What is medicine? How are drugs tested?
Many people think that medicine can cure diseases.
So, what are the criteria for curing a disease?
Some people say that the standard is,
Just eat it and it will be fine.
For example,
I cough before eating, but I don’t cough after eating; I have a fever before eating, but I don’t have a fever after eating. This is healing.
But this standard is actually problematic.
Because, for some diseases, you don’t take any medicine and will be cured the next day. For example, if you have a sore throat, drink some water and it will be fine the next day. Drink some water and you may not have a fever the next day.
Is it better to take a magic medicine, or is it better naturally?
This is unclear.
Therefore, we need to add a "control group" to conduct a controlled experiment:
One "treatment group" takes medicine, and the other "control group" does not take medicine, and then conduct observation and analysis.
But this is not enough.
Sometimes, although the medicine you take is useless, because you think it is, your confidence and belief make you happy. This optimism also helps your body recover. So it seems that the medicine is effective, but in fact it has nothing to do with the medicine.
This is called the " placebo effect ".
Therefore, it is not enough to just have a "control group". Another group of "placebo groups" must be added, that is, the members of the "placebo group" are told that they are taking the same medicine as the "control group", but it is actually a useless "placebo" such as "starch".
This is called " controlled trial ".
Is this the end?
still has problems.
Although members of the control and placebo groups did not know what they were eating, the doctors on site did.
In this way, the doctor's attitude and expression may also make the patient guess, oh, I am taking a placebo. This will affect the test results.
Therefore, we also need to carry out a " double-blind " design, which means that neither the doctor nor the patient knows who is taking the medicine or the placebo, and the blinding will not be "unblinded" until the study is completed.
This is the " double-blind controlled trial ".
Is such a rigorous test okay?
is not enough.
Because there is another important factor, which is the "quality" of the members in each group, which must be "fair".
You can't take real medicines for people with mild symptoms, good health, or good immunity, and give placebos for people with poor health. This will obviously "exaggerate" the efficacy of the medicine.
Therefore, the members of each group are preferably selected at random without any inclination.
This is called " randomized double-blind controlled trial ".
is not finished yet.
Think about it, if I only select ten people for comparison, what if these ten are all young people? This is not objective.
Therefore, we need to select a "large sample", that is to say, the number of people should be large enough, so as to increase the coverage as much as possible and reduce the chance.
This is called " large-sample randomized double-blind controlled trial ".
This experimental method was recognized as the standard method for evaluating "reasonable treatment" by the late 20th century. It was also considered the most reliable method of obtaining scientific evidence in the medical and health field because it reduced "false causality" and "bias" as much as possible.
This is the "scientific method" of modern medicine.
Therefore, only the drugs and treatments that have passed such trials can be accurate and credible in their efficacy.
In fact, what needs to be verified is not only the efficacy, but also other indicators such as side effects. Therefore, the research and development of modern drugs is also very expensive. The three phase clinical trials require as many as 1,000 to 3,000 people to test. As for the cost, it is reported that the average research and development cost of each drug of AstraZeneca is as high as 11 billion US dollars.
So, is it worth going to such great lengths to go to war and spend so much effort?
value.
As a comparison, let's take a look at "traditional medicine" in ancient times.
For example, there was "bloodletting therapy" in ancient Europe, which believed that blood and other body fluids must maintain a proper balance for the human body to remain healthy.
Note that this kind of bloodletting does not mean taking out a needle, but it is comparable to killing a pig.
For example, the famous founding father of the United States George Washington required a large amount of bloodletting due to a throat infection (possibly tonsillitis) in 1799. A total of about 2.6 to 3.75 liters of blood was released in 10 hours (multiple data vary), and he eventually died. What is the concept of
? We only donate 200-400 ml (0.2-0.4 liters) of blood at a time. A normal person of 70 kilograms only has a total of about 5 liters of blood in the body. Loss of 2 liters of blood has the risk of shock.
In this era, bloodletting was used for almost all diseases: acne,asthma, cancer,cholera, coma,convulsions,diabetes, epilepsy, gout, herpes, sterilization Infertility, insanity, jaundice, leprosy, ophthalmia, plague, pneumonia, scurvy, smallpox, stroke, tetanus, tuberculosis and about a hundred other diseases, bloodletting became a magical skill to cure all diseases.
Funnily enough, phlebotomy is even used to treat most types of bleeding, such as nosebleeds , too many aunts, or bleeding hemorrhoids . Even before surgery or at the beginning of labor, blood is drained to prevent infection.
Even more exaggerated is that it was considered beneficial to draw large amounts of blood to induce fainting, and many bloodletting treatments were only completed when the patient began to faint. Such confusion of right and wrong, and no distinction between men and monsters, was precisely because the medical community at that time did not have the concept of modern science, or at least the concept of popularizing science. Is
scary?
In fact, there was something similar in ancient China. For example, I found a document, and there was a very interesting passage in it:
Widow's bedside dust
The owner's ear was cut and sore, and oil anointing had the same effect.
- "Emergency Materia Medica for Classics, History and Syndrome, Volume 4" Tang Shenwei (Song Dynasty)
My level of classical Chinese is average. I guess the meaning is:
The ash accumulated on the widow's bedside can be mixed with oil into a paste and applied to the sores, which can cure pustules on people's ears.
I checked the information, and modern medicine gave an explanation (not verified, for reference only):
Some widows have not had sex for many years, and the bed will not shake violently, so a large amount of dust will accumulate on the bedside, and Penicillium breeds in the dust, producing penicillin. It happened that someone applied this dust on the pustules, and the effect was good. So the author recorded this "recipe".
It can be seen that the actual situation is that this "recipe" may happen to be effective, but in fact it is a hit and miss, and is usually ineffective, because you cannot guarantee that the dust on the bedside of the widow you found is exactly the right kind of Penicillium. On the contrary, it is more likely that the infection and ulceration will be aggravated due to the large number of other bacteria in the dust.
Obviously, the fact is that the whole thing has nothing to do with the widow, nor does it have anything to do with the gray.
In fact, it is not easy to confirm whether there is an inevitable causal relationship between two things. This kind of difficulty exists not only in the medical field, but also in other industries. It is quite common.
For example, Mr. Liu Xuefeng introduced an example in his book "Knowing It in Mind":
A customer bought a car and often drove to buy ice cream after meals, but the car often failed to start. Moreover, after buying vanilla ice cream, it would not start when he returned to the car. After buying other ice cream, the car started normally.
What's going on? Does the flavor of ice cream affect engine operation?
Finally, engineers went to the site to investigate. After detailed records and analysis, they found that because vanilla-flavored ice cream took less time to make and the engine temperature had not dropped too much during the waiting period, "air lock" occurred, resulting in poor oil suction. Finally, this problem was completely solved.
If this were replaced by some miracle doctor, would he have to do something about ice cream again, such as mixing it with the ashes on the shop table and eating it? Or kneel down and pray before getting in the car, which delays the time. The engine cools down and the comes down. The problem is indeed solved, but in fact the whole process is nonsense.
Therefore, if you are still copying what the ancients called "great wisdom" in 2022, it will be too unwise.
Then again, why did the ancients believe these nonsense methods so easily?
The root cause is that there is no complete set of systematic scientific methods to eliminate "false causality" and "prejudice", and knowledge can only be obtained through "experience" and "oral transmission".
As for experience, sometimes it may work, but sometimes it doesn't work. Therefore, we can only rely on the personal prestige of the magicians and doctors, and spread rumors, and finally confuse right and wrong, and play the piano in a confused manner.
Just like some people think, my family has an ancestral treatment method passed down from my grandfather’s father, who is a miracle doctor.
That’s no problem. Let’s do a “large-sample randomized double-blind controlled trial”. If it’s effective, it’s effective. If it’s ineffective, it’s ineffective. If it’s toxic, it’s toxic. You say you have feelings for your ancestors, that’s okay. Feelings are feelings, and the therapeutic effect is the therapeutic effect.
Anyone who treats feelings as a therapeutic effect is a fool, and anyone who uses it to make money is a liar.
