Take a look at Oeuvres and be sure to read the notes left by the Curator.
Please, Read this lovely article regarding the Oeuvres.
Paré prided himself on being a man of science and research. Most of his publications were works that were reflections of a life time of medical research. However, much of his work was based on personal experience rather then what would now be considered proper research methods. There is a great deal of advantage in a medical provider having first hand experience in their field of practice. There is much that a person cannot learn from a book! But when it comes to researching new ways to practice medicine, there is much folly in this method of research. Yet, there were things that he was doing that are still practiced today when researching. It is important to remember that methods for researching in medicine was a new field unto itself and both Paré and Vesalius contributed towards developing that field which was founded by both Hippocrates and Galen.
So, let’s consider medical research!
All through out history, doctors have harmed their patients when they believed they were helping because they were using treatments that had not been properly tested. This is documented as far back as Hippocrates time and there are cases within modern times. Paré (as well as the other men we’ve talked about) understood the importance of medical research for improving medical practice.
Ignoring uncertainties about the effects of treatments has led to avoidable suffering and deaths. To reduce this suffering and premature mortality, treatment uncertainties must be acknowledged and addressed, first by reviewing systematically what is already known, and then in well designed research to reduce continuing uncertainties.
Hippocrates developed the theory of the humors and from that theory many treatments were developed. For centuries, this theory was not questioned. Galen furthered this theory by expanding on it with the concepts of keeping the humors in balance with various treatments. For centuries people believed the theory that illnesses were caused by humoral imbalances, and patients were bled and purged, made to vomit and take snuff, in the belief that this would end the supposed imbalances. This is an example of the medical world ignoring the uncertainties of treatment. No one considered to question their value.
One thing that Paré was doing right was that he was comparing treatments. He stumbled upon the importance of this when he ran out of the oil and then tried a different treatment instead. This story paints a clear picture as to the importance of trying and comparing different treatments before settling upon a single treatment as the “best.” It is important to constantly seek to improve care by continuing to try knew treatments in an effort to find better ways to care for our patients.
Treatment comparisons are required to take account of the natural course of health problems, placebo effects, and to go beyond impressions about treatment effects. But treatment comparisons need to be fair to avoid untrustworthy and sometimes dangerously incorrect conclusions about the effects of treatments.
The thing is that there is this weird thing called the placebo effect. When we believe that we are going to get better, we have better out comes. This is often referred to as “mind over body.” We really don’t know why the faith in the treatment makes such a difference, but it does. Sometimes, we need only have faith in God or our doctors to get this same benefit. The wellness of our soul and heart does lead to the wellness of our bodies. Thus, when looking at the effectiveness of a treatment, we need to take the placebo effect into account. Paré didn’t know about the placebo effect and thus didn’t take it into account when performing any of his research. Because even surgical outcomes are effected by the placebo effect.
Our bodies are amazing. They heal themselves very well when they are allowed to do so. When trying a new treatment, research must look for evidence that the treatment is improving the healing course. Treatment should improve the way that our bodies heal or improve the outcomes of the disease course as compared to what our bodies could do on their own. If they make things worse or make no difference they we should let our bodies do what they do best. Paré also believed in this one. He was known to have said: “Cure occasionally, relieve often, console always.” This was a recognition that medicine is limited and that it is often better to let nature run its course.
The amount the treatment effects the illness or injury matters. First, it can determine if the treatment is worth the side effects that it will cause (all treatments have side effects). Secondly, the more dramatic the effect of the treatment, the more sure we can be that the benefit is coming from the treatment rather then from bias derived through comparison. Paré always suggested that his treatments had dramatic effects, but this is unlikely. It is more likely that he was falling into the trap of bias and limited research sampling.
It is clear that good research is needed, but there is always the challenge of discovering the best ways to perform that research. Medical research must struggle to find fair ways to research differing treatment options to ensure that the treatments doctors provide are not harming their patients.
Untrustworthy treatment comparisons are those in which biases, or the play of chance, or both result in misleading estimates of the effects of treatments. Fair treatment comparisons avoid biases and reduce the effects of the play of chance.
Fair tests entail taking steps to reduce the likelihood that we will be misled by the effects of biases of various sorts.
Whether biases are inadvertent or deliberate, the consequences are the same: unless tests of treatment are fair, some useless or harmful treatments will seem to be useful, while some useful treatments will seem useless or harmful.
References and Other Sources:
- Treatment Comparisons
- Placebo Effects in Surgery
- Fair Treatment Comparisons
- Avoiding Biases
- Treatment Uncertainties
- About Fair Tests
- Why are fair tests of treatments needed?
- Why do we need fair tests of treatments?
- Key Concepts for assessing claims about treatment effects