Evidence-based medicine and the man with an elephant nose

As an economist, I typically measure treatment value based on clinical trials, real-world data and other sources. However, sometimes medicine is more an art than a science. Consider the cases reported in the Early Modern Medicine blog of the man with the elephant nose:

In sixteenth-century Leuven, a troubled man sent for a physician to help him with his unusually long nose. The man believed that his nose was of ‘such a prodigious length’, it resembled the ‘snoute’ of an elephant. It hindered him in everything he did, to the extent that sometimes it ‘lay in the dish’ where his supper was served. His physician, at this point, artfully and carefully, ‘conveighed a long pudding’ onto the nose of the desperate man, and then with a Barber’s razor ‘finely cut away’ the offending pudding nose while his patient was drowsy from a sleeping draft. The physician prescribed him a wholesome diet and sent the man away, relieved of his extraordinarily long nose, and the burden of ‘fear of harme and inconvenience’.

This case history was described in the English translation of the medical treatise, The Touchstone of Complexions (1576) by the Dutch physician, Levinus Lemnius, as an example of ‘melancholicke’ fantasy. Instead of assuming the man was possessed by a malevolent spirit or demon (a possible diagnosis at this time),[ that he was a ‘lunatic’ and beyond treatment, or dismissing his delusion to his face, the sixteenth-century physician in the story entered into the world of the ‘phantasie’ to try and help his patient’s obvious distress.

Clearly, there is not–nor likely ever will be–a clinical trial for the benefits of shaving a pudding nose. Nevertheless, allowing physicians the time and space to be able to identify creative solutions to patient problems should not be considered a thing of the past. She also my post summarizing Charles Manski’s article on the limitations of evidence-based medicine.

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