Science Fiction Project - Free Culture
Analog - All editorials - John Wood Campbell
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LOUIS PASTEUR, MEDICAL QUACK
"Be not the first by whom the new are tried, Nor yet the last to lay the old aside".
Essay on Criticism, Alexander Pope
My recent editorial on "Fully Identified" concerning the FDA's press splash that Krebiozen had been "fully identified" as creatine brought in a lot of letters, and a lot of phone calls from people acutely interested in Krebiozen.
My point in the editorial had been single, simple, and specific: whether Krebiozen was or was not useful in treatment of cancer I did not know - but that the FDA's press release was exceedingly bad science, anyone who took the trouble to study the matter a little could readily see. It was a great piece of publicity work - all about the summer student who tracked down the spectrogram... charts and whatnot - got a big splash in Life and the newspapers. As publicity stuff, that was a Grade A piece of work. Having some familiarity with the art myself, I recognize a real artist's touch.
That doesn't make it science. I've learned since that it not only wasn't science, it wasn't even honest reporting. The sample of Krebiozen the FDA reported on, according to data published in the "Congressional Record" was light tan in color, and fluorescent under ultraviolet light. Creatine is snow-white, and not fluorescent. The fact that any sophomore chemist would immediately recognize that an impurity was present seems not to have reached the scientists of the FDA's staff.
My objection was simply and solely to the specifically non-scientific methods being used in the name of Science in that instance. The letters I got - and the telephone calls - were from individuals who had a very different problem.
One typical one was from an electronic engineer in his late thirties. Four years ago he was operated on for cancer of the intestines; a year ago the cancer recurred. The doctors who examined the situation then told him that it had spread, and was inoperable; they could offer him only palliative medication that would prolong his life, and reduce the pain.
Six months ago, he started taking Krebiozen. The pain left, and the tumor shrank away.
The FDA has now announced that they have "determined" on the basis of "scientific evidence" that Krebiozen is ineffective because it is "nothing but creatine" and, therefore, have ruled that he cannot have Krebiozen any more; it will be illegal to sell it.
So what's his situation? In effect, the FDA is telling him to go back on a "morphine diet" and toddle off to the grave like a good little man, and stop messing around with these unorthodox treatments that aren't good for him.
I would like to raise a question here: is it ethical for a group of men who can offer him no hope whatever, to deny him the right to try a remedy of which they do not approve?
For that matter, is it ethical to take from a man who is recovering, a remedy which he believes is curing him?
Any doctor knows that there is such a thing as a "placebo effect"; that a completely inert material, which the patient believes in, can produce an effect when a biologically potent material, which the patient distrusts, will not.
One example of that: an arthritis patient, when cortisone first began to become available, had been begging her doctor to let her have some. The doctor told her it was hard to get, but that he had a new remedy that was supposed to be almost as effective, and he would start trying to get cortisone for her as soon as he could. In the meantime...
He did, in fact, have cortisone on hand. He did, in fact, give her cortisone injections. For four weeks, she was getting cortisone, while the doctor told her he was trying to get some for her. She showed no improvement or reaction to the "substitute" - which was in fact cortisone. The fifth week, with great showmanship, the doctor told her the cortisone had finally come in, showed her the cortisone ampule with its label, filled a hypodermic with sterile saline solution, and injected that.
She showed immediate and dramatic improvement on the sterile salt-water therapy.
That phenomenon is one of the things that makes evaluating therapeutic techniques somewhat more difficult than measuring a voltage, or weighing electrons or the companion star of Sirius.
The field of medicine is one area where subjective reality and objective reality directly interact; they cannot be separated. The term "psychosomatic" has been sort of dropped, and a new term not including the offensive "psycho" term substituted; they are now called "stress-associated diseases" or "stress-associated" conditions.
Every indication is that cancer is a stress-associated disease.
With the above data in mind - is it ethical for any group of men to deny Krebiozen to an individual in the spot my telephone caller was in?
The problem in this whole area of medical therapy is acutely emotional; that is why such exceedingly bad "science" as the FDA's Krebiozen report keeps showing up. It's long been known that human beings tend to count their successes carefully, and forget their misses - and to forget the other guy's successes, and count all his misses. The more intensely emotional the situation, the more powerfully that tendency is manifested.
And medicine is the field where emotional forces are on a full par with objective forces. The problem is that that applies not only to the patient - but to the doctor as well.
Let me put it this way: consider two ideals of what a doctor should be.
1. The patient wants a doctor whom he can trust not only as a wise and learned man, but as a friend in his time of trouble, a man with genuine sympathy and empathy - a man who is personally and genuinely concerned for his patient's welfare. Simply - a doctor should be a man who cares what happens to his patients.
2. The theoretical ideal of a doctor is a man who is highly trained, skilled, and intelligent, a man who thinks coolly and objectively at all times, in all emergencies, who does not get flustered, and whose judgment is not warped by emotional factors.
Look those two ideals over carefully - and you'll see at once that they are mutually exclusive. If a man cares - then he is influenced by emotional factors. If he is cool and objective - then he is not warmly sympathetic. Moreover, he'll make a poor doctor - because the emotional factor is a critical factor in the therapy of the patient, and the "cool, objective thinker" specifically withholds emotional warmth.
Now anyone - in or out of the medical profession - will agree that there are always some cynical men who become doctors as a way of making a high income, and getting high social status. And that such men do not deserve the title "doctor".
And if you think about it carefully, you'll recognize that the cynical, money-hungry, status-seeking M. D. will be coolly objective in his evaluations, his judgment will not be warped by emotional involvements. He will, in other words, closely approximate the logical-theoretical ideal of what a doctor should be... and that no one wants for a therapist himself!
Such a doctor is like a highly skilled mercenary soldier; he may be more skillful, more effective in the battle, than a true patriot dedicated to the cause. He fights coolly, effectively, and skillfully - but entirely without loyalty or dedication. He wants his side to win, because that's the side that will pay him for his work.
The man who is dedicated to a cause is, by definition, emotionally involved in it; his evaluations of that cause will not be objective. His judgment will be warped by his involvement.
A parent can not judge his child objectively; an Englishman can't evaluate England's policies in the world objectively, any more than an American can evaluate ours objectively. And a true, dedicated healer-physician can not judge medicine objectively.
Yet each of those - parent, Englishman, American and doctor - will be sincerely and honestly convinced that he is being objective.
And emotional involvement will make a well-trained, highly-logical scientist become completely unreliable and unscientific.
It's long been known that it is very unwise of a doctor to treat his own family; his hopes and fears - his emotional involvements - will warp his judgment under precisely the circumstances he most ardently wants to be most effective. It is not ill-intent that warps his judgment, but excess of deep concern!
Strangely, a doctor could be more accurate in his evaluations when treating a man he despised than in treating his own wife or child.
Only the money-hungry status-seeking cynic - the medical mercenary with high skill and no dedication - can remain objective!
There's intense emotion on the part of the patients, too, of course; medicine is a matter of life and death, of health and crippling, of successful living or agony and slow death. No other success can have much value, if health is lost.
This leads to another aspect of the problem, one that affects the medical mercenary as acutely as the dedicated doctor. In our current society, the concept of the Welfare State and Security has spread to a quite unsane degree. People now demand Security against Death and ill health.
The Declaration of Independence was - as it openly states - prepared primarily as a propaganda document. It asserts that Life, Liberty and the Pursuit of Happiness are inalienable rights; this is a self-evident falsity. If they were inalienable, no one would ever have to defend them. The one truly inalienable right is the right to try - with no guarantee whatever of success. You have an inalienable right to try to live, to try to be free - but today, the Welfare-Security concept has promoted the concept that we should have those, that we should be guaranteed success in our efforts.
And - that a doctor should guarantee that there is no risk in his therapy.
The rise of that concept has led to more and more extreme malpractice suits. It used to be that if a woman was unfortunate enough to bear a Mongoloid idiot baby, she and her family would accept it as one of the risks of life and the life-process of reproduction.
Now they sue the doctor.
It used to be that if someone were unlucky and seriously injured in an automobile accident, they sued the driver who nearly killed them.
Now they sue the doctor who stopped by the roadside and rendered first-aid treatment.
Under this philosophy, Jesus' parable of the Good Samaritan would have wound up with the injured man suing the Good Samaritan for restoration of the money the thieves took.
This constitutes a problem for the medical-mercenary as well as the dedicated doctor. Such suits are always based on "second-guessing" the doctor on the job. "If he hadn't done... then I believe that..." is easy for the second-guessing doctor to say (and a doctor willing to second-guess under those circumstances is always findable; the unskilled as well as undedicated medical mercenaries specialize in that as a source of income).
Some human beings are violently allergic to wheat, strawberries or bee stings. This does not prove that wheat, strawberries or bees are deadly, lethal, evil, intolerable, terrible things to be eliminated from the world. It proves that the guy's unlucky in that he doesn't fit the world very well. It's not the world's fault - it's his fault.
But the man who turns up allergic to penicillin, thalidomide, MER-29, or some other new and highly useful drug - he sues the doctor.
It's a refusal on the part of patients to acknowledge that the act of living involves risk - and he has to accept that risk. Oh, no! Not under the Welfare-Security philosophy! He feels he is guaranteed success and health.
All of these factors focus in on the problem of new therapies, new drugs - plus one more.
Back before Pasteur discovered germs, Semmelweis discovered a 99.9% successful method of stopping childbed fever. There was a hospital in Vienna, one half of which was run by nuns, and the other half by doctors. The incidence of childbed fever in the doctor's half of the hospital at times ran as high as 90% - nine out of every ten young women who came in to have their babies died of infection. The nuns had a far better record.
The doctors didn't observe that fact particularly; the women of Vienna were acutely aware of it, however (the human tendency to count your hits, and forget your misses - while the women observed the misses a lot more actively).
Semmelweis, studying the situation, came to the conclusion that the difference was that the doctors, as part of their routine, performed autopsies on the dead women; the nuns did not. Semmelweis came to the completely false, crackpot notion that it was the odor of death on the doctors' hands that transmitted the disease. It just happened that he picked, as his deodorizer, chlorine water. It did indeed deodorize the doctor's hands; also, quite unknown to Semmelweis, it was an extremely powerful antiseptic - the concentration he used would kill anything.
At that time - about a century ago - it wasn't customary to wash the hospital sheets very often, either - until Semmelweis detected the "odor of death" there, too. "Wash 'em! And use chlorine water!".
The death rate from childbed fever among Semmelweis' patients dropped from about 90% to 0.9%.
For this, Semmelweis was thrown out of the hospital by the other doctors, and violently attacked and harassed by the medical profession of Europe.
Why? Because of a certain emotional factor involved.
His work - his absolutely unarguable and shocking success - said "Doctor - healer! - you killed those young women. You killed them with your dirty hands. They didn't just "happen to die; you killed them!".
Semmelweis was, of course, a dedicated healer; he could not endure standing idly by, so he was very busily spreading the word to laymen - telling them not to let a doctor examine a woman unless he scrubbed his hands in chlorine water.
There's the old saying "What you don't know won't hurt you". With respect to objective factors, that's obviously false. With respect to emotional things, however - it's true. So long as a doctor could hold off from his own mind the realization that it truly was his unclean hands that did it - then he did not have the grinding agony of regret.
Of course, the medical-mercenary type wouldn't have such a reaction; they could be more objective, less emotional. They never had cared particularly anyway - and Semmelweis' techniques would assure them of more patients (except for that damnable chlorine water; scrubbing in the stuff ruined the hands and devastated the fingernails. But it might presently be found that a dilute perfume - diluted with the usual 70% alcohol solvent - removed the odor of death just about as effectively).
Of course, the Philosophical Logical Ideal doctors wouldn't resist Semmelweis' new idea; they wouldn't react to emotional factors like regret or remorse or guilt. And such men wouldn't be doctors worthy of the name, either.
In summary, then, the true, dedicated doctor, by the very nature of his dedication, cannot be an objective scientist; he cannot evaluate new proposed therapies objectively because he is dedicated - has a loyalty to his art. And he will have powerful emotional blocks against learning such lessons as Semmelweis taught, which show unmistakably that the doctor himself has been killing his patients through ignorance.
On top of that, the modern attitude that the patient has a right to perfect security, puts the doctor under terrific pressure to refrain from any new therapy.
Now let's consider for a moment what's meant by a "quack" in the medical field.
The usual charge is that a quack is someone who uses an improper treatment, one which does not help, or actually injures the patient, while inducing the patient to pay for this mistreatment, and keeping the patient from going to a licensed doctor and getting the treatment he needs. That a quack is in the business solely to make money at the expense of suffering humanity.
Now any time A disapproves of B emotionally, he'll attribute B's actions to some generally demeaned motivation - "just for money" being the most common, with "just for his own pleasure" being runner-up.
Let's be a bit objective about this business of what a quack does. Suppose a man, calling himself Dr. Jones, treats a patient who has a lethal disease, and uses a method that he knows for a positive fact will not save the man's life. He charges fees, and sees to it that the patient doesn't go to any other therapist - just gives him some drugs that do not save him, but let him die slowly.
That set of actions fulfills exactly what the AMA accuses those awful, nasty, wicked quacks of doing.
It is also precisely what an AMA doctor does when he treats a leukemia patient; he knows that the standard treatments for leukemia do not work, do not save lives. Leukemia, treated by AMA methods, means death.
The AMA, moreover, does everything in its power to make it impossible for the victim to get treatment from any other therapist who might be able to do better, and most certainly couldn't be less effective.
The patient will, moreover, wind up broke, and his family in debt - a charge constantly leveled against those wicked quacks! - by the time he dies.
But this is not quackery, of course.
Why not? Because the doctors know they are doing their best, with the best of intentions - which is strictly an emotional statement.
How about an unlicensed non-M. D. who does his best, with the best of intentions - despite the AMA's convictions that he must be evil - and actually does better than the AMA's best?
Oh... I see. That never happens, huh...?
Well, it hasn't yet been proven for leukemia... but how about that unlicensed non-M. D. - that charlatan, that fraud, who'd gotten crackpot ideas from studying silk-worms and wineries, no less! - who started treating human beings for rabies? That chemist, with only half a brain, Louis Pasteur?
Or how about that licensed M. D. charlatan, expelled from the hospital and the medical society - Semmelweis?
Or take a few other notorious quacks like Lister - who was most violently attacked for his temerity in opening the abdomens of living patients (ethical doctors of the time never opened the abdomen until after the patient died). And Ehrlich, another chemist, who invented the concept of chemotherapy.
Every time someone outside - or even inside! - the field of medicine brings up a break-through discovery, he'll be labeled a quack. The field is too emotional.
He'll be charged with being a fraud, a charlatan out after money, a blood-sucking leech.
Hoxsey had something that appeared to help cancer cases. Standard Operating Procedure of the AMA is to deny it, and charge the innovator with being a fraud, a charlatan, a money-seeking leech...
Hoxsey sued the AMA, Dr. Morris Fishbein, their President, and the Hearst newspapers which published the statement, for libel. He won the case.
Whether his cure actually worked or not was never investigated; the AMA flatly refused to test it.
But the question of whether Hoxsey was a charlatan, a deliberate fraud, was tested. He wasn't. Whether he did, in fact, have a cure has nothing whatever to do with whether or not he was a fraud; a fraud is someone who knowingly and deliberately misstates facts. Hoxsey had excellent evidence to lead him to the conclusion that his cure worked; that fact alone is complete and final proof that he was not illy or fraudulently motivated.
Look - let's be objective. Hoxsey may have been wrong - but the AMA doctor who treats leukemia by methods he knows will not save the patient's life seems to me in a damn poor position to call Hoxsey a quack. Hoxsey didn't know he couldn't save lives, and did, in fact, have a lot of reason to believe he could. And Hoxsey wasn't urging the passing of laws that would prevent the victim of such a disease from even trying to get help elsewhere.
As I say - this whole business is a mass of tangled, boiling, violent emotions. Does intent count in such matters? How much should it count? How do you know a man's real intentions? The medical mercenary intends to make money and gain status - and he may be the most highly skilled, highly competent surgeon in the city. Another man may be deeply dedicated, completely sincere... and unfortunately just not really bright. He lacks the spark that makes real surgeons. So here is one man with the "evil" intention of making money, the medical mercenary, and another who has the best of intentions. And - should we say the incompetent man is a better doctor?
I propose a new approach to this problem.
Let's license quacks. Well make it wide open; anyone whatever, with no qualifications required save only that he be over twenty-one, and never committed to an institution for insanity, can apply for and get a license to set up in business as a medical quack.
Here's why: if a doctor diagnoses a man and tells him "The disease you have will kill you within three months; there is nothing that we can do to save you. All we can do is give you drugs to ease your pain, and perhaps prolong your life a little" that man is unsane if he does not seek some other therapist. And a man does have an inalienable right to try to live; you may try to stop him, but you'll have to lock him up to prevent his trying to find someone who will offer him some hope.
The fact that there are conditions which can be diagnosed, but which can not be cured by medicine today - and there always will be, no doubt! - is the fundamental reason why there are, and always will be quacks.
A quack is a man who thinks he can help conditions medicine cannot help. A man like Louis Pasteur, treating the Russian victims of rabies with a new technique no doctor in Paris would touch - treating them at the risk of a trial for murder, if they died.
Not all quacks are evil men. And there is a definite place for quackery! The area where medicine is competent to diagnose, and helpless to cure. If medical science can't help - then by all that's honest and ethical, they should damn well acknowledge it, step aside, and let someone else try!
Try a witch doctor, a faith healer, a numerologist - try a herbalist, or a chemist with a theory, or maybe a nuclear physicist. When you have nothing to lose, and life to win - try anything!
And don't talk about money! Whenever emotions start running high - and they always do, everywhere, in medical problems! - the business of money charges gets thrown in as the triumphant "That proves they're wrong! They do it for money!".
Have you taken a look at a standard AMA hospital and doctor bills for a couple of months of cancer treatment, with death of the patient? Talk about money! See, that proves they're just doing it for the money, huh?
Drop that money nonsense out of the thing; it's a question-begging argument from start to finish.
On the patient's side, he has a right to try anything he chooses; the organized medical groups have no right to deny him the right to try.
But there's a doctor's side, too. We're going to license these quacks - but it will be strictly, publicly, and thoroughly understood that it's a matter of "When you choose to gamble - you can't whine if you lose your bet". The quack is absolutely immune to suits for malpractice. Legally declared totally irresponsible for any deaths, crippling, or disasters that may result from his treatments.
This is simply putting into formal, legal and publicly stated terms what exists in fact anytime a man goes to a quack; it is the patient's responsibility to choose his own quack - and to take his licking if he gets licked.
But this means that a licensed M. D., a qualified man with a new theory, a new therapy to try out can also take out a license as a quack. He can hang out his shingle as "Thomas R. Brown, M. D., Licensed Quack Specializing in..." whatever it may be he's researching.
This would give the doctor a chance to do experimental work, and get out from under that insane business of unlimited malpractice suits. If the patient insists on Security - he goes only to tried-and-true, standardized-technique licensed doctors. If he has a disease in which the standard therapies don't work - he can take his choice of being perfectly secure in his dying, or sticking his neck out and taking a chance on a new therapy.
There's a third side to this system though - Society as a whole. And Society as a whole will benefit enormously from a system of licensed quackery.
Quackery always has existed; it exists now - and it always will exist, for the reasons given above. Diagnosis always precedes therapy; diagnostic techniques will always exist before therapeutic techniques have been able to cure the newly diagnosed conditions. In that twilight zone, quackery exists.
Now, however, quackery is illegal - a hit-and-run business pretty largely. No undercover operation can keep good records, and what records it does keep aren't communicated.
Let's license the quacks... and make them keep extremely careful records. They'll be the most useful research records Mankind has ever assembled! Even if the quack himself doesn't learn anything, other men very well may, from studying the records.
Now, the quacks are unlicensed, and, therefore, unlimited (they aren't even limited to over twenty-one and no-recorded-insanity!). Licensed, they can be limited in a number of ways - but the ways will not include any requirement of degrees or previous training. Put on such limitations, and the unlicensed quacks will immediately pop up where their records won't be available, and their activities will be unrestrained. The only restraint will have to do with two matters of statistics:
1. Only patients diagnosed as having diseases or conditions which standard medical records show to be, say, seventy-five per cent or higher lethal under known treatments will be automatically free to go to a quack if they want to. If the disease or condition is non-lethal, and has a zero cure rate - some skin diseases for example - the patient can ask for and must he given a pass to present to a licensed quack. The patient, not the doctor must determine this - because patients who want to go to quacks and are denied the pass will supply a group to maintain unlicensed and unrecorded quacks. But it gives the doctor a chance to point out to a girl with a disfiguring and incurable skin condition that while a quack might cure it - he's also quite apt to kill her.
But... any quack caught treating someone who does not have such a pass loses his license, and gets jailed.
2. The statistics on the quack's records are studied periodically. If his death rate is higher than the death rate under standard treatment - he gets shut down. We want better, not worse, treatments!
The gain to the Society as a whole is that, by such a system, a huge number of things that might work can be explored with the full co-operation and free permission of the self-assigned human guinea pigs. No man has to go to a licensed quack; it's his decision to be a human guinea pig. And in the process, we can learn a great deal about a lot of things that don't work - and thereby eliminate duplication of that useless effort.
There's a lot of emotionalism tied up in that concept of the human test subjects, of course. Doctors, when fulminating against quacks, have horrid things to say about such things.
But dedicated doctors, knowing the importance and good intent of what they were doing, aren't so upset when doctors in a major New York hospital, inject live human cancer tissue into human patients without the knowledge or consent of the patients.
That's different! That was for a good purpose, and they knew what they were doing!
Actually, it's pretty clear, the definition of "quack" is "someone I believe to be dangerous, evil, destructive and unprincipled".
Trouble is - the term "quack" was - in their own place and time - violently hurled at many men we consider today among the greatest medical heroes. Jenner - Harvey - Ross - Lister - Pasteur - Ehrlich - Sister Kenny - even Roentgen, who didn't even try to practice medicine!
One very certain thing about the field of medicine: it is not, and never will be a field of objective science. It's too deeply dominated by emotional factors.