The Case for Scientific Scrutiny Even for Time-Honored Remedies

Engaging with the arts is good for health. Biophilic architectural design is good for stress. Expressing gratitude is good for well-being. These claims, it would seem, are self-evident. Anecdotes abound and believers believe. So do I.

But, are the claims true? Should they be investigated? I argue, yes, by looking at three cases of traditional practices to promote health and wellness that persisted for centuries. Consider trephination, bloodletting, and acupuncture. These interventions are more invasive than many current wellness interventions. But, as repositories of cultural wisdom refined over millennia, we might also feel more confident that they work. Surely, if the practices weren’t effective, they wouldn’t have survived over the ages. One might reasonably wonder why we should bother to study what works when research costs money, time, and effort. Surely, limited resources could be directed more usefully.

The problem with this logic is that we don’t always know what we think we know.

Trephination

Trephination (also known as trepanning) is an ancient surgical procedure in which a hole is drilled or cut into the skull. Trephination traces back to at least 5000 BCE (Nanayakkara and Gunarathne, 2022). This procedure has been practiced in Africa, Asia, and Europe, and used for therapy and in rituals. It probably evolved independently in different regions rather than diffuse through cultures. Neolithic trephination was thought to relieve people of evil spirits and to make the “dead” undead (Prioreschi, 1991). The history of trephination in Africa also dates at least to the time of Herodotus and was used to treat headaches (Rawlings and Rossitch, 1994).

Many trephined skulls, especially in South America, had fractures and may reflect treatment after blunt head trauma (Potts, 2015). Trephination was conceivably discovered to be helpful in people in comas and with altered mentation from hematomas following head trauma and was then generalized to treat other mental afflictions like convulsions and psychosis. Survival rates of patients varied depending on the method used, with drilling and cutting being particularly dangerous. Over the many years, survival rates are estimated at around 70 to 80 percent, suggesting remarkable skill in these healers. The practice is still used in modern neurosurgery, most commonly for subdural and epidural hematomas, where blood clots on the surface of the brain cause symptoms by compressing underlying brain structures.

Bloodletting

Bloodletting was used therapeutically for thousands of years, as early as 3,000 years ago among the Egyptians, and flourished during the time of Hippocrates, more than 2,000 years ago (Parapia, 2008). Bolstered by ancient Greek humoral theory, the idea was to remove impurities from our circulation. It was used to treat many conditions, including fevers, inflammation, apoplexy, and cholera, and was part of Arabic traditional medicine, even mentioned by Prophet Mohammed. Bloodletting practices occurred in Africa, South America, and India. Prominent physicians over the centuries such as Maimonides, Avicenna, Andreas Vesalius, William Harvey, and Thomas Sydenham defended the practice.

Leeches were used commonly in 19th-century Europe, well past the Age of Enlightenment. However, by the end of the 19th century, bloodletting was recognized as ineffective for most ailments, when mortality statistics and advances in pathology showed bloodletting to be scientifically unsound (Kerridge & Lowe, 1995). Today, bloodletting is used for a handful of very specific conditions, such as polycythemia vera and hemochromatosis, in which people produce too many red blood cells that can lead to stroke and heart attacks. Despite its long history and endorsement by influential authorities over the ages, bloodletting did its share of harm to patients and has proven useful only for relatively uncommon conditions.

Acupuncture

Acupuncture is a traditional Chinese medicine technique in which needles are inserted into the body. This procedure has also been used for at least 4,500 years and possibly as far back as neolithic times. The first clear description of acupuncture as an organized system of diagnosis and treatment is found in The Yellow Emperor’s Classic of Internal Medicine, dating from about 100 BCE (White and Ernst, 2004). The practice diffused to other parts of East Asia and was imported to Europe by travelers like Marco Polo (Hong, 1998a). While the underlying theory of adjusting chi energy across major bodily meridians does not translate easily into modern allopathic medicine, clinical studies in the last half-century demonstrate its effectiveness in treating pain, asthma, postoperative nausea, dysmenorrhea, and motor dysfunction from stroke (Hong, 1998b). Acupuncture is now used commonly to supplement conventional Western medicine (Ahadian, 2002) and is increasingly covered by medical insurance.

Why bother with research?

None of these interventions were transiently fashionable or of limited appeal to a niche group. They persisted for centuries, were bolstered by authorities, and practiced around the world. Yet, they differ from each other when viewed with modern eyes. Trephination helps conditions with increased intracranial pressure, but not indiscriminately to exorcise evil spirits. Bloodletting, based on theory and supported by major authorities, is useful for uncommon disorders and not for whatever ails you. Acupuncture, with a theoretical underpinning that does not translate easily to Western frameworks, is nonetheless finding a place in our therapeutic armamentarium (Burke and colleagues, 2006). We understand the benefits and limitations of these practices because we’ve subjected them to scientific scrutiny, substituting belief with evidence.

Corporations are tripping over themselves to promote wellness programs. However, they are not exactly rushing to find out if the programs actually work; not to mention, how they work, for whom, and under which conditions. The reason to conduct research is that wanting something to be true, by itself, does not make it so.