In this issue, WJM starts an ongoing series called Medical Myths. We aim to encourage readers to evaluate critically even the most standard and widespread practices, when they are based on tradition and the weight of authority, but in the absence of, or contrary to, available evidence.
Although our use of the term myth does not necessarily imply all the elements of classical mythology, it is appropriate because mythological medical practices may well arise from the same social needs, and serve a similar purpose, as cultural mythology. In the larger sense, myths are shared stories that arise and live for generations, initially in oral tradition, but eventually taking on new life in literary versions created by poets, journalists, and historians (or textbook authors). Myths seem to respond to profound communal needs, most often including the need to justify existing power relations, whether they be between gods and humans, the community and the individual, men and women, parents and children, teachers and students, or specialists and generalists. Myths try to assure us that our experiences are shared, and they can function as a means of social control and certification of legitimacy.
Myth does its work in the heart and can therefore be more powerful than the logic to which it has always been opposed. Poets like Homer were the first great mythologists, but myth plays a role in all aspects of communal life. Great logicians—like Plato, for example—frequently recognized this, and deployed mythos to support their abstract logos, which they thought most people would never be able (or even want) to comprehend. Politicians, throughout history, have used and manipulated mythology to win support for projects the underlying logic of which might be otherwise unappealing. Hitler used the Greek myth of racial purity with enormous success, and the feuding aristocracy of Europe, in World War I, relied on myths of nationalistic pride, religious hatred, and racial superiority to help convince the poor of their countries to murder each other by the millions. Modern politicians exploit all types of mythology—from ancient Biblical “promises” about land, to religious pronouncements about the “proper” relationship between men and women, to memories of glorious past battles against brutal enemies, to nationalistic concepts of racial or ethnic unworthiness—to further their ends. Readers can surely think of many of the ways in which myth is used today to incite group hatred, or attack protest, or innovation, or any real challenge to the status quo.
Medicine, too, has long been the subject of mythology. The Greeks and Romans created myths about the first physician, Asklepios (or Aesculapius), a son of Apollo. The Greeks believed that all human skills came from the gods, and by tying medicine to such an important god as Apollo, they invested it with great power and importance. Asklepios' two sons were included by Homer as heroic warriors in the Trojan War, thus conferring aristocratic status on physicians, who as a group became known as Sons of Asklepios.
Early Greek and Roman poems told mythological tales about medicine and healers. The first such poem, the anonymous Hymn to Asklepios, hails this first physician as a “great source of delight to human beings,” one who “charms away pain.” Similarly, the great poet Pindar calls him the “gentle architect of pain relief.” Although Greek healers could not easily claim to prolong life, they attained heroic status nonetheless. On the other hand, when Pindar's Asklepios (and by extension all physicians) over-stepped his bounds by reviving a dead man, he was blasted to Hades by Zeus' thunderbolt, reminding us of the danger of pride (hubris), such as is reflected by a physician's attempt to be god-like (by cheating death).
Medical myths based on authoritarian dictates, in the absence of or contrary to evidence, must also serve a similar need. The first myth we will cover is the prohibition of analgesia for patients with a possible surgical cause of abdominal pain—a telling example (see p 209). Restriction of pain relief—relief of pain being the very core of what healers have always done and for which they have always been exalted (as the Greek myths remind us)—seems clearly antithetical to the interests of both physicians and their patients. How could an authority like Cope have propounded this contrarian principle so forcefully, and he and his disciples inculcated it so successfully throughout the profession, in the absence of any evidence? Whose interests did it (and does it still) serve? Why do physicians of all stripes continue to underuse analgesics, not only in the setting of acute abdominal pain, but also in so many other areas of medicine, based on discredited concepts (but ongoing mythology) about “creating addicts,” and “drug-seekers” and “obscuring diagnosis”?
Mythology in general plays to our hearts, to get us to believe things for which logic or evidence is lacking. When myths convince us to act in ways that are contrary to our own interests, or (for healers) to the interests of patients, we must first recognize them for what they are, then critically challenge their assumptions, and finally, have the courage to abandon them.
Competing interests: None declared