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Whatever Happened to Speculative Thought? Some Historical Evidence Against Evidence-Based Medicine

Whatever Happened to Speculative Thought? Some Historical Evidence Against Evidence-Based Medicine

Imagine yourself, at your age and your acquired wisdom level, returning to medical school. I had at least a few gray hairs when I less returned to than started medical school, after a previous academic career. My field of specialty was the Ancient Near East, specifically its influence on the Ancient Mediterranean. I find it interesting now how the intellectual freedom I had formerly enjoyed in a field that, in light of sparse physical evidence had little choice but to reward speculation, has been less squashed than simply unacknowledged in my newly chosen field of medicine.

Such was the inspiration for this essay. The idea originally occurred to me one night as I found myself absently wondering how an Ancient mind might interpret a randomized controlled trial. To the pre-Greek intellect—a nearly perfectly empirical mind—the end always far outweighed the means; the idea of clinical detachment was wholly incomprehensible.

For example, if a sick man swallows a pill and becomes healthy, then there is “magic” in that pill; if another sick man with the same manifestations of disease swallows a pill in every way like the first man’s and does not become healthy, then there is no magic in the second pill. To the Babylonian or Egyptian mind, there would be no issue: the gods favored one man and not the other. In fact, if one were to believe that a pill was all that was necessary to cure a man of illness, then one might indeed be considered mad in a world where the evidence changed daily.

But let’s say an especially observant ancient physician noticed over time that half of those who swallowed that pill recovered their former health, while the other half did not. Statistically, by current standards, this would be considered a pretty effective treatment; however, by ancient standards, this would be considered exactly what it is: the equivalent of a coin flip.

The Ancient Mesopotamians were exceptional classifiers, maintaining inventories of lists of every conceivable category. Much like early and late Enlightenment naturalists, such as Linnaeus and Darwin, cataloged the natural world as far as they could see, so did Mesopotamian and Egyptian scribes meticulously catalog the natural world around them. Was this science? If, at its core, science relies on empirical observations of the natural world, then there is no legitimate argument against it. Where the Enlightened and the Ancients part ways, however, is in the cataloging of the supernatural. The Mesopotamians especially, living in a more volatile environment than the Egyptians, along with their lists of fauna, flora, gods, kings, words, historical events, and laws, maintained extensive catalogs of omens. These were based on standardized interpretations of dreams, physiognomy, star alignments, oil-in-water patterns, miscarriages, and the internal organs of animals and humans.

Beyond the Enlightenment, how might one conceive of a scientific study to test the reliability and validity of such phenomena? The Mesopotamians essentially performed prospective cohort studies. Standard mantic texts, such as the Dream Book and the Diagnostic Manual, were compiled over centuries. These were conclusions based on centuries of observations that clearly indicated that if a man dreamed such and such, then such and such, more often than not, was likely to happen; that if a goat’s entrails displayed such and such, then such and such, more often than not, was the likeliest outcome. This is not religion, nor is it superstition. This is empiricism at its purest. And if the diviners were correct even one-third of the time, would that not validate their practice by current standards?

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