| The Starting Point: Shaman Medicine Three thousand years ago, when medical knowledge was limited, healing practices were deeply intertwined with superstitions. This era, known as the time of Shaman Medicine , was marked by shamans who claimed to possess supernatural powers to heal diseases. They lived in a period that came before the time of Hippocrates. Back then, illnesses were thought to be caused by hidden mystical forces, and treatments involved magical mixtures and strange rituals that had no scientific basis. These practices were dominated by magical beliefs and false notions, making them more like myths than actual medicine as we understand it today. This approach to healing lasted for many centuries until Hippocrates introduced a new philosophy of medical practice that changed the course of medicine. ----------------------------------------- The Beginning of Medicine: Hippocrates and Galen Medical practice was influenced by Greek philosophy, which rejected magic and superstitions and established the foundations of a new medical paradigm led by physicians like Hippocrates and Galen. They advocated using reason and logic to understand diseases, based on the concept that illnesses arise from physical changes within the body. This understanding paved the way for treatment through herbs, rest, hygiene, and moderation in food and drink. These ideas were revolutionary for their time, focusing on the healing power of herbs and their role in curing diseases, thus forming the basis for modern medicine. Not only did they distance themselves from magic as a medical philosophy, but they also established new principles for medical practice, such as refraining from treatment without proper diagnosis and adopting a philosophy of non-intervention in cases where the disease was not understood. Although there were no clinical trials, scientific research, or even statistical records of diseases, an essential development occurred: the beginning of documenting physicians' personal experiences in dealing with illnesses, describing, and treating them. This marked the start of medical history and the accumulation of therapeutic knowledge over the centuries. The era of medical documentation began with personal experiences, and theories emerged to explain diseases, such as the theory of temperaments and theories of balance. Despite many erroneous theories, they encouraged a departure from magic and superstition. ----------------------------------------- Medicine in the Middle Ages: During the Middle Ages, physicians built upon the foundations laid by Hippocrates and Galen while incorporating improvements and expanding the documentation of medical practices. This era saw the creation of monumental medical works, such as Avicenna's The Canon of Medicine , as well as the contributions of notable figures like Al-Razi and Al-Zahrawi. It was a time of intensive documentation, where physicians recorded their personal experiences with illnesses and treatments. Muslim physicians played a crucial role in translating and preserving Greek medical knowledge while also contributing their own insights and advancements. However, the medical practices of this time lacked organized clinical trials as we understand them today. Similarly, basic sciences like physics, mathematics, and chemistry were not yet applied to explore the nature of diseases or the body's mechanisms. The medical philosophy of the Middle Ages can be described as phenomenological. Physicians focused primarily on treating visible symptoms without fully understanding the internal workings of the body's organs. This symptom-based approach remained the dominant paradigm until the 18th century, when modern medicine began to emerge, evolving in its methods, content, and overall philosophy. ----------------------------------------- The Beginnings of Modern Medicine and the Use of Scientific Methods: By the 17th century, medicine underwent significant changes driven by scientific advancements in physics, chemistry, and mathematics. The foundations of modern scientific philosophy began to emerge, emphasizing scientific inquiry as the primary tool for discovering truth. This approach relied on testing hypotheses through experimentation, marking a shift in how medicine was understood and practiced. However, this transformation was slow and gradual. Initially, medical experimentation was adopted cautiously and on a small scale. A key example is the famous scurvy treatment experiment in the early 18th century, which demonstrated the potential of the scientific method in medicine. Later, groundbreaking studies, such as John Snow's work in epidemiology and the discoveries of Robert Koch and Louis Pasteur in bacteriology, laid the groundwork for modern medicine. The formal establishment of modern medical philosophy came in 1865, a pivotal year in medical history. This was largely due to the publication of An Introduction to the Study of Experimental Medicine by the French physician Claude Bernard . This book revolutionized the medical field, compelling the global medical community to adopt hypothesis testing as the basis for scientific truth. It also challenged prior knowledge that lacked evidence, experimentation, and proof. This shift led healthcare practitioners to embrace scientific research as the best way to discover truths. They rejected magical thinking, intuition, and preconceived notions, adopting the motto: "Don't think; conduct the experiment." ----------------------------------------- The Medical Information Explosion and Evidence-Based Medicine: Today, healthcare practitioners publish approximately one million medical studies annually. This raises an important question: how can practitioners keep up with such a vast amount of research, evaluate it, and make informed medical decisions? In response to this challenge, there was a growing demand for a structured scientific methodology to help practitioners make well-informed decisions. This led to the emergence of a new medical philosophy in the early 1990s known as Evidence-Based Medicine (EBM). EBM relies on the systematic evaluation of research and provides clear guidelines to help healthcare practitioners make accurate decisions, especially in the face of an information explosion and conflicting medical evidence. The term "Evidence-Based Medicine" was established as a cornerstone of modern medical philosophy in 1991. It introduced tools to evaluate, critique, and identify gaps in medical research. These tools quickly gained global recognition due to their immense value to healthcare practitioners and have since become an integral part of medical education. In the first image, you can see the original Evidence-Based Medicine pyramid, published in 1991. The second image showcases its updated version, redesigned as a table in 2004, to improve usability and effectiveness. |
