Browne's Law of Medicine
MJA 1999; 171: 686
|
|
To the Editor: I would like this opportunity to enunciate "Browne's
Law of Medicine", which states that "The more widely accepted any
proposition is in Medicine, the more likely it is to be wrong." This, of
course, excludes true evidence-based medicine, but many of the
things that we do often have no factual basis, and are undertaken for
some reason that superficially seems logical, and is later found to be
nonsense. The Law fits well with Walter Lippmann's observation that
"When all think alike, no-one is thinking".1
As well-known examples of Browne's Law, I would like to put forward the process of bloodletting, with or without leeches, while even the idea of a physician's washing hands between patients was thought to be heretical, and opposition to this idea drove poor Semmelweis out of the profession.2 The Semmelweis syndrome is still alive and well when one considers the opposition to the idea that ulcers were caused by a bug, not acid. In the more modern era, we gave intragastric milk drips for gastric ulcers,3 kept wounds covered for a week, made postoperative patients stay in bed for a week, precribed complete bedrest for patients who had had heart attacks, and so on. In my own specialty, we gave diuretics to pregnant women to prevent pre-eclampsia,4 and shaved women in labour to prevent infection, while some still believe that oedema alone is a bad obstetric sign or that haemoglobin levels alone are an index of anaemia. I suspect that the almost universal practice of performing total rather than subtotal hysterectomy for benign conditions falls into the Browne's Law category also, as the original reason for performing this operation has long since passed, although it continues to be performed in spite of the increased risks and complications. I am sure that we can all think of examples of Browne's Law and feel that we should never accept what we are told until it can be proven. In the words of the late Professor Julius Sumner Miller, we need to ask ourselves at all times "Why is it so?". David S Browne
©MJA 1999
Readers may print a single copy for personal use. No further reproduction or distribution of the articles should proceed without the permission of the publisher. For permission, contact the Australasian Medical Publishing Company. Journalists are welcome to write news stories based on what they read here, but should acknowledge their source as "an article published on the Internet by The Medical Journal of Australia <http://www.mja.com.au>". <URL: http://www.mja.com.au/> ª 1999 Medical Journal of Australia. We appreciate your comments. |