It may come as a shock, but the United States should look to Ancient Egypt to reform its health system by re-committing to evidence-based medicine. Sure, the Ancient Egyptians may have relied on “magic” . . . but, at the end of the day, their medical treatments were actually quite good. A 2008 article in the Lancet investigated Ancient Egyptian medical treatments and found that Ancient Egypt’s medical system was phenomenally effective, even when held to a modern standard. Pharmaceutical “recipes” were codified in papyri, in sufficient detail to replicate today, with precise instructions given to Ancient Egyptian doctors on how to prescribe them; archaeobotany and phytogeography have helped reveal that 64% of those prescriptions would be therapeutically effective. Even seemingly irrational treatments, like crocodile excrement as a contraceptive, have withstood modern analytical scrutiny.[i]
Contrast Ancient Egypt with the United States. Nearly half of medical procedures in the United States may not genuinely be supported by evidence.[ii] Hundreds of thousands of stable patients receive a cardiac stent in the United States even though this procedure will not prevent myocardial infarction or prolong life, and will precipitate a serious adverse event in 2% of patients.[iii] Astonishingly, the Mayo Clinic published a study in 2013 that contradicted 146 studies, which had previously recommended changing the standard of care (i.e., patients were better off when doctors applied the old standard of care).[iv] The FDA, for example, only requires that drugs be more effective than placebos.[v] Antibiotics are needlessly overprescribed to enhance patient satisfaction.[vi] Even Congress has decided evidence isn’t all that important anymore. The 21st Centuries Cures Act (§ 3031) enshrined “summary level review” into law, lowering evidentiary requirements for drug approval.[vii]
The Ancient Egyptians, under Ptolemy I and Ptolemy II, sought to create the strongest system of medicine the world had ever seen.[viii] They recruited the Greek physician, Herophilus, of Chalcedon, the first to dissect the human body systematically (he effectively invented the disciplines of anatomy and cardiology).[ix] They brought in Erasistratus, of Chios, who rejected Hippocrates’ system of humours, and effectively invented the discipline of pathology.[x] Beyond the medical discoveries, though, the greatest contribution was a process innovation – the systematic critical review of medicine.[xi]
Ancient Egyptians were so committed to evidence-based medicine that they invented successful cures, which could only have been ascertained through meticulous observation. One Ancient Egyptian text, for example, recommended placing moldy bread on wounds (similar to how penicillin might work).[xii]And while Ancient Egyptian physicians had access to metal tools, in practice they preferred seemingly inferior stone tools.[xiii] They had discovered that freshly-sharpened flint tools yielded better patient outcomes (and would have been sterile).[xiv]
Of note, Ancient Egyptian physicians used honey prolifically on open wounds.[xv] They did not understand the mechanism of action; only by utilizing evidence-based medicine could they discover its substantial efficacy. A 2014 study in the Annals of Fire Disasters illustrates the value of evidence-based approaches.[xvi] Cutting-edge antibiotics that had been developed in the 1940’s, such as penicillin, many no longer be effective, on account of adaptations bacteria have developed over time. Honey, however, has not generated any antibiotic resistance and is efficacious against at least 80 species of microorganisms, including MRSA.[xvii] While it may seem far-fetched, the United States should look to Ancient Egypt’s commitment to evidential rigor for insight into meaningful health reform.
image credit: https://www.telegraph.co.uk/culture/art/art-features/10973256/Why-the-world-went-wild-for-King-Tut.html
[i]Rosalie David, The Art of Medicine: The Art of Healing in ancient Egypt: a Scientific Reappraisal, The Lancet Perspectives (2008), https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)61749-3.pdf.
[ii]Eric Ptashnik, Why American doctors keep doing expensive procedures that don’t work, Vox (Feb. 14, 2018), https://www.vox.com/the-big-idea/2017/12/28/16823266/medical-treatments-evidence-based-expensive-cost-stents.
[iii]David Epstein, When Evidence Says No, But Doctors Say Yes, ProPublica (Feb. 22, 2017).
[iv]Vinay Prasad, A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices, Mayo Clinic (Aug. 2013), https://www.mayoclinicproceedings.org/article/S0025-6196(13)00405-9/fulltext.
[v]Aaron Carroll, This Drug Is Safe and Effective. Wait. Compared With What?NY Times (Aug. 20, 2018); Russel Katz, FDA: Evidentiary Standards for Drug Development and Approval NeuroRx (July 2004), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC534930/.
[vi]Jessica Glenza, Doctors in US Incorrectly Prescribe Antibiotics in Nearly a Third of Cases, The Guardian (May 3, 2016), https://www.theguardian.com/society/2016/may/03/us-doctors-antibiotic-prescriptions-study; Kathryn Martinez, et al., Association Between Antibiotic Prescribing for Respiratory Tract Infections and Patient Satisfaction in Direct-to-Consumer Telemedicine, JAMA Internal Medicine (Nov. 2018), https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2705078; Rachel Cohen, Patients Give Doctors High Marks For Prescribing Antibiotics For Common Sniffles, NPR (Oct. 3, 2018), https://www.npr.org/sections/health-shots/2018/10/03/653446952/patients-give-doctors-high-marks-for-prescribing-antibiotics-for-common-sniffles; Brian Krans, Patient Demand Drives Antibiotic Overuse, Healthline (July 22, 2014), https://www.healthline.com/health/antibiotics/addiction-how-patient-demand-helps-drive-epidemic.
[vii]21st Century Cures Act, P.L. 114-255 (Dec. 13, 2016), https://www.congress.gov/bill/114th-congress/house-bill/34/text?overview=closed.
[viii]H.N. Sallam, Aristotle, Godfather of Evidence-Based Evidence, F, V & V in ObGyn11, 13 (2010), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154333/.
[xii]Richard Pérez-Peña, Secrets of the Mummy’s Medicine Chest, NY Times (Sep. 10, 2005), https://www.nytimes.com/2005/09/10/nyregion/secrets-of-the-mummys-medicine-chest.html.
[xv]Pérez-Peña, supra note xii; A Zbuchea, Up-to-date use of honey for burns treatment, Ann Burns Fire Disasters (Mar. 31, 2014), 22-30.