Galen, Darwin, and P.T. Barnum

My friends would tell you that the Minor Heretic is an easygoing guy. Rarely does anything make me pound my fist on the table and utter a sharp Anglo Saxon verb. Something I saw in the paper did just that the other day.

First, I should lay some historical groundwork. The Greeks, around 400 BCE, adopted a view of human health based on the theory of four humors, which in turn was based on the four elements of ancient physics. The elements were earth, air, fire, and water, and the humors were blood, black bile, yellow bile, and phlegm. By this theory, disease was caused by an imbalance in these humors. An attempt at restoring this balance constituted medicine as it was known, and consisted of bleeding, purging, or sweating the patient, until death or recovery.

A Roman of Greek extraction named Galen (b. 129 CE, d. ~217) popularized this method in his writings. His work was preserved and disseminated by scholars of the Byzantine Empire, and physicians merrily bled and purged according to his system, filling graves till the mid-19^th century. Like a gambler attributing his occasional wins to the efficacy of his lucky rabbit’s foot, a fifth or tenth or seventeenth century physician thought that Galen had shown the one path to human health.

Of course, it was all a crock. Patients of antiquity survived despite the ignorant cruelties of their doctors. It’s a wonder anyone did. Some unfortunate medieval burgher already struggling with influenza, malaria, or cholera would be fed emetics or laxatives, burned with heated metal cups, or have a vein cut and a pint or two drained off.

The practice didn’t let up until the beginnings of modern medicine appeared in the mid 19^th century.

Imagine my dismay when I came across a calendar listing in a local paper advertising a workshop in “Traditional Bleeding and Cupping, Module III” Some quack by the name of Julia Graves has the temerity to charge money for instruction in self mutilation and semi-suicide. Just to add to the hair-tearing aggravation of it, she tagged it with “Module III,” as if it were part of a legitimate course of medical study. The kitchen table in the Minor Heretic household received a minute of serious abuse.

I am trying to imagine who actually signed up for this. I am assuming that P.T. Barnum was correct, that there really is a sucker born every minute, and that some gullible wretches showed up, forked over real money, and offered up their veins to the knife.

I should note that the practice of cupping often involves soaking a small piece of cloth in flammable liquid, placing the cloth in a metal or glass cup, igniting it, and then placing the cup against the victim’s skin. The flaming cloth is thereby doused and the resulting vacuum sucks out a bump of skin. In Galenic theory this extracts some humor or another. In reality it just creates circular burns.

It staggers me that people living in 21^st century America, whatever their religious or political beliefs, could be so ignorant of the basic-below-basic foundations of human biology. We learned things in junior high school that blew this out of the water. Junior high? Hell, elementary school. And yet there are dimwits out there who will consider pre-medieval torture a plausible alternative to medical treatment.

I was talking (ok, ranting) about this with my neighbor, and he suggested that there is a knowledge elite in this country. Information about the physical world is all around us for the taking, essentially free. Only a small percentage of us are paying attention to it, absorbing it, processing it, and acting on it. Many people are just skating along on the minimum information necessary to do their jobs and get through the rituals of daily life.

When confronted with something outside their normal range of experience, these people have no tools for analyzing the truth or falsehood of claims. Armed only with emotion (an instinctive distrust of profit driven corporate medicine?) they think, “’Traditional’ feels good, and ‘Module III’ sounds official,” and expose their throats to the butcher.

And yet, a trip to the emergency room will save them. Natural selection has been blunted by the Trauma Center. Modern medicine, for all its faults, is at its best when confronting the results of abject human stupidity. Reckless drivers, YouTube stunt artists, careless gun owners, and neo-medieval self-medicators will mostly get reassembled and sent off to breed. Critical thinking and impulse control are both made irrelevant by QuickClot bandages, fine suturing, and a ready supply of blood plasma.

I am hoping that the VT Department of Health and/or the Attorney General’s office catch up with Ms. Graves and shut her down. She certainly doesn’t have to worry about a skeptical and informed populace.

For those of you who want further information on medieval medicine, I refer you to the third season of Saturday Night live and a performance by Steve Martin.

Dissecting the Market

I have written about this before – the oxymoron “free market.” I keep hearing it and reading it, so I guess I’ll keep writing about it.

We all know what the “free” in “free market” means – unrestrained or unregulated. The term “market” has more moving parts. I have read many definitions of a market, and they could be summarized as “a set of rules governing a particular type of commercial transaction.” Sometimes the particular rules are as simple as a defined place and time, but they are always backed up by a host of general rules concerning buying and selling.

Markets can’t be unrestrained because they are made out of restraints. They are intrinsically not free.

The same goes for “free trade.” The trade in question is across national borders, which are, by their very nature, restraints. Part of the very definition of a nation state is the ability to restrict what goes across its border. True “free trade” would means a complete transfer of sovereignty from governments to international businesses. Visualize one world government by Wal-Mart and you get the idea.

“Free enterprise” goes down the drain on the same arguments as “free market.” In short, no rules, no trust. No trust, no transaction.

The thing that surprised me as much as coming to this conclusion was the fact that I hadn’t heard of this basic logical contradiction somewhere else. This is not a political argument, really. It is a matter of the accepted meanings of the words contradicting each other.

It makes me think that popular economics is in the same condition today that human anatomy was 467 years ago. That was just before the publication of De Humani Corporis Fabrica (The Structure of the Human Body) by Vesalius. He had performed many dissections of human bodies and published a seven volume illustrated treatise of his work. It angered a lot of anatomy professors.

Before Vesalius, the medical community relied on the works of Galen, a Roman physician who formulated the four humors theory of illness and wrote about human anatomy. Unfortunately for the clients of medieval physicians, both his four humors theory and his anatomical studies were wrong. Forbidden to dissect human bodies, Galen had dissected apes and pigs. The apes were somewhat close to humans, but pigs are quite different in their internal arrangements.

This resulted in ongoing absurdities in the medical schools of the Middle Ages. The students would sit in an operating theater, grouped around a body and a barber-surgeon. The surgeon would cut apart the body as a professor read from a book of Galen. The surgeon would lift up and display a human liver. The professor would describe a pig’s liver. The description would not correspond to reality, as it hadn’t in any of the past dissections, but the students would nod, take notes, and go on to slaughter another generation of patients. Galen, after all was an authority with 1400 years of tradition. The corpse must be defective, not the theory. (See my essay on triumph of doctrine.)

This disconnect was vital to the medical schools of the time. If the discrepancy was acknowledged, the medical establishment would have had to admit that it didn’t know jack, and that paying to hear its members spout nonsense was a waste of time. Likewise paying for actual treatment. Bleeding and purging, anyone?

Today we have economists spouting self-evident nonsense every time they use the word “free” in conjunction with “market,” “trade,” and “enterprise.” They also write about leveling the playing field, as if a single set of economic rules could equally benefit T. Boone Pickens and a retail clerk. They theorize about an economic environment populated by fully informed, rational individuals making decisions with enlightened self interest.

The students nod, take notes, and go forth to change the rules, bend the rules, obscure the facts, and generally rig the game. After all the analysis they still play hunches. All the while they continue to spout about free markets and rational actors. Our economy goes to hell.

The economists have arguments about the greater or lesser role of governments in regulating markets. The free marketeers would have you believe that there is some possible ideal state where government doesn’t interfere with markets. This is impossible, because governments are the necessary makers and enforcers of laws that make markets possible. The New York Stock Exchange is the bastion of free market economics, right? Utterly wrong. The NYSE couldn’t exist without thousands of laws regulating the sale of stocks. In fact, the NYSE is, in essence, a huge set of laws regulating the sale of stocks. Those laws are enforced by the Securities and Exchange Commission. When the SEC fails to do its job of enforcement, and/or Congress fails in its lawmaking responsibilities, we have disasters such as the present economic collapse.

Proposing that government should stop meddling in markets is like proposing that bricklayers should stop meddling in the building of brick houses. The real question is one of architecture. What design will best serve our needs and protect us from the elements?

There are economists who are beginning to study the real, ill-informed, irrational behavior of human beings participating in markets. There are critics pointing out the imperial nudity of classical economics. We need to start listening to these scientific economists who recognize that economics isn’t an exact science. We need to pressure our government to stop playing a supposedly hands-off game with our economy that is actually hands-on in favor of big campaign donors.

We need to start calling bullshit on the use of the expression “free market” and its siblings. That would get us into the realm of modern economic medicine. We need to acknowledge that any system of economic rules has winners and losers, and that as a society we can and should decide that question.