We stand on the shoulders of giants, but it can be an uncomfortable perch.
“This will help your cough,” I said firmly, summoning up all the authority of our ancient profession, of our eternal battle against superstition and ignorance, of titans like Harvey and Lister and Semmelweiss and Pasteur, and of the sacrifices they made often in the face of persecution and ridicule.
“Simple linctus 10 mL qid,” I wrote, and the ghosts of the titans shrank back in disgust. Lister made a retching noise, and Semmelweiss gave me the fingers.
But what can I do, I asked. There is a long cultural tradition of prescribing bottles. The placebo effect may be significant; it’s a gesture of concern, that I’m taking the problem seriously—and it’s safe: “first do no harm” and all.
The ghost of Galileo appeared, waving his bloody thumbs at me. “Look at these bad boys,” he said bitterly. “The fucking pope did that to me, and I endured all this torment for what?”
“Some bastards even tried to poison me,” chipped in Galen. “And for you to prescribe sugar flavoured water is spurious and deceitful. A Cochrane review of the use of antitussives in patients with acute cough showed no clear benefit for duration of cough.”1
“That’s pretty rich,” I said, “coming from someone whose anatomical knowledge was gained from dissecting monkeys.”
“That’s true, monkey boy,” said Vesalius. “You proposed that that the interventricular septum was permeable; set the science of anatomy back a thousand years.”
“Hey,” said Galen, “they wouldn’t let me use gladiators; I tried it once and then there was all this ‘I am Spartacus!’ shit.”
By now I was feeling like a Fox News anchor, and getting sick of all this, like, science. Climate change denial, creationism: at last I understood the attraction, the simplicity of it all. Science is just too conflicting and confusing; fantasy is safer.
“Confusion is not an ignoble state, lad,” said kindly old Bones McCoy, “Sometimes there’s no right thing to do, just the least wrong thing; that’s real medicine for you.”
“Remember,” said Van Helsing, “a firm stab, through the heart.”
“Surely you can’t be serious,” I protested.
“I am serious,” said Rumack, “And don’t call me Shirley.”