Re: From monkeys to medicine

In the June edition of the BCMJ Dr Lloyd Oppel continues his long-standing crusade against non-pharmaceutical and non-surgical remedies [BCMJ 2011;53:217]. He evokes a tortured comparison between the famous Scopes Monkey Trial of 1925 and current materials employed in the education system in British Columbia. 

He is particularly irked by statements that express respect for the empirical data gathered by First Nations and other indigenous peoples. He compares this unfavorably to what he feels to be the ideal “realm of systematic, testable, and self-correcting scientific fields.” This realm is, presumably, the world of conventional medical research, published in leading medical journals.

I wish to make two points. First, indigenous peoples often employed the healing (or poisonous) properties of plant- or animal-derived substances in the world around them on the basis of a very pragmatic understanding of these properties. In a world in which survival could be easily influenced by events over which humans had little control, “getting it right” was at a premium. 

Assuming that indigenous peoples belonged to primitive and undeveloped precursors of our sophisticated and balanced modern society is to betray rather astonishing ignorance of history and human culture. There is something to be said for thoughtful empiricism when the price of failure is starvation or death. It seems unwise to dismiss the knowledge gained by people functioning in such a charged context.

Second, Dr Oppel’s unshakeable trust in the solidity of the modern medical research database seems more faith-based than scientific. Repeated studies have shown that this database is often flawed and at times grossly misleading. 

I would urge him to thumb through some back issues of the Therapeutics Initiative newsletter; despite the best efforts of the current BC government to destroy it, the TI continues to critique the errors and penetrate through the smokescreen of relentlessly positive studies in the literature, studies which we physicians too often uncritically embrace, at our own and especially our patients’ peril.

If former NEJM editor Dr Marcia Angell thinks that “physicians can no longer rely on the medical literature for valid and reliable information,”[1] it behooves all of us to modulate our sense of entitlement and superiority. 
I plead for balance, fairness, and respect.
—Warren Bell, MD
Salmon Arm

References

1. Angell M. Industry-sponsored clinical research: A broken system. JAMA 2008;300:1069-1071.