Originally published 2 July 2002
In 1770, an English country doctor named Edward Jenner noticed that milkmaids who had previously contracted cowpox, a relatively mild disease of cattle, were immune to the more virulent human affliction, smallpox. His observation led to the development of a cowpox vaccine for the prevention of smallpox.
Vaccines for other diseases followed. Polio, measles, and yellow fever no longer trouble our children. The same principles of scientific medicine that guided Jenner led to the effective elimination of many other diseases. In this country, malaria, plague, typhoid, scarlet fever, and mortal flu are mostly things of the past.
Toothache and infant mortality have been dramatically reduced.
Antibiotics have mostly eliminated death by bacterial infection. Cancer and heart diseases claim fewer victims.
A hundred years ago, an early death from disease was the default condition; long life a stroke of luck. Today, in the developed world, we consider good health a civil right. How did we get from there to here — from a world racked by suffering and death to newsstands packed with magazines celebrating robust good health? The answer is simple: by the scientific study of cause and effect.
In Jenner’s time, there was no shortage of strategies for reducing the likelihood of catching smallpox, or for treating the disease. People tried to protect themselves by holding vinegar-soaked rags over their noses, wearing amulets of animal teeth or bags of camphor around their necks, or carrying lengths of tarred rope. The color red was supposed to have therapeutic effect; smallpox victims were sometimes wrapped in red blankets and kept in rooms illuminated with red lamps.
Quarantine of smallpox victims was manifestly effective, as was a process called “variolation,” the deliberate inoculation of a healthy person with smallpox scabs or pus through a cut in the skin. No one knows when or where variolation was invented, or why it works, but mortality from smallpox introduced through the skin rather than through the respiratory tract is reduced from 30 percent to about 1 percent — a gamble many people were willing to take.
Jenner’s safe and effective vaccine changed all that, but not without a battle. His 1797 paper submitted to the British Royal Society was rejected as too revolutionary. More experimental proof was needed, said the editor. So, Jenner did more experiments, including the vaccination of his own 11-month-old son. Finally, he published his conclusions as a pamphlet addressed to the general public.
Still, Jenner’s cowpox vaccine was denounced by doctors and clergymen, who argued that injecting a healthy person with material from a diseased animal was dangerous and ungodly. Other, more open-minded doctors listened, and repeated the experiments. Cause and effect was solidly demonstrated. Today, there is not a single case of smallpox in the world.
In our present good health, we have other things to dispute about, and the liveliest battle in American medicine today is between conventional medicine and alternative therapies for which the experimental demonstration of cause and effect is sketchy or nonexistent.
Americans are big boosters of so-called “alternative medicine,” now more fashionably called “complementary medicine.” We spend something like $27 billion on unproven remedies. Forty-two percent of us have tried an alternative to conventional medicine, such as acupuncture, homeopathy, aroma therapy, herbal remedies, or massage therapy.
During the 1990s, responding to a growing alternative-medicine lobby and led by Iowa Democratic Senator Tom Harkin, Congress poured money into the establishment of a National Center for Complementary and Alternative Medicine (originally the Office of Alternative Medicine) at the National Institutes of Health, but not without howls of protest from practitioners of conventional medicine. The protesters object to bestowing prestige on practices that sometimes resemble “witchcraft,” and to diverting funds from research that is more likely to have useful outcomes.
What are we to make of the debate? It is my impression that alternative therapies are mostly benign superstitions, like red blankets for smallpox, that make people feel good, and work, if at all, by the placebo effect. But it is worth remembering that even a century after Jenner, the British playwright George Bernard Shaw called smallpox vaccination “a particularly filthy piece of witchcraft.”
So, yes, by all means, let’s invest a modest amount of money in the study of alternative therapies, if for no other reason than to prove they don’t work, but always open to surprise. Open-mindedness is a crucial ingredient of good science. It will also be helpful to know that alternative remedies are safe.
But those who would have us divert significant public funds to the study of therapies unsupported by a shred of reproducible evidence would do well to remind themselves of the triumphs of scientific medicine.
They might begin by reading Jonathan Tucker’s compelling paean to the study of cause and effect, Scourge: The Once and Future Threat of Smallpox.
