching was that the universe was based on four elements, fire, air, water, and earth, and that all heavenly bodies revolved around the earth. In medicine, this was interpreted as our bodies being composed of blood, bile, black bile and phlegm, and sickness was the result of a loss of balance of these four elements.
The physicians’ job was to rebalance them through purges, bleeding and other means. These views prevailed for millennia. As an example, George Washington ill with probably epiglottitis was bled to death in 1799 as his physicians were trying to re-balance these four elements. Human anatomy for over a thousand years was taught from a text written by Galen, a Greek physician to Roman emperors whose descriptions were based on animals as Roman law prohibited human dissections.
Notice that none of these beliefs were based on observational data, but rather taken for granted as truths. Then in the early 16th century, trade and migration of intellectuals to the city-states of northern Italy fostered creativity and inquiry began to flourish. Padua and other Northern Italian Universities were centers that had a monumental place in this story.
While studying to become a physician at Padua, but still keeping his interest in astronomy, was the great intellect Nicolaus Copernicus (1473-1543). Although his income producing activity was as a Canon of the church, he also practiced medicine for nobility, was an economist, and poet. But, his real love was astronomy. He discarded the dogma of the time.
Using data drawn from careful observation he created a hypothesis that the sun rather than the earth was the center of the then known universe. His seminal work, De Revolutionibus Orbium Coelestium (On the Revolutions of the Celestial Spheres) was published in 1543. In the same year Andreas Vesalius (1514-1564), a physician who studied at Padua and Bologna universities, published his masterpiece De humani Corporis Fabrica Libri septem (The Seven Books on the Structure of the Human Body), basing his drawings on careful observation, disputing the works of Galen and considered accurate to this day.
These two physicians along with other scientists (i.e. Galileo Galilei) during the Renaissance were developing a new way of trying to understand the natural world. They were in the process of developing perhaps man’s greatest achievement—the scientific method. This way of thinking consists of creating and testing hypothesis to develop concepts which undergo constant refinement as knowledge accumulates.
But, before this revolutionary idea could be accepted, further progress to freeing up thinking was needed. This brings us to the Enlightenment, also called the Age of Reason.
The Enlightenment, centered in France and Great Britain, is thought to have occurred during the late seventeenth through the eighteenth centuries. Two French philosophers, Jean-Jacques Rousseau and Francois-Marie Arouet (Voltaire), published a great deal.
Rousseau espoused the concept of the sovereignty of all individuals that required adequate education so as to be productive in an organized society. Voltaire proposed freedom of expression and separation of church and state. In Great Britain, John Locke, also a physician, wrote about the concepts of self and identity that were the foundations of Thomas Jefferson’s concepts enunciated in the Declaration of Independence. In Scotland, David Hume valued data and empirical information to better understand the world we live in. Adam Smith, also writing in Scotland, published the seminal work in economics, An Inquiry into the Nature and Causes of the Wealth of Nations in 1776. He stressed that wealth could be created by markets, innovation and entrepreneurship and not by seizing it from others.
By the very late eighteenth and the entire nineteenth centuries, the intellectual stage was set for the creation of entirely new knowledge in human biology. But before delving into this amazingly productive period, words of caution are needed. There are always skeptics who for reasons sometimes obscure resist and even try to refute certain scientific advances.
One of the most dangerous and active even at this time is the skepticism around the vaccination of children. Vaccination has saved millions of lives and has proven to be amazingly free of serious side effects. However, because an ill-conceived fear of autism made more well known by unscrupulous frauds and a few ill-informed celebrities, many children are not being vaccinated. Some have died because of this.
This is a present-day tragedy that need not occur.
Before medicine could become truly beneficial, concepts of each human’s worth and the value of creative thought had to be established. This was groundbreaking thinking that took over a thousand years to occur.
Although, over a shorter time- frame, we must adjust our thinking as how to make the advances of modern medicine available to all in our society.