Sir William Osler editing his textbook of medicine in 1891 at Johns Hopkins.
Ah, Sir William Osler. Who doesn’t love a good Osler quote? My favorite:
One special advantage of the skeptical attitude of mind is that a man is never vexed to find that after all he has been wrong.
Few men in medical history are as venerated, referenced, quoted, and, dare I say, worshipped as Sir William Osler, “the Father of Modern Medicine.” Rarely have I heard a talk about medical ethics, professionalism, communications, or medical education, where the name of the Great One was not invoked in reverential awe.
We in medicine like our demigods. Medicine has Osler. Surgery has Halstead. Gynecology has Tait, Sims, Kelly, and Bonney. Obstetrics has Williams and DeLee. Don’t get me wrong: each of this men made important breakthroughs. But, in retrospect, they were wrong about almost everything they taught and believed. They were also each powerful personalities of their time, who weren’t necessarily better or smarter than the next guy (or gal), but just happened to be in the right place at the right time to be very influential. But they were definitely creatures of their time.
Joseph DeLee, for example, gave us routine episiotomy and forceps because he believed it would protect the brain from damage caused by the vagina and perineum. I wouldn’t call him the father of the obstetrics that I practice. Was there no other obstetricians of the time who disagreed with him on these (in retrospect) crazy ideas? There definitely were, but they did not have the pulpit to preach from that DeLee had.
Osler was given the greatest pulpit of his generation, as Physician-in-Chief of the well funded Johns Hopkins Hospital (where Halstead and Kelly also headed up their respective departments). Osler was 40 years old when he was so installed (Halstead was 37 and Kelly was 31 when they became Hopkins’ chairs). All of them were just regular guys, who had fairly pedestrian careers up until that point. Howard Kelly frankly had almost no career before being given the reins at Johns Hopkins, but he went on to profoundly influence generations of gynecologists, as Osler did internists and Halstead did surgeons. I suspect I was even named after him. One major impact Howard Kelly had on the field of gynecology was all but killing the then thriving field of vaginal hysterectomy in favor of abdominal hysterectomy (thanks for fighting the establishment, Noble Sproat Heaney).
We still have our demigods today. Physicians are overly-awed by the Distinguished Chair of Such and Such at Ivy League University. We put great faith in the intelligence and integrity of prolifically published professors who spend more time on the speaking circuit than taking care of patients. We aren’t too skeptical of their well-spoken talks of highly-cited papers. It seems a little too cynical to believe that these very successful folks might sometimes put self-interest or self-promotion in front of intellectual honesty and academic integrity. Of course, if you are fan of Retraction Watch like I am, you realize how compromised modern academic journals truly are. Academic medicine and science in general is chock full of folks looking to self-promote, in a quest to push forward their pet ideas, pepper the CVs on the way to tenure or promotion, and shows some success for their next round of funding. This New York Times piece is chilling.
Academic dishonesty and scientific misconduct are rampant today. Career pressure and the need for publications, combined with how easy it is make up data, modify data, or just use inappropriate statistical techniques, makes its very tempting to fudge things just a bit. Anil Potti made up data behind at least 10 hugely impactful cancer genomics papers from Duke University. Dipak Das of the University of Connecticut made headlines for his research into the health benefits of resveratrol, found in red wine. But over 140 of his articles have been retracted due to data falsification. Andrew Wakefield was famously banned from medical practice in the UK after he was convicted of scientific dishonesty in connection to his now retracted paper which claimed to establish a link between the MMR vaccine and autism.
The list of frauds goes on for days. How many people still believe that resveratrol is a legitimate thing, or that vaccines are linked to autism? These are examples of blatant data falsification, but dramatically more commonplace is data fudging or the use of inappropriate statistical methods. It seems the desire to be published is just too much for many “researchers.” Hundreds of papers are retracted each year. Even among the honest authors, peer-review does little to ensure that appropriate conclusions are being drawn or that appropriate methodologies are followed. Sometimes, we just know we are right if only we could prove it! Such is the milieu of academic dishonesty.
We are all only human, and even our demigods are biased and make honest mistakes. Fifty years from now, we will look back at today’s medical science in the same way that today we look back at DES and other medical mistakes of the last century. Forty years ago we were absolutely positive that IV alcohol stopped preterm labor, just as we today are “sure” of lots of things today that undoubtedly will not stand the test of time. This is the nature of scientific discovery. We are no smarter than Osler, Kelly, and Halstead. But at least these giants were men of integrity and honesty, who valued the scientific process and would never allow it to be corrupted by ego, fame-hunger, and manipulation of the peer review and the scientific publication process.
Which brings us to penis captivus.
What is penis captivus? A quick Google search reveals more than 81,000 hits on many leading health websites. The term is meant to describe when, during intercourse, the vagina so tightly clamps down on the penis that the penis cannot be withdrawn from the vagina. Apparently this is a medical emergency, as the penis becomes engorged and blood flow is cut off. The Internet loves penis captivus, with dozens of articles about the true but rare condition. Legitimate authors have researched the condition and written reviews in respected medical books and journals.
So what’s the problem? It’s likely all a fraud. One of the most influential case reports about penis captivus was written by Egerton Yorrick Davis in 1884 in the Philadelphia Medical News. Davis wrote his detailed case report in response to an article that had been previously published in the same journal by Theophilus Parvin entitled An Uncommon Form of Vaginismus.
Below is the E.Y. Davis letter:
This report was repeated dozens of times in the medical literature soon after its publication and eventually became standard fare in textbooks and literature reviews. No doubt it was a favorite of physicians everywhere for its bawdry content.
Egerton Yorick Davis, Jr. contributed many letters and case reports to medical societies over the years and several were apparently published, until his death by drowning shortly after writing the letter about penis captivus. The only problem is that Dr. Davis was a hoax. He never existed. Yorick was the court jester in Hamlet, whom Prince Hamlet speaks of in the famous monologue in the Fifth Act:
Alas, poor Yorick! I knew him, Horatio; a fellow of infinite jest, of most excellent fancy; he hath borne me on his back a thousand times; and now, how abhorred in my imagination it is! My gorge rises at it. Here hung those lips that I have kissed I know not how oft. Where be your gibes now? Your gambols? Your songs? Your flashes of merriment, that were wont to set the table on a roar?
It turns out that the E.Y. Davis was the playful alter ego of one of the Philadelphia Medical News editors, who wrote the piece after Parvin, another editor, wrote his report of treatment of vaginismus with a dilute cocaine solution because he wanted to make fun of Parvin, whom he considered a competitor.
So who was he? None other than Sir William Osler. Yes, Osler committed many cases of academic fraud using this pseudonym. His supporters call it all just good fun and use it to highlight his practical joker side, but it’s more than a practical joke when one uses his position of editorship to create fraudulent medical literature. The Philadelphia Medical News was not gomerblog.com. Osler apparently loved joking about it privately but never admitted that E.Y. Davis was fake. Consequently, a myth was perpetuated. Osler also committed other unmistakable acts of dishonesty and ethical depravity, like stealing the organs from a corpse when the family would not permit an autopsy.
I won’t spend time now discussing why penis captivus is almost certainly not a real clinical entity, though I will say that the vaginal muscles themselves could not physiologically stay so tensed for so long. If you are interested in more detailed commentary, here is an excellent resource. But there are a few lessons to be learned from this story.
- Osler was no peach; and if Sir Osler was no peach then neither are the modern demigods of medicine.
- Don’t believe what you read; apply a skeptical mindset to what you read and consider the overall bulk of the evidence; also consider alternate explanations of the data.
- Don’t be glammed by flashy names, like Duke University or the New England Journal of Medicine; they make the same mistakes and have the same (if not more) academic fraud and dishonesty as smaller institutions and lesser known journals.
- Just because someone has a particular degree or position doesn’t mean that they know what they are doing.
- Don’t believe much of anything from case reports; most case reports are just wrong explanations for something that went diagnosed incorrectly.
- Go with the majority of evidence, not the one bit of outlying data that gets hyped because it is contrary to what we already know.
- Don’t be surprised if many things you hold dear as scientific truths are completely upended in a few years; such is the nature of science.
- Stop believing in Scientism; when someone says, “Science has proven,” stop listening. Science isn’t designed to prove anything. We seek to disprove and tentatively use things we can’t disprove until better evidence comes along allowing us to disprove them.
- Wrong conclusions are sometimes made innocently and sometimes made perniciously; either way, abandon bad science and move on.