Even in this life-and-death situation for so many people, CDC remain staunch in defense of double-blind testing. Now that several months have passed, politicians, commentators, scientists and doctors have all been humbled. Perhaps there is an opening for non conventional thinking.
Steven Collinson’s editorial, (CNN) Trump peddles unsubstantiated hope in dark times, politicizes a scientific question. Mr. Collinson would have done better to focus on the medical issues. He chose instead to follow the path of Socrates, an otherwise great thinker who made a great mistake. Socrates declaimed that all he had to know he could learn from “men in the city.” He saw no need for natural science. Socrates was the first thinker to politicize science.
Double blind testing is dear to medicine, because for all but the last 150 years, medicine killed more people than it healed. Double blind testing is ritual purity, because it removes human judgement from the outcome. It would have saved humanity from these deadly treatments:
- Roentgen therapy, X-rays as a healing source — not to be confused with legitimate radiation therapy.
- Thalidomide in pregnant women.
- The opioid epidemic.
- In the 1918 flu epidemic, a massive dose of aspirin, as much as 30 grams in one dose, was frequently prescribed, which by itself would kill the patient.
- To the above, add the lay healers, swallowing chlorine bleach. Laetrile, and, in many cases, herbs.
Yet during World War I, military surgeons packed wounds with pure sugar, which worked to prevent gangrene. Pure sugar is toxic to bacteria. Nobody thought of double blind testing while Doctor Sawbones waited.The history of medicine is littered with treatments that worked, yet are forgotten:
- Coley’s toxins.
- Arsenic for some neoplasms, which has recently been revived as an import from China.
The Wikipedia article on Coley’s toxins begins with the statement,
“There is no evidence that Coley’s toxins have any effectiveness in treating cancer, and use of them risks causing serious harm.“
The statement is false. It is true is that Coley’s toxins were extremely dangerous, yet acceptable as a personal choice in a time when no alternative treatment, even palliative, was available. If you ignore the opening statement, and read the article without the prejudice of the opening statement, you may conclude that there is a better than even chance that Coley’s toxins did some people some good. The rest faced inevitable death.
Today you have better alternatives, treatments that target the immune system blockade, without risking deadly bacterial infection.
Now refocus on the statement, “”There is no evidence that Coley’s toxins…” It’s wrong! It is more correct to say, “If someone offers to treat you with Coley’s toxins, run in the other direction.” But somehow, it got dumbed down. Why?
It is an expression of two cultures:
- Medical culture, which medical practitioners subscribe to, based on science but going beyond science to include paternal responsibility towards the patient and the public.
- Consumer culture, which accepts the paternal role of professional medicine, with simplification of the truth.
With all this culture, and the very sophisticated statistical methods of research medicine, something is missing: modern decision theory. It’s missing because double-blind testing is the medical equivalent of ritual purity. We need it now.
To be continued shortly.