Buddha and evidence based medicine

The BMJ's efforts to highlight the evidence for evidence based medicine reminds us of its origins.¹ I believe that evidence based medicine has been around us much longer than we think. One of its oldest proponents was the great Indian philosopher, the Buddha.

The Buddhist aim of eliminating suffering coincides with the objectives of medicine.² The emphasis on compassion finds natural expression in the care of the sick. In the Buddhist monasteries it was laid down that the monks must undertake the nursing of the sick. According to a story in the Mahavagga the Buddha himself first showed the precept.³ One day, when he was taking his daily round in the monastery, he noticed an unattended monk suffering from stomach disorder, covered in his own excreta. The Buddha immediately asked one of his disciples to fetch water and washed the monk with that water and laid him down on his bed. Then the Buddha addressed the monks: “Ye, O Bhikkhus [monks], have no mother and father to wait upon you. If you wait not one upon the other, who is there, indeed, who will wait upon you? Whosoever, O Bhikkhus, would wait upon me, he should wait upon the sick.”⁴

Another fragment from the Anguttra Nikaya or “Collection of Gradual Sayings” reads:

Yes, Kalamas, you may well doubt, you may well waver. In a doubtful matter wavering does arise. Now look you, Kalamas. Be ye not misled by report or tradition or hearsay. Be not misled by proficiency in the collections [citing the authority of religious texts], nor by mere logic or inference, nor after considering the reasons, nor after reflection on and approval of some theory, nor because it fits becoming, nor out of respect for a recluse (who holds it).

But if at any time ye know of yourselves: these things are profitable, they are blameless, they are praised by the intelligent; these things, when performed and undertaken, conduce to profit and happiness — then, Kalamas, do ye, having undertaken them, abide therein.⁵

This sutta shows the importance of mistrusting hearsay and tradition long before odds ratios and cost effectiveness analyses came into existence.⁶ The outcomes that the Buddha desired 2000 years ago—“profit” and “happiness”—on a more universal scale are the same that evidence based medicine needs to strive for in the years to come.