History of Medicine

1. History of Medicine • Body health dependent on the balance of 4 humours: • Blood, phlegm, bile, and black bile • Sweating, vomiting, urinating, bleeding, oozing pus were ways to restore balance • Treatment linked to this theory • Blood letting – cutting, cupping, leeches • Induce vomiting - Ipecac, calomel • Blistering – mustard pack to induce infection

2. History of Medicine • News Flash 1799! George Washington has a sore throat! • Blistered throat • Leeches behind ears and on throat • Enema • Emetic • More blood letting = 5 pints!

3. History of Medicine • News Flash 1881! President Garfield Shot! • Drs probed wound with fingers • “Healthy pus” discharged – Whew! We thought he might die… • Died of infection – strep bacteria were introduced by probing of doctors

4. History of Medicine • Rise of Thomsonians in early 1800s • Less violent treatment • Thought that disease was a result of cold • Herbs used to purge the body • Warm baths • Return medicine to laypeople • Others • Homeopaths: Let nature do it…diet, exercise, hygiene • Hydrotherapy: Diet, bathing • These beat throwing up and enemas!

5. History of Medicine • Why were these therapies supported? • No cures! • Some benefits – diet, exercise, cleanliness • Accidental successes – Many diseases are self limiting – “post hoc ergo propter hoc” • Popular press • Placebo effect • Reason was used instead of experimentation

6. History of Medicine • New Advances…Europe 1800s • Microscope, stethoscope, thermometers • Study of Bacteriology • Study of parasites • Epidemiology: Correlation of disease and treatments - found bleeding to be ineffective – Whew!

7. History of Medicine • James Lind - 1747 • In a controlled experiment, gave oranges/lemons to British sailors and they didn’t develop scurvy • Joseph Lister – 1850s and 1860s • Aseptic surgery • Antiseptic carbolic acid • 4% mortality rate

8. Paradigm shift: • Development of microscope • Humours to microorganisms

9. Claude Bernard: “Why think? Exhaustively experiment, then think.”

10. History of Medicine • Advances in U.S. • Johns Hopkins dies and leaves 3.5 million to open a university/hospital Quaker trustees of estate decided on the German model • Research and experimentation began with much success • Immunizations – Typhoid, cholera, rabies

11. Research Culminated In… First Cure 1891: Diphtheria “El garrotillo” Francisco de Goya 1746 - 1828

12. History of Medicine • Sometime in the early 1900s… “a random patient, with a random disease, consulting a doctor chosen at random had, for the first time in the history of mankind, a better than fifty-fifty chance of profiting from the encounter” - Lawence Henderson, Harvard, 1964

13. Science Makes a Difference!

14. Current Tx in Autism Field • Rapid prompting • Sensory integration • Facilitated communication • EDTA Chelation • Xango juice • Mega-Vitamins • GFCF diet • Auditory integration • Relationship development intervention • Psychomotor patterning • Sciopathy • Behavior Analysis*

15. Current Tx in Autism FieldWhy are there so many? • No cure for autism • Accidental successes • Kids may improve for unknown reasons • Kids may improve due to concurrent Tx • Press and internet blogs • “(Child’s name) reasoning and behavior have changed for the better since drinking this juice. “ • Placebo effect? • Lack of appropriate experimentation – sound familiar? Reason vs experiments

16. Current Tx in Autism FieldWhy are they used? (cont’d) • Proponents tell us that Tx is supported by “Research” • But sometimes studies don’t have objective measurement • Some studies don’t establish causality

17. Current Tx in Autism FieldShould I Try This One? • Is there scientific support? • Make evidence-based decisions • Are the studies that support it correctly done? • Weigh risks/costs vs benefits • Short term vs long term • What about cost of not trying alternatives

18. Beware of “Research Shows” • HRT (Hormone replacement therapy during menopause) • 1985: 122,000 nurses studied by Harvard Medical School • HRT is effective at managing menopausal symptoms • Also, concluded that nurses taking HRT during menopause had 1/3 as many heart attacks • This result formed the basis of therapeutic wisdom for the next 17 years

19. Beware of “Research Shows” • 1998: Heart-Estrogen Replacement (HERS) Clinical Trial– post-menopausal women • Concluded that estrogen increased frequency of heart attacks in those women who had existing heart disease. • 2002: Women’s Health Initiative (WHI) Clinical Trial – post-menopausal women • Concluded that HRT was a potential health risk for all post-menopausal women including heart disease, stroke, breast cancer. But may offer protection from osteoporosis and maybe colorectal cancer. • 2011 – Effects of HRT less clear – short term use maybe OK

20. Collection of Subjects: Some take Drug and some do not Assignment for Analysis Observational Study - Nurses Prescriber Effect: Drug may be prescribed to healthier (or sicker) patients Drug No Drug Compliance Effect: Those who follow Dr orders are generally healthier! BIAS!! Healthy User Bias: Those who take the drug do many things right! (diet, exercise)

21. Observational Studies “They can distinguish associations between events…But they cannot inherently determine causation…” -Gary Taubes, New York Times, Science Journalist

22. Drug Placebo Controlled Experiment – HERS/WHI Subjects Random Assignment No Systematic Bias