Experience as a Tool

Empiricism was not an invention of the Renaissance, but it breathed life into it. The obvious idea of the importance of knowledge derived from experience has been found in the works of ancient philosophers before, but has never been truly influential. Perhaps the reason was that such a philosophy is not compatible with the existence of hidden and unknowable gods-the measure of any truth and the source of any knowledge. It took a later Revival, with its spirit of freedom and the gradual diminution of the role of religion, for empiricism to resound in full force. His voice was sir Francis bacon, a distinguished scholar, philosopher and statesman.

Living XVI–XVII century in Britain bacon was one of the most extraordinary people of his time. He received an excellent legal education, was early noted for his brilliant mind and made an exceptionally successful career as a civil servant, rising to the position of Lord Chancellor. Bacon played a decisive role in the formation of the North American colonies and seriously influenced the legislative system of the United Kingdom. His originality and unconditional diverse gifts have prompted some researchers to suggest that he is the real author of Shakespeare’s plays.

Bacon entered the history of science primarily because he described a new philosophy of obtaining knowledge. He saw the imperfection of the method inherited from Aristotle, and argued that if the theories from which logical reasoning is based are based on nothing, then any of their conclusions are meaningless. No matter how brilliant the logic, wordplay, which has no support in reality, is notoriously fruitless. Bacon’s alternative formed the basis of what we now call the scientific method. Bacon suggested doing the exact opposite of scholastic approaches: not trying to logically deduce facts from “self-evident” concepts, but moving in the opposite direction, from observable facts to more General theories. These theories, in turn, should not become immutable truth. They can and should change if further observations reveal facts that do not correspond to them.

Are bacon’s ideas about the primacy of observation identical with those of the ancient Greek empiricists, who relied on any evidence of the usefulness of treatment? And why were the hundreds of drugs in their Arsenal ineffective?

The empirical nature of knowledge does not make it necessarily true. For example, the evidence of patients that the drug helped them, by themselves do not prove the effectiveness of the drug. Thousands of useless drugs wouldn’t exist if people didn’t keep buying them. The bloodletting would have stopped quickly if the patients hadn’t thanked the doctor for the relief. There were several reasons for this. One of them is natural recovery: we do not die of any disease, a significant part of them passes by itself. As for chronic diseases, they often have a wavy character-exacerbations are replaced by remissions. We treat them in the acute stage, when the symptoms are most pronounced – of course, in such cases, the patient’s condition will also improve after a while and without treatment. In these situations, it is likely that the patient will associate recovery with the intervention of a doctor, even if it was absolutely useless.

It must also be remembered that the stories of treatment were spread primarily by those who were getting better. But those who did not help the treatment, or those who it sent to the light, no one could tell about it. So how do you separate the true impact of a drug from other reasons that lead patients to claim that it has benefited?

Bacon assigned an extremely important role to experiments-actions specially invented and produced in order to test the hypothesis in practice. The experiment was, for example, conducted Galen vivisection: the animal immediately fell silent when Galen cut the recurrent nerve – it clearly showed that it regulates the vocal cords. Important experiments put in the Middle ages Arab scientists: with the help of a specially created dark room Ibn al-haysam, known in the West as Alhazen, created the foundations of optics and studied the basic principles of the human eye. But although experiments were mentioned even in the Bible, they were not perceived as an important tool of knowledge for a long time.

A human experiment conducted to examine the efficacy and safety of a treatment is called a clinical experiment (or clinical trial or clinical trial). Clinical experiments are useful not only to demonstrate the effectiveness of a working drug, but also to show the ineffectiveness of a useless one. They were first used for this purpose in the XVI century by the French surgeon Ambroise Pare, whose life has preserved many fascinating stories.

Before becoming a court surgeon under the four French kings, Pare worked for a long time in the army, “removing the superfluous, putting in place the displaced, dividing the fused, restoring the divided and correcting natural defects.” The army part of his career fell on the war, and he gained extensive experience in the treatment of a wide variety of injuries and wounds. Pare was the first to use ligatures – a technique of binding vessels to stop bleeding that saved the lives of countless soldiers and surgical patients. Pare was extremely skeptical of some popular treatments at the time. Known for his performances against the powder of Egyptian mummies and edinoroses horns, for which he received its share of curses from physicians who were not in awe of the fact that some surgeon is all up in my business.

While serving at court, he experimentally tested the bezoar, a gallstone that can be found in the digestive tract of some animals. For a long time bezoar was considered a universal antidote. Pare did not believe in its effectiveness, and once he had the opportunity to test it in practice. One of the cooks of the Royal court was caught stealing silverware and sentenced to death. Pare persuaded the executioners and the cook to replace the hanging with poisoning, promising the condemned a chance for salvation. After the cook had taken the poison, Pare gave him a bezoar and waited for the result. Alas, his skepticism was justified – a universal antidote does not exist, and the bezoar is no exception: a few hours cook died in terrible agony. It is difficult to imagine a more convincing method of demonstrating the ineffectiveness of a popular remedy.

But would the result have been as clear if the cook had lived? After all, this could happen both thanks to the bezoar, and the fact, for example, that the poison has lost its power from long storage. Obviously, Pare couldn’t go back in time and see if the convict would die without the antidote. In this case, he would have been helped by the presence of a second convict. If both had been poisoned, and one had taken bezoar and lived, and the other had not taken it and died, He would have had a much better reason to attribute the miraculous escape to the antidote.

Such an experiment involving two groups, the only difference between which is the effect studied, is called a controlled experiment. The group receiving the drug is called the experimental group. And the one whose role is to show what would have happened to the experimental group if it had not received the drug is called the control group.

Had he had two condemned cooks, He would doubtless have done just that. After that time, in practice, the Pair already had a case which showed the usefulness of the control group. During the campaign in Italy, while still a novice, he was faced with a lack of combustible elderberry oil. Cauterizing with burning oil or hot iron was a standard wound treatment technique. It was made to destroy the poisonous particles of gunpowder that were believed to be in the gunshot wound-the cause of the subsequent inflammation. Lacking sufficient fuel oil, Pare decided to treat the wounds of several soldiers with an improvised mixture of rose oil, egg yolks and turpentine.

The next morning, those whose wounds had been treated with the new mixture felt well and their wounds healed. Those who received traditional cauterization were in a much more serious condition. Most likely, the difference was due to the fact that cauterization only caused serious additional harm and its abolition was beneficial. Although this method has been used for decades, in the absence of a control group, neither Pare nor other surgeons noticed a slowdown in recovery. After these observations, the Pair completely abandoned cauterization.

Although pare’s experiments pointed the way to a reliable method of separating drugs into effective and ineffective ones, they remained amusing incidents and were forgotten after His death. The first clinical trial, planned and conducted in search of a cure for a deadly disease, was destined to come true only two centuries later. And it was only the first step of a long and difficult path that medicine had to go to create a reliable method of testing the effectiveness of drugs.

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