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Vol. 2, No. 3, Winter 2001-2002

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Vol. 2, No. 3, Winter 2001-2002 NETWORKNETWORK T H E N E W S L E T T E R O F T H E I N T E R N A T I O N A L N E T W O R K F O R C A N C E R T R E A T M E N T A N D R E S E A R C H Volume 2, Number 3, Winter 2001/02 — Inside: Regional News - 5 Special Report on Childhood Leukemia - 8 ALL Case History - 10 Tata Memorial Centre - 13 Profile in Cancer Medicine - 14 THE PRESIDENT’S MESSAGE THE RISE OF SCIENCE AND James Lind, CONSCIENCE in the first by Ian Magrath modern con- trolled trial, demonstrated Sir James Frazer, in his pioneering work the ability of on magic, mythology and religion, has oranges and much to say on the thought processes lemons to of early human communities. In The cure scurvy. Golden Bough, he refers to the “primi- tive” magical reasoning that led to a broad range of ritual practices that en- able humans to survive in the face of odds weighted heavily in favor of the natural forces that threatened them. Primitive or not, and fallacious or not, the fruits of this formative era of hu- man culture continue to have a re- insufficient basis for the management ited from the past. Any hint of a depar- markable influence on our lives. A sec- of human affairs, since it does not in- ture from tradition has been given ond type of reasoning, which we may volve emotion, conscience or morality. short shrift. Paracelsus, for example, refer to as scientific, has played an in- We may, then, surmise that human so- who rejected the notion that medical creasingly dominant role in human so- ciety results from a compromise be- knowledge must be garnered from ciety; there are few corners of the tween these two thought processes, ancient texts, was barred from the uni- world that have not been touched by just as it also depends upon a compro- versity and in 1528 lost his position as its practical application, even though mise between the needs of the com- Physician to the city of Basle. His holis- most of the world’s population has had munity and those of the individual. tic approach to medicine was roundly little scientific training. It would be Throughout human history, these rejected in Europe for at least 400 years. pointless to discuss the pros and cons closely related dualities have vied for In the 21st century, science is, at last, of each type of reasoning since both supremacy. taking an increasingly prominent role are part of the human condition, al- In medicine, the threads of scientific as the basis for medical practice, but though it is surely correct to state that reason have existed since the begin- the hard edges of science must be in the absence of scientific reasoning, ning of time, although buried for much blunted by compassion. For at its heart, humans would not have evolved be- of human history under the weight of it derives from individualism - that as- yond the stage of hunter-gatherers. Yet magical thinking, or by tomes of medi- pect of “Western civilization” which scientific reasoning alone provides an cal wisdom, sacred or otherwise, inher- surged to center stage in the Renais- NETWORK sance era. But in this same era private sacred animal or plant was also a criti- anthropology, mythology and reli- conscience also emerged, leading to cal dietary element (e.g., corn, or the gion. The primacy of magical thinking passionate discussions of the conflict- bison) the link between the animals’ in meeting the needs of the commu- ing interests of individuals and society, well-being and the salvation of the nity with respect to survival, accounts and so to human liberty and human community was direct. for the slow emergence of science, rights. Such ideas were alien to the Sometimes the vitality of the which required a degree of individual primitive communities described by people and their world were closely al- genius on the one hand, and toler- Frazer, who considered the individual lied to their King, who usually also en- ance by dominant societal forces (in- as a representative rather than a mem- joyed divine status. His enfeeblement variably threatened by new ideas) on ber of society. and death must therefore be avoided the other. Moreover, in the absence of logical precepts, glaring contradic- tions bore little weight, and thus had It is the duty of the physician to promote and safeguard the no ability to undermine the magical health of the people. The physician’s knowledge and conscience basis of society. Predictably, the rise of science has been associated with le- are dedicated to the fulfillment of this duty. gions of detractors, or overt oppo- —Declaration of Helsinki, 2000 nents, and even today, there are many who argue against it (The Flight from Science and Reason, Ann NY Acad. Sci, KILLING AND EATING GODS at all costs - by killing him whilst still vol. 774). In his chapter “Eating the God,” Frazer in his prime, in order to ensure that his In the practice of medicine, the in- describes how among the still vigorous soul would be passed on ability (or unwillingness) to perceive Acagchemem native American Indians to a younger successor. Plants, animals, how knowledge based on clinical tri- of California, “The notion of the life of a or people were often used as surro- als involving many participants can species as distinct from that of an indi- gates, particularly as gods became be applied in the service of the indi- vidual, easy and obvious as it seems to more supernatural. Frazer records that vidual patient has constantly hin- us, appears to be one which (they) “Twice a year, in May and December, dered the assimilation of the scientific ....cannot grasp.” He describes how the an image of the great Mexican god method. This attitude, part of the life of a species of animal cannot be Huitzilopochtli or Vitzilipuztli was backlash against science, has similar conceived of as “anything other than made of dough, then broken in pieces, origins - discomfort with novelty, a an individual life, and therefore ex- and solemnly eaten by his worship- perceived challenge to the su- posed to the same dangers and calami- pers.....” The Aztecs believed that by premacy of professional leadership, ties which menace and finally destroy consecrating bread their priests could and, to a degree, an aversion to the the life of the individual.” The turn it into the very body of their god, need to acquire new knowledge. Ac- Acagchemem worshiped the wild buz- “so that all who thereupon partook of cording to Murray Enkin’s foreword in zard, and every year, at the feast of the consecrated bread entered into a Alejandro Jadad’s excellent book, Panes, sacrificed one of these birds in mystic communion with the deity by Randomized Clinical Trials, practicing order to preserve the species - for ac- receiving a portion of his divine sub- physicians confronted by the initial cording to their rationale, killing a stance into themselves.” In this, the stirring of clinical science “were un- young healthy animal liberated the life Aztecs were entirely at one with their willing to hold their decisions in abey- force, which would then be reborn in Spanish conquerors. ance till their therapies received nu- another, equally vigorous bird. Not to merical approbation, nor were they kill, at intervals, one of these sacred ani- SCIENCE VERSUS TRADITION AND prepared to discard therapies vali- mals at the peak of its health would re- MAGIC dated by both tradition and their own sult in the gradual loss of the vitality of Frazer’s enormous scholarship and ac- experience on account of somebody the entire species, and eventually its ex- cumulation of volumes of evidence else’s numbers.” tinction - with serious consequences from all over the world had wide- Enkin describes how, in 1836, an ar- for those who held it sacred. When the spread implications for psychology, ticle by the Frenchman PDA Louis in 2 M E S S A G E the American Journal of Medical Sci- terms of the patient population, to the mated that the results of clinical trials ences, hailed by the editor as “the first cohort that participated in the clinical take, on average, 17 years to become formal exposition of the results of the trial. part of accepted medical practice! only true method of investigation in Controlling the treatment adminis- regard to the therapeutic value of re- JAMES LIND AND SCURVY tered by health service providers in a medial agents,” caused a storm of criti- The first documented controlled clini- non-research setting remains difficult, cism. Comments such as “The physician cal trial of modern times is believed to but the Royal Navy could have de- called to treat a sick man is not an ac- be that of James Lind, a ship’s doctor creed that sailors should be protected tuary advising a company to accept or in the Royal Navy. Lind performed a against scurvy in the manner shown deny risks, but someone who must study whilst at sea, which involved 12 by Lind to be effective. Why did it take deal with a specific individual at a vul- sailors with scurvy (a disease caused so long? While many factors may have nerable moment” and “Averages could by deficiency of vitamin C) and the use played a role, the lack of understand- not help and might even confuse the of six different remedies applied for ing of the scientific method is likely to practicing physician as he struggles to two weeks.
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