PsychiatricTimes Members: Login | Register

|     

PsychiatricTimes SearchMedica Medline Drugs

Powered by SearchMedica

 
Risk Assessment
News
Current Issues
Blogs
Special Reports
CME
Conferences
Resources
Careers
Multimedia
About Us
 

Home » News

PsychiatricTimes.com.
Pages: 1  2  
Next
RESIDENT’S CORNER 

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

By Elliott B. Martin Jr, MD | February 3, 2012
Dr Martin is a Resident Physician in the department of psychiatry at the Yale University School of Medicine in New Haven, Conn. He reports no conflicts of interest concerning the subject matter of this article.

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?

Pages: 1  2  
Next
 

Join the Conversation

Want to join the conversation? If you're a healthcare professional, we'd like to hear your comments. Just sign in or register today to become part of our growing, online community.






 
TOPIC INDEX

Addiction Medicine
Alzheimer Disease
Anxiety Disorders
ADHD
Bipolar Disorder
Child & Adolescent Psychiatry
Dementia
Depression
DSM-5
Geriatric Psychiatry

 

Health Care Reform
Major Depressive
Disorder
OCD
Personality Disorders
Schizoaffective Disorder
Schizophrenia
Sleep Disorders
Somatoform Disorders
All Topics

 


 
FROM PHYSICIANS PRACTICE
Five Steps to Improving Patient Access
Judy Capko,  May 21, 2013
Patient access is getting increased attention through reform initiatives. Here are five steps you can take to make sure patients get appropriate access to care in your office.
Growing HIPAA Threat – Ignore Windows XP at Your Own Peril
Marion K. Jenkins,  May 21, 2013
Chances are good that you have some major ticking software time bombs lurking in your medical practice's computer environment, namely Windows XP and Server 2003.
Finding Physician Work-Life Balance in the Small Moments
Jennifer Frank, MD,  May 21, 2013
At my practice and at home, things are always busy. There's laundry or homework, or a patient with needs.
Three Areas to Reduce Costs at Your Medical Practice
Greg Mertz,  May 19, 2013
By taking a hard look at reducing costs for staffing, overhead, and technology at your medical practice, you may see increased physician compensation.
Dos and Don’ts for Starting a Physician Blog
Michael Woo-Ming, MD,  May 18, 2013
Starting a physician blog can provide your medical practice with marketing benefits, but it's important to do it right.
 

 

 
MOST POPULAR
  • Most Popular
  • Most Emailed
  • Most Recent
  • Developmental Psychopathology Comes of Age
  • The Moral Struggles of Practicing Psychiatrists
  • Grief and Depression: The Sages Knew the Difference
  • Update on Mental Health Benefits and Substance Use Disorder Services Under the Affordable Care Act
  • Synthetic Cathinones: Signs, Symptoms, and Treatment
  • Grief and Depression: The Sages Knew the Difference
  • Successful Aging: Strategies to Help Maintain and Nurture a Healthy Brain
  • Synthetic Cathinones: Signs, Symptoms, and Treatment
  • Developmental Psychopathology Comes of Age
  • Psychiatry and the Myth of “Medicalization”
  • Will Your Clinical Records Support You in Court?
  • Refinements in ECT Techniques
  • Successful Aging: Strategies to Help Maintain and Nurture a Healthy Brain
  • Capacity Evaluation in Geriatric Psychiatry: Key Ingredients
  • Eco-Psychiatry: Why We Need to Keep the Environment in Mind
Click here to subscribe to our newsletter
 
CAREER CENTER

  •   Featured Jobs  
  •    Resources   
  • Psychiatry and Nurse Practitioner Opportunities
  • Associate Medical Director - Psychiatrist Delray Beach, Florida
  • Retiring Child Psychiatrist Seeks Replacement August 2010 or Before
  • Chairperson, Dept of Psychiatry Needed
  • FT Staff Psychiatrist - Excellent Benefits
  • BC Adult and Child Psychiatrits - PT and FT Positions Available
  • Managing Risks When Practicing in Three-Party Care Settings
  • 12 Tips for Making Your Practice Greener
  • Keys to Avoiding Malpractice: Standard of Care in Psychiatric Practice
  • Take This Job and Shove It
  • Merging Administrative and Academic Careers in Psychiatry

CancerNetwork | ConsultantLive | Diagnostic Imaging | Musculoskeletal Network | OBGYN.net | PediatricsConsultantLive |
Physicians Practice | Psychiatric Times | SearchMedica | Medical Resources

© 1996 - 2013 UBM Medica LLC, a UBM company
Privacy Statement - Terms of Service - Advertising Information - Editorial Policy Statement - UBM Medica Network Privacy Policy