Eternal Medicine

Most fans of modern medicine do not realize how similar in appearance was ancient medicine:

While the Greeks left a vast legacy of medical texts in a familiar language, we know of only 12 from the time of the pharaohs – written on papyrus in a vanished language that scholars are still grappling with. From their descriptions of diseases and treatments, the texts have left little doubt that the ancient Egyptians had considerable medical skills, but weighing up their pharmaceutical knowledge has proved trickier: although the papyri include some 2000 prescriptions, doubts surround the identity of many of the ingredients listed. ….


Focusing on four key papyri, which contain 1000 prescriptions and date from 1850 BC to around 1200 BC, Campbell analysed each prescription and compared it with contemporary standards and protocols. … After five years of painstaking analyses, … Of the original 1000 prescriptions, she could now say exactly how 550 were made and whether they would work. For another 156, she knew all but a minor ingredient – enough to say if the remedy worked. …

The Egyptians’ choice of ingredients has certainly stood the test of time. When Campbell consulted Martindale’s Extra Pharmacopoeia – the 1977 edition, when drugs were still prepared in a dispensary – she found that 62 per cent of ingredients named in the papyri were still in use in the 1970s.  … The formulations stood comparison too. Checking against the 1973 British Pharmaceutical Codex, which lays down standards and protocols for making up medicines, Campbell found 67 per cent of the ancient Egyptian remedies complied, with one proviso – the Egyptians knew nothing of the need for sterility. … They had enemas, draughts and linctuses, lotions and liniments, creams, ointments and mouthwashes. …. Ignorant of the causes of most diseases, ancient Egyptian doctors inevitably focused on symptoms. …

Knowing the drug, the dose, how it was to be administered and what it was prescribed for meant it was possible to compare its effectiveness with modern remedies. Campbell was impressed. "Sixty-four per cent of the prescriptions had therapeutic value on a par with drugs used in the past 50 years. In many cases even the dosing was right."

As long as he was arrogant, wore a white coat, put his drugs in capsules, and spoke the local language, I doubt most people today could tell the difference if they were treated by an ancient Egyptian doctor.  By the way, the oldest known successful brain surgery was 8000BC.

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  • tcpkac

    All doctors are arrogant ?

  • Betty

    As long as he was arrogant, wore a white coat, put his drugs in capsules, and spoke the local language, I doubt most people today could tell the difference if they were treated by an ancient Egyptian doctor.

    Yea, with the obvious exception of STERILITY.

    And the fact that even though 64% is a pretty decent number… it still means that 36% of the medicines given were not on par with today’s medicine. Seriously, who would go to a doctor where 36% of his treatments did not work well or at all? And who did not wash his hands before/after giving you an enema?

  • Adam Safron

    Arrogance/authority/gravitas could be an essential part of the main ingredient in many medical interventions; i.e. the placebo effect. I would also be willing to bet that ancient Egyptian doctors didn’t just share many of the ingredients with modern medicine, but they also got a lot of mileage out of mechanisms that had little to do with those purported by the treatments: to some extent, ancient Egyptian doctors may have been aware of the power of placebo effects for alleviating psychosomatic contributions to illness; and although they wouldn’t call it by this name, they would also be aware of regression towards the mean. Often times, you just have to give the body time to adapt to the homeostatic perturbation of the current moment, but if your patients come to see you when the illness is at it’s worst, you’re in an ideal position to take credit for the regression towards the mean. For many doctors it’s an extremely convenient thing that people conflate correlation and causation.

  • brent

    I’ve had a doctor, an OLD doctor, give me an injection by jabbing me with the needle, then trying to work out how to attach the syringe to the needle (they were separate in the packet) then wiggling the needle around in my bum to see if that would work, then pulling out the needle and handing it back to us and saying “Take this to your GP, I’m sure he’ll help you.”

    GP threw out the now completely unsterile needle and put the injection into a syringe and managed to give me the shot without wiggling the needle to see what would happen.

    “By the way, the oldest known successful brain surgery was 8000BC.”

    Ok, I’m interested. Tell me more about this.

  • Adam Safron

    Just to be clear, I’m not trying to disparage medical practice/science nor say that all of the efficacy is due to non-rational aspects of treatment. I’m merely bringing up these non-rational aspects because they’re relevant to a blog on the finer points of rational thinking.

  • http://blog.greenideas.com botogol

    I guess you’d know the difference when it came to administering the anaesthetic.

  • http://profile.typekey.com/Unholysmoke/ Ben Jones

    A pinch of salt required with the brain surgery assertion….

    Scientists have found trephined skulls, with neatly cut holes, dating to about 8,000 B.C. On some, the cut edges of bone show definite signs of healing. It means that the patients lived for at least weeks or months after surgery.

    The complaint that the trepanning ‘cured’? A nasty headache.

    The post rings very true though – minus penicillin and sterile instruments, modern doctors don’t have much on their ancestors.

  • Tom

    I’m studying biomedical science at the moment, so I’m particularly interested in OB commenters’ views on this. Hypothetically speaking, what would it take to fix medicine? That is, how can the medical profession as a whole ensure that they cure more people than they kill? Should money currently spent on useless aspects of medicine be put into different aspects, or spent on something else entirely (i.e. non-medical)? In funding science, should we focus on basic research, in the hopes of understanding the body and being able to fix it when it malfunctions, or should we continue sifting through molecules with clinical trials in the hopes that one of them will cure something?

  • Caledonian

    Hypothetically speaking, what would it take to fix medicine? That is, how can the medical profession as a whole ensure that they cure more people than they kill?

    Doctors would have to value their patients’ well-being more than 1) money, 2) the sense of well-being that comes from believing you’ve done the right thing, 3) their fear of breaking with the group / tradition and screwing up, thus being personally responsible.

    And, of course, patients would have to care more about their health than feeling familiar, safe, conventional, and trusting.

    There are very few people who value correctness more than they value being perceived as ‘correct’. People want to feel better. They don’t necessarily want to be better. Which is why they love quacks.

  • Sean

    We haven’t gotten much past trepanning ourselves. Frontal lobotomies were given to cure things like teenage moodiness even into the 80s.

  • scott clark

    To Tom’s question and as a follow on to Caledonian’s response:

    You may want to see Robin’s work on He Who Pays the Piper Must Recognize the Tune, in addition to his work on medicine as showing that you care. If a Dr. delivers medicine (suppose real, effective, health enhancing medicine) in a way that doesn’t fit the patient’s conception of medicine should look and feel like, that Dr. will not get rewarded for it. The larger problem is then that the Drs. have no incentive to gather more and better information about these effective treatments because patients don’t buy it. It is another information/knowledge/bias problem that needs to be worked out.

    To Betty:

    Were you being sarcastic? People go to Drs. all the time and more than 36% of what they do has no discernable effect at all, some have negative effects. See Robin’s work on Cutting Medicine in Half and the reponses that followed on Cato Unbound.
    In fact the rise in homeopathic medicine in the late 1700’s and in the 1800’s was based on the fact that it didn’t do anything, which was better than the alternative medicine at the time which was more likely to make you worse or kill you. My wife is undergoing treatment for an endocrine disorder, and modern medicine in her case still seems to be trial and error, try these drugs, oh, nothing happened, try these drugs, oh you got worse, try these drugs, oh now your a better for six months. In that scenario 66% of what they did was no good.

  • http://billmill.org Bill Mill

    > and modern medicine in her case still seems to be trial and error, try these drugs, oh, nothing happened, try these drugs, oh you got worse, try these drugs, oh now your a better for six months. In that scenario 66% of what they did was no good.

    And what would you have them do instead? What we’ve developed is a wide range of medicines, each of which may or may not work depending on many variables in a supremely complex biological system.

    How, in your opinion, should doctors avoid trial and error?

  • scott clark

    Bill:
    I have no better solution, of course, and I was’t complaining, I was just saying that modern doctors do a lot of things that are not effective, or sometimes harmful, as they try and triangulate to something that works, in response to the comment about who would go to a doctor that was 36% ineffective. Answer: Everyone.

  • scott clark

    Let me be more precise.

    Who would go see a doctor that is 36% ineffective? Answer: My wife, for one.

  • http://billmill.org Bill Mill

    Scott: cool, I just wasn’t sure which side you were coming down on. (Hope the wife does well, btw)

  • Floccina

    Betty asked:
    Seriously, who would go to a doctor where 36% of his treatments did not work well or at all? And who did not wash his hands before/after giving you an enema?

    All those people who go for neck and back surgery. All those people who go to chiropractors.

    Maybe all those people who go to modern doctors.

    Also think about herbalists, acupuncture, even organic food the list goes on.

  • Ian

    Let’s get back to reality here folks. Most humans who ever existed would do almost anything to have the kind of medical care many of you take for granted. You aren’t going to have to watch your children die one after the other. Most of your family will still be alive in 10 years. You probably won’t suffer for large portions of your life.

    It’s an insult to those who have nothing to trash the greatest gift the human race has ever bestowed on itself: modern medical care. Think it’s not so great? I invite you to cancel your insurance. Use the money to buy insurance for someone who will appreciate it. There are people out there suffering and dying every day from conditions that you don’t even know the name of. Grow up.

  • Sam

    This blog is hilarious. Forget the fact that vaccinations and antibiotics have made it possible to actually live past the age of 25, or that the average lifespan is almost 3-4X what it was in ancient egypt… or the fact that people can actually live after a heart attack or cancer…

    No doubt some of the ingredients used in the past are useful today, as many of the drugs today come from plants. Aspirin being a classic example. But no one back then knew that taking aspirin once you are 50+ could reduce your risk of a heart attack (then again, no one back then lived til 50, and no one died of a heart attack, they died because they spited Anubis). But the percentages dont matter, the sheer NUMBER of drugs available today to treat diseases the Eygptians didnt even know existed are what matter.

    I love how you twist the facts in this blog to play to your illogical biases. Is medicine perfect? No. Are doctors perfect no? Are medications perfect? No. Surprise surprise. But you would have be brain-dead to want to choose the medical practices of ancient Egypt over modern medicine.

  • Spanners

    Ancient medicine is something I’ve taken an interest in, as a student of archaeology. There’s actually a lot of interesting medical practices from the ancient world as well as those mentioned here. Trauma surgery, for one, has been around a good while – records of Alexander the Great’s campaigns note that he was treated by his personal surgeon for several wounds; the surgeon was famed for having successfully removed an arrow from the eye of Alexander’s father, Philip of Macedon – this involved the use of a specially designed surgical tool for the job.

    Whilst many commenters are right about the lack of good anaesthesia and sterility in ancient medicine, it’s worth remembering that open injuries, if they could be kept submerged in a pool of the patient’s blood, could be surgically closed with a much reduced risk of infection. But that’s pretty touch and go – trauma victims tend not to lie still, plus there’s little evidence that much effort was made to address shock or pain. Still, there are plenty of good examples from records of the Napoleonic era that describe this practice still in use, so there must (I assume) have been positive observable results.

    There’s loads of other great info on this subject – this is a nice summary 🙂
    http://www.channel4.com/history/microsites/H/history/a-b/ancientsurgery4.html

  • http://tech.groups.yahoo.com/group/futarchy_discuss Tom Breton

    People go to Drs. all the time and more than 36% of what they do has no discernable effect at all, some have negative effects.

    That’s shifting the terms. Campbell (or whoever; I don’t trust New Scientist‘s assignment of credit, because they chronically play games with it) did not conclude that 64% of ancient Egyptian treatments worked, which is what it would have to be for that comparison to make sense. She said that 64% were on a par with drugs used sometime in the last 50 years. She’s giving herself plenty of room to make a favorable choice of comparisons. One also has to suspect that her standard of equivalence was pretty loose.

    She said:

    Campbell was impressed. “Sixty-four per cent of the prescriptions had therapeutic value on a par with drugs used in the past 50 years. In many cases even the dosing was right.”

  • scott clark

    Sam, that’s a pretty skewed reading of posts here. Nobody said Egyptian medicine was superior, just that it has some remarkable similarities to modern medicine.

    Futhermore, I wouldn’t attribute longer lifespans to antibiotics and vaccines, or medicine alone, though of course I am happy to have these things and I have certainly taken advantage of them. Don’t discount nutrition, improved sewage and sanitation systems, mechanization to enhance human labor, and other forms of capital formation and accumulation that make longer life possible.

    No one would be surprised to learn that medical doctors and the field that they are experts in are not perfect. The suprising thing to me is that the rest of society views them and treats them so differently from other experts in other fields.

  • michael vassar

    The claim is not that 36% of Egyptian drugs didn’t work but rather that to the best of our knowledge 36% didn’t work. This probably implies that almost 36% more of their drugs didn’t work than of our drugs, and maybe also that they knew a few useful things that we don’t.

  • Dileepan

    tcpkac,

    >> Seriously, who would go to a doctor where 36% of his treatments did not work well or at all?

    I guess everybody. Modern doctors are generally known to get either the diagnosis or at least the dosage wrong more than once every three times! 🙁

  • Floccina

    Sam the people who contribute to this blog are well aware that vaccinations and antibiotics save lives but in the context that they speak those considered to be more along the line of food, clean water, sanitation and vitamins all of which are not for this discussion considered healthcare though they are necessary for health.

  • Patri Friedman

    While this article is quite interesting, I think it is using the wrong metric. A straight percentage of remedies does not reflect the incidence of these conditions. Most big pharma R&D is focused on a few very common conditions, since that is where the most profit and benefit are to be found.

    So this could just be indicating that there is a “long tail” of conditions & remedies where we still use the old treatments because it is not yet cost-effective to find new ones. Yet we may be getting most of the benefit at the head of the condition distribution. The biotech revolution seems quite promising for better addressing this long tail.

  • Psychohistorian

    The attack on modern medicine is not a claim that it’s the same, it’s a claim that, at the margin, the difference is a lot less than we’re paying for.

    If an ancient Egyptian doctor came to our time an took a high school class to learn about sanitation, he could do many functions (though obviously not all) as well as a modern doctor with a twenty-five year long education. This supports the claim is that doctors do a lot of work where they do not provide much added value given their expense.

    As such, the claims about vaccinations and antibiotics are not terribly relevant. These do not encompass a large portion of our medical expenditures (to my knowledge). Hanson’s point seems to be that doctors are overpaid or we use doctors for work that does not require their expertise, and that a lot of the advances in medicine have been fairly simple and inexpensive and should not translate into our current costs. This post certainly supports that.

    Though “Someone drilled a hole in someone else’s skull, and he didn’t die for at least a few months” doesn’t really count as brain surgery. And the motivation was probably to let out demons or evil spirits or some such, so I’d hardly tout that as the efficacy of ancient medicine.

  • Ian

    I feel that I have definitely gotten my money’s worth from Western medicine. Why? Because I’m still alive. If I lived 2,000 years ago I would be dead now (type I diabetes). So would: my mother and my brother (major childbirth complications), one aunt (like 10 different things), an uncle (alcohol withdrawl resulting in grand mall siezures). My grandmother would have died earlier from skin cancer, and her sister from complications of type II diabetes. My dad had the Hepatitis that can be cured – not sure if that’s lethal if untreated. And I’m sure I’m forgetting stuff.

    Think about it – how many people you know would be dead by now without the modern western medicine you pretend to have so much disdain for? And how many of these things would have been fixable in ancient Egypt? If you pray, give thanks every night for not living 2,000 years ago.

  • Max

    Ian,

    so the modern medicine undoes natural selection? It would be interesting to ponder on the consequences. I know I avoided being voted off this island due to the ulcerative colitis. Bleeding to death ain’t fun.

  • Douglas Knight

    Rather than compare ancient Egyptian medicine to today’s medicine, let’s compare it to the medicine of 1900 or 1850. I’m pretty sure 1850 loses.

  • anonymous

    When I googled define:bias, I got the following definition:

    “A bias is a prejudice in a general or specific sense…”

    Now I look at your statement:

    “As long as he was arrogant, wore a white coat, put his drugs in capsules, and spoke the local language, I doubt most people today could tell the difference if they were treated by an ancient Egyptian doctor.”

    So if you’re saying he would have to be arrogant in order for most people to be unable to tell the difference, aren’t you implying that most doctors are arrogant? Isn’t that a bias? Isn’t this blog called “overcoming bias”?

    Now I look up arrogant in the OED:

    “… aggressively assertive or presumptuous…”

    Now for a definition of presumption:

    “the act of presuming a thing to be true”

    So unless you’ve somehow reliably ascertained that most doctors are arrogant, you’re being presumtpuous, that is, arrogant..

    So you’re being biased on a blog called ‘overcoming bias’, by arrogantly calling doctors arrogant…
    I’ll leave you with one last definition:

    hypocrisy: “the assumption or postulation of moral standards to which one’s own behaviour does not conform”

  • http://brian-jaress.livejournal.com/ Brian Jaress

    I see a few comments pointing out some of the ways that modern medicine is clearly much better than ancient Egyptian medicine, but everyone else seems to be blowing them off.

    Think of it this way: If modern medicine has an effective treatment for something that ancient Egypt had no treatment for, where does that show up in the percentages quoted above?

    It doesn’t.

    The percentages are all percentages of ancient treatments, not modern ones. If the figure were 100%, it would mean that we kept their treatments, or some equivalent, and went on to develop new treatments for other things.

    Considering our bodies haven’t really changed, improving on 36% of what was already shown to work isn’t bad — but the real improvement is all the additional things we can treat.

  • http://entitledtoanopinion.wordpress.com TGGP
  • http://zbooks.blogspot.com Zubon

    For those playing the drinking game at home, we are at three instances of “for a blog called ‘Overcoming Bias'” so far in this comment thread.

  • http://www.poeMD.com Ddx:dx

    Even most physicians have little concept of marginal benefit and “number needed to treat” when considering an intervention. It was stated above “survive a heart attck”…So lets look at the numbers. Angiography and thrombolysis for MI were big interventions developed in the 1990’s. Both saved about 2 lives/1000 when compared with “standard treatment”(O2, meds, hospitalization). So, is that the marginal benefit you expect for this level of intervention? This cost? When I share this well-done data with physicians they are mute. I(an MD) would still recommend the intervention, but awareness of our limited marginal benefit is critical for good advice, care…I’m not sure it’s how I’d want to spend my last $100K.
    Most increases in longevity in human populations can be attributed to public health measures(water, sewer, dwellings). Most of modern medicine is heroism…

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