Experimental Medicine in History

Claude Bernard and Experimental Medicine

Claude Bernard is regarded as one of the first physicians, surgeons, to embrace scientific experimentation as a means of defining medicine. He believed that people who conducted statistical experimentation and stated statistically derived numbers without a definite purpose were in error. His belief was that there should always be a definite article that the experiment was looking for. He gave several examples of his belief in experimentation toward a goal in which he was able to relate his idea of the ridiculousness of just spouting numbers for their sakes. He relates the study of spinal root nerves that found that sometimes they were sensitive and other times they were not. He argued that this experimentation yielded nothing of value because it specified nothing.[footnoteRef:1] He next put forth the example of an individual who conducted a series of operations for the same condition and said that they resulted in a 40% mortality rate.[footnoteRef:2] Bernard again contended that this result meant nothing because it did not say under what conditions the person would be expected to live or die upon receiving the operation. Thus, his biggest complaint was that the so-called medical scientists did not provide true scientific findings that could either be verified or refuted. Their method was lacking. [1: Claude Bernard, An Introduction to the Study of Experimental Medicine, translated by Henry Copley Green (New York: Dover Publications, 1957), 137.] [2: Ibid]

It is the tendency of people to believe in their own observations and trust the statistics that they have compiled. For example, the doctor who gave a 40% fatality rate for his particular surgery may have understood what made one patient live and one die, but he did not share this with the rest of the world, at least not according to Bernard. This misuse of statistics occurs currently just as much as it did in the past. One researcher gave the example of a recent United States census that found that there was a "high correlation between location of churches and violent crime."[footnoteRef:3] Whereas it is a surety in most people's minds that this fact does not exist in reality, the correlation can still be made. The reason for this is that at times people believe just because something correlates with something else they are related. It is poor science not to look farther and discover exactly what is going on to make the statistic seem to work. The reality is that there are a great number of churches, and that many different occurrences, such as violent crime location can be related to the location of churches because they are prolific. Bernard was saying much the same thing. He looked at the so-called scientific experiments that were being done with clinical cases and realized that because doctors were not applying the correct rules of scientific inquiry they were reaching false conclusion, or, at the very least, conclusions that meant exactly nothing when applied. [3: Rahul Dodhia, "Misuse of Statistics," Raven Analytics (accessed Nov 13, 2012) ]

His first argument is that statistics cannot be applied to medicine because it should be what he calls a "determinate" rather than an "indeterminate" science.[footnoteRef:4] He says that he realizes that much of medicine is conjectural, but that physicians should be working toward making it less so. The way that they can do that is with scientific experimentation rather than by believing that medical practice is somehow an art form.[footnoteRef:5] He gives another argument which is the use of the law of large numbers.[footnoteRef:6] His statement regarding this practice is that it is fine in an indeterminate science because they need large numbers to make any sense of what they are looking at many times. It is the argument against a small sample size that they are making, and this applies to most types of science where the numbers are large and can be accessed. However, he says that this does not apply, to any great degree, to medicine. Most of the time a physician is not dealing with a large number of cases. He or she must examine what is available to them and not be afraid to use this experimentation just because there are not a large number of patients with a particular disease of disorder. [4: Claude Bernard, An Introduction to the Study of Experimental Medicine, translated by Henry Copley Green (New York: Dover Publications, 1957), 139.] [5: Ibid.] [6: Ibid, 138.]

Bernard makes the case that statistics are useful to the physician because they lead to the indeterminate, but that cannot be a stopping point.[footnoteRef:7] The solution is to find these indeterminate issues and, through experimentation to make them determinate. He based his entire book "Principles of Experimental Medicine" on the principle of "experimental determinism" instead of on "statistical conjecture." [footnoteRef:8] His belief in the superiority of his system comes from the belief that it is the only way to yield "absolute law" in medicine.[footnoteRef:9] He said that once someone sees a law as determined by experimentation that they can no longer go back to conjecture. The individual has to view it as a certainty then. It seems that his concern is for the patient in a strange way because his belief in experimentation made medicine more exact and actually probably saved many lives. He was trying to bring the profession a step closer to scientific enlightenment and out of the dark ages. [7: Claude Bernard, An Introduction to the Study of Experimental Medicine, translated by Henry Copley Green (New York: Dover Publications, 1957), 140.] [8: Ibid.] [9: Ibid.]

Article One

In a book entitled "Understanding the Language of Science," Steven Darian, himself a scientist, explains many different phenomena, but when taking about medical science he gives a great deal of credit to Claude Bernard. Throughout the book Darian tries to explain how certain scientific language came into being and how the author of the language used it. He says that Claude Bernard was the instrument behind the establishment of medical science in the nineteenth century.[footnoteRef:10] [10: Steven G. Darian, Understanding the Language of Science, (Austin, TX: University of Texas Press, 2003).]

The main goal of the section on Claude Bernard in the book is to explain how he used experimentation to further medical science, and how he advanced all other scientific inquiry also. He quotes Bernard as saying "The observer listens to nature; the experimenter questions and forces her to unveil herself."[footnoteRef:11] This thought that it is possible to take the vagaries of nature and make them, through experimentation, into something that can be used was a quality of Bernard. Darian writes that he was a pioneer who began to use his insights to drive the medical profession forward by leaps and bounds. He discovered that the liver synthesizes glucose which had previously been discounted as an impossibility. He also talks about Bernard's methods of experimentation through comparison. He quotes Bernard as saying that comparative experimentation if "true foundation of experimental medicine."[footnoteRef:12] This writing expanded upon the knowledge to be found in Bernard's own book and showed how his genius was used even further. [11: Ibid, 40.] [12: Ibid, 41.]