TESTING
TREATMENTS - BETTER RESEARCH
FOR BETTER HEALTHCARE - EXCERPT
CHAPTER I - Page 2
NEW – BUT NO BETTER
OR EVEN WORSE
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THE DEATH OF
KING CHARLES II
Sir Raymond Crawfurd (1865-1938) wrote a vivid account of the death of
King Charles II in 1685. The King had suffered a stroke. His physicians
rushed into action with an array of barbarous therapies:
‘Sixteen ounces of blood were removed from a vein in his right arm with
immediate good effect. As was the approved practice at this time, the
King was allowed to remain in the chair in which the convulsions seized
him. His
teeth were held forcibly open to prevent him biting his tongue. The
regimen
was, as Roger North pithily describes it, first to get him to wake, and
then to
keep him from sleeping. Urgent messages had been dispatched to the
King’s
numerous personal physicians, who quickly came flocking to his
assistance; they
were summoned regardless of distinctions of creed and politics, and
they
came. They
ordered cupping-glasses to be applied to his shoulders forthwith, and
deep scarification to be carried out, by which they succeeded in
removing
another eight ounces of blood. A strong antimonial emetic [a medicine
to cause
vomiting] was administered, but as the King could be got to swallow
only a small
portion of it, they determined to render assistance doubly sure by a
full dose of
Sulphate of Zinc. Strong purgatives were given, and supplemented by a
succession
of clysters [enemas]. The hair was shorn close, and pungent blistering
agents were applied all over his head. And as though this were not
enough, red-hot
cautery was requisitioned as well. The King apologised for being ‘‘an
unconscionable time a-dying’’.’
Crawfurd R. Last days of Charles II. Oxford: The Clarendon Press, 1909.
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Artificial joints have helped countless people, and organ transplants
have become commonplace.
Of course many improvements in health have come about because of social
and public health advances, such as piped clean water, sanitation, and
better nutrition and housing. But even sceptics would be hard put to
dismiss the impressive impact of modern medical care. Over the past
half century, much of our increased life expectancy can be attributed
to better healthcare, as can years of improved quality of life for
those with chronic (persistent) diseases.4
Even now, however, too much medical decision-making is based on poor
evidence and there are still too many medical treatments that harm
patients, and worthwhile treatments that are not used enough (see
below, and Chapter 5). Almost invariably there will be uncertainties
about effects
and effectiveness when new treatments are devised – treatment effects
are very seldom overwhelmingly obvious.
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