The Charlatan, the Academic, and the Showman

THE CHARLATAN, THE ACADEMIC, AND THE SHOWMAN

I end the chapter on a sad note: our ingratitude toward many who have helped us get here—letting our ancestors survive.

Our misunderstanding of convex tinkering, antifragility, and how to tame randomness is woven into our institutions—though not consciously and explicitly. There is a category of people in medicine called the empirics, or empirical skeptics, the doers, and that is about it—we do not have many names for them as they have not written a lot of books. Many of their works were destroyed or hidden from cultural consciousness, or have naturally dropped out of the archives, and their memory has been treated very badly by history. Formal thinkers and theorizing theorizers tend to write books; seat-of-the-pants people tend to be practitioners who are often content to get the excitement, make or lose the money, and discourse at the pub. Their experiences are often formalized by academics; indeed, history has been written by those who want you to believe that reasoning has a monopoly or near monopoly on the production of knowledge.

So the final point here is about those called charlatans. Some were, others were less so; some were not; and many were borderline. For a long time official medicine had to compete with crowds of flashy showmen, mountebanks, quacks, sorcerers and sorceresses, and all manner of unlicensed practitioners. Some were itinerant, going from town to town carrying out their curative acts in front of large gatherings. They would perform surgery on occasion while repeating incantations.

This category included doctors who did not subscribe to the dominant Graeco-Arabic school of rational medicine, developed in the Hellenistic world of Asia Minor and later grown by the Arabic language school. The Romans were an anti-theoretical pragmatic bunch; the Arabs loved everything philosophical and “scientific” and put Aristotle, about whom nobody seemed to have cared much until then, on a pedestal. For instance we know very, very little of the skeptical empirical school of Menodotus of Nicomedia—we know a lot more about Galen, the rationalist. Medicine, for the Arabs, was a scholarly pursuit and founded on the logic of Aristotle and the methods of Galen; they abhorred experience. Medical practitioners were the Other.

The regulation of the medical establishment corresponds to worries about the empirics for economic reasons as competition made their incomes drop. So no wonder these were bundled with the thieves, to wit this long title for an Elizabethan treatise: A short discourse, or, discouery of certaine stratagems, whereby our London-empericks, haue bene obserued strongly to oppugne, and oft times to expugne their poore patients purses.

“Charlatan” was held to be a synonym for empirick. The word “empiric” designated someone who relied on experiment and experience to ascertain what was correct. In other words, trial and error and tinkering. That was held to be inferior—professionally, socially, and intellectually. It is still not considered to be very “intelligent.”

But luckily for us, the empirics enjoyed immense popular support and could not be uprooted. You do not see their works, but they left a huge imprint on medicine.

Note the initial peaking of iatrogenics after the academization—and institutionalization—of medicine with the onset of modernity. It has only recently started to reverse. Also, formal academics, seen in the light of history, were not better than those they called charlatans—they just hid their fraud under the weight of more convincing rationalizations. They were just organized quacks. My hope is for that to change.

Now, I agree that most nonacademically vetted medical practitioners were scoundrels, mountebanks, quacks, and often even worse than these. But let’s hold off jumping to the wrong conclusions. Formalists, to protect their turf, have always played on the logical fallacy that if quacks are found among nonacademics, nonacademics are all quacks. They keep doing it: the statement all that is nonrigorous is nonacademic (assuming one is a sucker and believes it) does not imply that all that is nonacademic is nonrigorous. The fight between the “legitimate” doctors and the Others is quite enlightening, particularly when you note that doctors were silently (and reluctantly) copying some of the remedies and cures developed and promoted by the Others. They had to do so for economic reasons. They benefited from the collective trial and error of the Others. And the process led to cures, now integrated into medicine.

Now, reader, let us take a minute and pay some respect. Consider our ingratitude to those who got us here, got our disrespect, and do not even know that they were heroes.