Quacks, cures and the evidence

A medical practitioner administers leeches Credit: Wellcome Library, London.

One of the joys of the Wellcome Collection is the elan with which they throw together fun, silliness and high calibre intellectual entertainment, all in the same event.

Friday evening’s Quacks and Cures event was a good example. We met friends in the foyer, had a beer and a bite to eat at the cafe, listening to live music. Then we headed off to explore three floors of medical mystery.

We encountered live leeches in the exhibition hall, where we watched tiny comma-shaped leeches being hatched from their cocoons. We were invited to handle some meatier specimens, which we’re reliably informed are used as a handy form of anticoagulation in some hospitals, for example to keep blood vessels open when doctors want to reattach the end of a severed finger.

In the library, we were accosted by a couple of rather scary nurses, who ushered us in to watch a panel of doctors in the reading room, offering diagnoses from the 18th, 19th and 20th centuries based on visitors’ symptoms.

Upstairs, we lounged in the comfy seats to watch hilarious public information films from the 1960s and 1970s. I don’t think you’d get away with some of them nowadays, especially the somewhat forthright approach to childhood obesity.

Finally, we filed back down to the basement lecture theatre, for a lively and informed debate about the nature of evidence in medicine, with a panel of four excellent, eminent speakers. How do we know what works, and how can we account for what seems to work, but doesn’t give positive results in a randomised controlled trial?

Sir Iain Chalmers, Dr Simon Singh and Professor Adrian Renton were largely in agreement that the RCT may not be perfect, but is the best way to demonstrate efficacy and pick up whether a treatment is doing good or ill. Professor Renton pleaded for the use of ‘scientific imagination’ to explore the predictive value of other, non-Western medical traditions.

Professor Paul Dieppe was the main dissenting voice. No surprise that he works in rheumatology, where the interplay between mind and body mediates pain every bit as much as the painkillers that pharma comes up with. He made a heart-felt plea for people to stop dismissing the importance of the therapeutic context as ‘just the placebo effect’.

I was tickled to notice that Sir Iain, a founder of the revered Cochrane Collaboration and one of the foremost exponents of evidence-based medicine in the country, began almost every point with the words: ‘Let me just tell you a quick anecdote.’ As he would be the first to recognise, the plural of anecdote is not evidence. Yet anecdote, stories, the way we make sense of the world, is far more powerful to most people than dry statistics. Thanks heavens for doctors like Sir Iain who understand the importance of both.

Afterwards, I sat with my friends in the bar till they threw us out, chewing over the nature of health and illness, pain and absence of pain, the importance of stories and eventually, evidence for the existence of  God and the afterlife. Probably as well they closed the bar at that point.

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