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establishment had adopted such simple ideas as the clinical trial, then progress became swift. Today the clinical trial is routine in the development of new treatments and medical experts agree that evidence-based medicine is the key to effective healthcare.
    However, people outside the medical establishment sometimes find the concept of evidence-based medicine cold, confusing and intimidating. If you have any sympathy with this point of view, then, once again, it is worth remembering what the world was like before the advent of the clinical trial and evidence-based medicine: doctors were oblivious to the harm they caused by bleeding millions of people, indeed killing many of them, including George Washington. These doctors were not stupid or evil; they merely lacked the knowledge that emerges when medical trials flourish.
    Recall Benjamin Rush, for example, the prolific bleeder who sued for libel and won his case on the day that Washington died. He was a brilliant, well-educated man and a compassionate one, who was responsible for recognizing addiction as a medical condition and realizing that alcoholics lose the capacity to control their drinking behaviour. He was also an advocate for women’s rights, fought to abolish slavery and campaigned against capital punishment. However, this combination of intelligence and decency was not enough to stop him from killing hundreds of patients by bleeding them to death, and encouraging many of his students to do exactly the same.
    Rush was fooled by his respect for ancient ideas coupled with the ad hoc reasons that were invented to justify the use of bloodletting. For example, it would have been easy for Rush to mistake the sedation caused by bloodletting for a genuine improvement, unaware that he was draining the life out of his patients. He was also probably confused by his own memory, selectively remembering those of his patients who survived bleeding and conveniently forgetting those who died. Moreover, Rush would have been tempted to attribute any success to his treatment and to dismiss any failure as the fault of a patient who in any case was destined to die.
    Although evidence-based medicine now condemns the sort of bloodletting that Rush indulged in, it is important to point out that evidence-based medicine also means remaining open to new evidence and revising conclusions. For example, thanks to the latest evidence from new trials, bloodletting is once again an acceptable treatment in very specific situations – it has now been demonstrated, for instance, that bloodletting as a last resort can ease the fluid overload caused by heart failure. Similarly, there is now a role for leeches in helping patients recover from some forms of surgery. For example, in 2007 a woman in Yorkshire had leeches placed in her mouth four times a day for a week and a half after having a cancerous tumour removed and her tongue reconstructed. This was because leeches release chemicals that increase blood flow and thus accelerate healing.
    Despite being an undoubted force for good, evidence-based medicine is occasionally treated with suspicion. Some people perceive it as being a strategy for allowing the medical establishment to defend its own members and their treatments, while excluding outsiders who offer alternative treatments. In fact, as we have seen already, the opposite is often true, because evidence-based medicine actually allows outsiders to be heard – it endorses any treatment that turns out to be effective, regardless of who is behind it, and regardless of how strange it might appear to be. Lemon juice as a treatment for scurvy was an implausible remedy, but the establishment had to accept it because it was backed up by evidence from trials. Bloodletting, on the other hand, was very much a standard treatment, but the establishment eventually had to reject its own practice because it was undermined by evidence from trials.
    There is one episode from the history of medicine that