5 ms·

How Early Modern Empire Changed Medicine

39 points by benbreen 6y ago

wisty 6y ago
Expecting medicine to work with any doctor on any patient is what made doctors stop making excuses for bad medicine - "It works when I do it" or "It works if you use it on the right patient" when they're just talking pure quackery. It's kind of similar in management, education, sociology, software development, and plenty of other not-so-well respected fields (a manager might get paid well, but they aren't respected like doctors are). Experts love to say that "every case is different" because then they can always defend their pet crackpot theory with "well, it will work if the right person does it properly in the right case" (which is kind of a truism). Yes, medical experts will take things from "medicine X works well" to "but we found certain interactions / contraindications where it won't work so well, and a few cases where it works better", but this is different - it's expected that they're specific.
- eru 6y ago
  That reminds me of the social sciences (and their replication crisis). There's nothing wrong with effects that only apply very narrowly, or medical techniques that only work for one person. What is wrong is to use the defence that 'every case is different' and 'well, it will work if the right person does it properly in the right case' one the one hand, but claim universal applicability of your techniques or results on the other. See also motte-and-bailey fallacy.
  - phreeza 6y ago
    Is it even possible in today's evidence based framework to consider a treatment that only works for a single patient? I think you'd need at least an entire class of such treatments applying to a group of patients to do any kind of RCT or similar study.
    - eru 6y ago
      Well, if RCT is your only standard of evidence, then you need multiple people almost by definition. But it's not the only standard of evidence used. Famously, there has never been an RCT for parachutes. (Until recently that is, see https://healthjournalism.org/blog/2019/02/breakthrough-research-reveals-parachutes-dont-prevent-death-when-jumping-from-a-plane/ https://healthjournalism.org/blog/2019/02/breakthrough-resea... )
  - barry-cotter 6y ago
    > That reminds me of the social sciences (and their replication crisis). It’s not a social science replication crisis. One of the central papers in this rediscovery of bad statistical practice was Ioannides “ Why Most Published Research Findings Are False” https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124 https://journals.plos.org/plosmedicine/article?id=10.1371/jo... and Bayer’s internal research finds most preclinical cancer studies don’t replicate. http://www.readthehook.com/103149/junk-science-most-preclinical-cancer-studies-dont-replicate http://www.readthehook.com/103149/junk-science-most-preclini...
  - thaumasiotes 6y ago
    > There's nothing wrong with effects that only apply very narrowly, or medical techniques that only work for one person. There's no way to tell the difference between a technique that only works for one person and a technique that works for zero people.
- jychang 6y ago
  The issue is that this only works in some cases where the root cause is well understood. "Bacterial infection, give this antibiotic which kills the bacteria". In other cases, the root cause of an issue is obscured under a complex system. The current cutting-edge pharmacodynamics understanding of depression is that "it is an issue with serotonin/norepinephrine/dopamine/etc... except sometimes it isn't". This leads to situations where you have psychiatrists prescribing a few SSRIs to treat someone's depression, except it sometimes doesn't work with the patient and they're not sure why, in which case they try atypical antipsychotics, except that sometimes doesn't work and they're not sure why, so they try NDRIs, which sometimes doesn't work, so they try MAOIs, except sometimes that doesn't work, in which case they try tricyclics, unless that doesn't work... you get the idea. This "guess and check" method is currently the legitimate scientific (not quackery) method that psychiatrists are working with. Unfortunately, since fields such as brain chemistry is immensely complex, "it works if you use it on the right patient" is still a legitimate scientific response in many situations.
SpicyLemonZest 6y ago
I don't know, this is an interesting read, but I got to the end and I'm still not sure what the author's trying to say here. He acknowledges that humoral theories were wrong, that the modern understanding of medicine is correct, and that embracing it has allowed us to greatly improve medical outcomes. So... what's the issue?
- eru 6y ago
  > Today we can point to the benefits of these changes in medical thinking, but we must acknowledge their history and their limitations, as well. These new ideas of universality might have obliterated bodily difference, but instead they became a framework used to justify it and inscribe hierarchies on people, most notably around nascent categories of race. From that historical moment when understandings of bodies shifted, we can see a logic emerge that has shaped our relationship to health care and, conversely, health care’s goals for us. It might be one of those 'critical overviews'? (As in 'critical theory'?) Or at least it uses some of that language.
- frenchy 6y ago
  I think the author is suggesting that necessities of empire building in the 17-1800's were a significant driver in the adoption of modern medicine. It reads very much like a just-so story though, so I'm not sure how valuable it is.
phreeza 6y ago
Reading about the 4 humours reminded me a bit of an embedding space. I wonder how far one could get with a 4d embedding for patients to describe their ailments and appropriate treatments, and to what degree the axes would align with the traditional notions of humours.
- TheGallopedHigh 6y ago
  Any diagnosis or hat is done with Neural nets effectively have embedding. And I am sure people have done that already.
RcouF1uZ4gsC 6y ago
> The nineteenth century brought advances in sanitation and real declines in mortality, while ideas forwarded by scientists like Robert Koch, Louis Pasteur, and Paul Ehrlich and the subsequent development in the twentieth century of new drugs such as antibiotics encouraged paradigm shifts in considering the human body and disease. Nevertheless, the fact that envisioning people as interchangeable patients—comprising both workforces and markets—has remained so economically and medically axiomatic, often at the expense of considerations of individual wellbeing, This approach has actually greatly increased individual well-being. Maternal and infant mortality went down. Compound fractures no longer became a death sentence. Pneumonia no longer became a death sentence. We developed and vaccinated whole populations and even eradicated entire diseases (smallpox). We are able to relieve pain much better, Yet throughout, the article seems to view as ambiguous the superiority of modern medicine over the "many ways of understanding medicine, disease, and the human body across a vast and vibrant world rife with competing medical cultures", seemingly because it was largely European nations that developed these medicines. This article almost reminds me of the scene in Monty Python "What have the Romans ever done for us?" Sure modern medicine gave us antibiotics and safe surgery and anesthesia and vaccines, but on the other hand, it was developed by those oppressive Europeans.
- throwaway123x2 6y ago
  Europeans in that time did a lot of things that were bad and wrong and laid the groundwork of a lot of bad and oppressive ideas (racism just one of them) but to view modern medicine as anything short of a modern miracle is ridiculous. I personally would have been dead three times over by now if not for modern medicine.
logicOnly 6y ago
I'd love to see a recap how the American Medical Association captured the healthcare industry. I've read the wikipedia and it's a slow process of lobbying and using crisis to strength their hold. Anyway I say this because my child can't get Physical Therapy until we get a prescription from a Physician. Wait 2 weeks for an appointment, pay 125$ to hear what I already know.
jhanschoo 6y ago
I feel like this author is just selecting facts and hypothesizing motivations to squint a narrative into existence. For example, empires have always existed and feared plagues, which are a big reason for political instability. If not for modern medicine, it's not as though the main criticism that it enables systematic exclusion wouldn't have happened. The author forgets or is ignorant to the fact that the ancients and much of the ancient and medieval world thought that a person's nature comes from the place and climate they grew up in. To the extent that modern medicine enables exclusion, it is much more limited than the ancient conception of it. If this is happening on a larger scale in the past it is because today's states have more control over their citizenry than in the past. > In the Hippocratic text Airs, Waters, Places, the soul is thought of as the place of courage or, as the case may be, its opposite: in the case of lowland inhabitants, courage and endurance are not in their souls by nature, but must be instilled by law (ch. 23); similarly in benign climates, men are fleshy, ill-jointed, moist, without endurance and weak in soul (ch. 24). Perhaps the author should have discussed medicine starting from modern medicine and germ theory. Then the narrative would make more sense, since it seems to be that it is antiquated and racist ideas of health combined with empire that has changed (modern) medicine. Instead, the author tries to portray modern medicine (in contrast with ancient medicine) as a multiplier in enabling exclusion. > emerged a radical idea, for the time: that people would react similarly to a particular medicine regardless of who (noble, poor, free, bound, man, woman, child, rural, urban) or where (Europe, Americas, Asia) they were > The medical revolutions of the next two centuries cloaked these early modern logics in new vocabularies and technologies but did little to displace them from expectations shaping the forms of health care to come. Is this really the case? In my experience as a patient doctors are always aware that symptoms may indicate any number of diseases with any number of treatment plans that need to take into account pre-existing conditions and allergies. > it also enables differences in outcomes to be explained away as natural, physiological, or behavioral rather than byproducts of the violent, unequal circumstances of their development. Those are both legacies of the early modern shift toward viewing people as patients. See: ancient conception of a person's nature. They are legacies of something more ancient than that. It's ironic that on the sidebar is a suggested article that begins like this: > What Is Medicine For? > In place of the hype over personalized medicine, we need a more sober evaluation of the meaning of health and health care.

39 points by benbreen 6y ago

Expecting medicine to work with any doctor on any patient is what made doctors stop making excuses for bad medicine - "It works when I do it" or "It works if you use it on the right patient" when they're just talking pure quackery. It's kind of similar in management, education, sociology, software development, and plenty of other not-so-well respected fields (a manager might get paid well, but they aren't respected like doctors are). Experts love to say that "every case is different" because then they can always defend their pet crackpot theory with "well, it will work if the right person does it properly in the right case" (which is kind of a truism). Yes, medical experts will take things from "medicine X works well" to "but we found certain interactions / contraindications where it won't work so well, and a few cases where it works better", but this is different - it's expected that they're specific.

eru 6y ago
That reminds me of the social sciences (and their replication crisis). There's nothing wrong with effects that only apply very narrowly, or medical techniques that only work for one person. What is wrong is to use the defence that 'every case is different' and 'well, it will work if the right person does it properly in the right case' one the one hand, but claim universal applicability of your techniques or results on the other. See also motte-and-bailey fallacy.
- phreeza 6y ago
  Is it even possible in today's evidence based framework to consider a treatment that only works for a single patient? I think you'd need at least an entire class of such treatments applying to a group of patients to do any kind of RCT or similar study.
  - eru 6y ago
    Well, if RCT is your only standard of evidence, then you need multiple people almost by definition. But it's not the only standard of evidence used. Famously, there has never been an RCT for parachutes. (Until recently that is, see https://healthjournalism.org/blog/2019/02/breakthrough-research-reveals-parachutes-dont-prevent-death-when-jumping-from-a-plane/ https://healthjournalism.org/blog/2019/02/breakthrough-resea... )
- barry-cotter 6y ago
  > That reminds me of the social sciences (and their replication crisis). It’s not a social science replication crisis. One of the central papers in this rediscovery of bad statistical practice was Ioannides “ Why Most Published Research Findings Are False” https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124 https://journals.plos.org/plosmedicine/article?id=10.1371/jo... and Bayer’s internal research finds most preclinical cancer studies don’t replicate. http://www.readthehook.com/103149/junk-science-most-preclinical-cancer-studies-dont-replicate http://www.readthehook.com/103149/junk-science-most-preclini...
- thaumasiotes 6y ago
  > There's nothing wrong with effects that only apply very narrowly, or medical techniques that only work for one person. There's no way to tell the difference between a technique that only works for one person and a technique that works for zero people.
jychang 6y ago
The issue is that this only works in some cases where the root cause is well understood. "Bacterial infection, give this antibiotic which kills the bacteria". In other cases, the root cause of an issue is obscured under a complex system. The current cutting-edge pharmacodynamics understanding of depression is that "it is an issue with serotonin/norepinephrine/dopamine/etc... except sometimes it isn't". This leads to situations where you have psychiatrists prescribing a few SSRIs to treat someone's depression, except it sometimes doesn't work with the patient and they're not sure why, in which case they try atypical antipsychotics, except that sometimes doesn't work and they're not sure why, so they try NDRIs, which sometimes doesn't work, so they try MAOIs, except sometimes that doesn't work, in which case they try tricyclics, unless that doesn't work... you get the idea. This "guess and check" method is currently the legitimate scientific (not quackery) method that psychiatrists are working with. Unfortunately, since fields such as brain chemistry is immensely complex, "it works if you use it on the right patient" is still a legitimate scientific response in many situations.

SpicyLemonZest 6y ago

I don't know, this is an interesting read, but I got to the end and I'm still not sure what the author's trying to say here. He acknowledges that humoral theories were wrong, that the modern understanding of medicine is correct, and that embracing it has allowed us to greatly improve medical outcomes. So... what's the issue?

eru 6y ago
> Today we can point to the benefits of these changes in medical thinking, but we must acknowledge their history and their limitations, as well. These new ideas of universality might have obliterated bodily difference, but instead they became a framework used to justify it and inscribe hierarchies on people, most notably around nascent categories of race. From that historical moment when understandings of bodies shifted, we can see a logic emerge that has shaped our relationship to health care and, conversely, health care’s goals for us. It might be one of those 'critical overviews'? (As in 'critical theory'?) Or at least it uses some of that language.
frenchy 6y ago
I think the author is suggesting that necessities of empire building in the 17-1800's were a significant driver in the adoption of modern medicine. It reads very much like a just-so story though, so I'm not sure how valuable it is.

phreeza 6y ago

Reading about the 4 humours reminded me a bit of an embedding space. I wonder how far one could get with a 4d embedding for patients to describe their ailments and appropriate treatments, and to what degree the axes would align with the traditional notions of humours.

TheGallopedHigh 6y ago
Any diagnosis or hat is done with Neural nets effectively have embedding. And I am sure people have done that already.

RcouF1uZ4gsC 6y ago

> The nineteenth century brought advances in sanitation and real declines in mortality, while ideas forwarded by scientists like Robert Koch, Louis Pasteur, and Paul Ehrlich and the subsequent development in the twentieth century of new drugs such as antibiotics encouraged paradigm shifts in considering the human body and disease. Nevertheless, the fact that envisioning people as interchangeable patients—comprising both workforces and markets—has remained so economically and medically axiomatic, often at the expense of considerations of individual wellbeing, This approach has actually greatly increased individual well-being. Maternal and infant mortality went down. Compound fractures no longer became a death sentence. Pneumonia no longer became a death sentence. We developed and vaccinated whole populations and even eradicated entire diseases (smallpox). We are able to relieve pain much better, Yet throughout, the article seems to view as ambiguous the superiority of modern medicine over the "many ways of understanding medicine, disease, and the human body across a vast and vibrant world rife with competing medical cultures", seemingly because it was largely European nations that developed these medicines. This article almost reminds me of the scene in Monty Python "What have the Romans ever done for us?" Sure modern medicine gave us antibiotics and safe surgery and anesthesia and vaccines, but on the other hand, it was developed by those oppressive Europeans.

throwaway123x2 6y ago
Europeans in that time did a lot of things that were bad and wrong and laid the groundwork of a lot of bad and oppressive ideas (racism just one of them) but to view modern medicine as anything short of a modern miracle is ridiculous. I personally would have been dead three times over by now if not for modern medicine.

logicOnly 6y ago

I'd love to see a recap how the American Medical Association captured the healthcare industry. I've read the wikipedia and it's a slow process of lobbying and using crisis to strength their hold. Anyway I say this because my child can't get Physical Therapy until we get a prescription from a Physician. Wait 2 weeks for an appointment, pay 125$ to hear what I already know.

jhanschoo 6y ago

I feel like this author is just selecting facts and hypothesizing motivations to squint a narrative into existence. For example, empires have always existed and feared plagues, which are a big reason for political instability. If not for modern medicine, it's not as though the main criticism that it enables systematic exclusion wouldn't have happened. The author forgets or is ignorant to the fact that the ancients and much of the ancient and medieval world thought that a person's nature comes from the place and climate they grew up in. To the extent that modern medicine enables exclusion, it is much more limited than the ancient conception of it. If this is happening on a larger scale in the past it is because today's states have more control over their citizenry than in the past. > In the Hippocratic text Airs, Waters, Places, the soul is thought of as the place of courage or, as the case may be, its opposite: in the case of lowland inhabitants, courage and endurance are not in their souls by nature, but must be instilled by law (ch. 23); similarly in benign climates, men are fleshy, ill-jointed, moist, without endurance and weak in soul (ch. 24). Perhaps the author should have discussed medicine starting from modern medicine and germ theory. Then the narrative would make more sense, since it seems to be that it is antiquated and racist ideas of health combined with empire that has changed (modern) medicine. Instead, the author tries to portray modern medicine (in contrast with ancient medicine) as a multiplier in enabling exclusion. > emerged a radical idea, for the time: that people would react similarly to a particular medicine regardless of who (noble, poor, free, bound, man, woman, child, rural, urban) or where (Europe, Americas, Asia) they were > The medical revolutions of the next two centuries cloaked these early modern logics in new vocabularies and technologies but did little to displace them from expectations shaping the forms of health care to come. Is this really the case? In my experience as a patient doctors are always aware that symptoms may indicate any number of diseases with any number of treatment plans that need to take into account pre-existing conditions and allergies. > it also enables differences in outcomes to be explained away as natural, physiological, or behavioral rather than byproducts of the violent, unequal circumstances of their development. Those are both legacies of the early modern shift toward viewing people as patients. See: ancient conception of a person's nature. They are legacies of something more ancient than that. It's ironic that on the sidebar is a suggested article that begins like this: > What Is Medicine For? > In place of the hype over personalized medicine, we need a more sober evaluation of the meaning of health and health care.