Correspondence

Ancient Clinical Trials

N Engl J Med 2003; 348:83-84January 2, 2003

Article

To the Editor:

With all due respect to Drs. Lepreau and Boylston (Aug. 29 issue),1,2 I would propose that the earliest clinical trial was neither Watson's study of smallpox3 nor Lind's study of the prevention of scurvy.4 The first published report of a clinical trial has biblical origins. In the Book of Daniel,5 reference is made to the unwillingness of the Israelite Daniel to accept the diet offered by the Babylonian king Nebuchadnezzar. The king's official had put a steward in charge of Daniel and his three friends (Shadrach, Meshach, and Abednego):

Daniel said to the steward . . . “Test your servants for ten days; let us be given vegetables to eat and water to drink. Then let our appearance and the appearance of the youths who eat the king's rich food be observed by you, and according to what you see deal with your servants.” So he hearkened to them in this matter, and tested them for ten days. At the end of ten days it was seen that they were better in appearance and fatter in flesh than all the youths who ate the king's rich food. So the steward took away their rich food and the wine they were to drink and gave them vegetables.

Edmund J. Lewis, M.D.
Rush–Presbyterian–St. Luke's Medical Center, Chicago, IL 60612
hfollmer@rush.edu

5 References

1. 1

   Lepreau FJ. Clinical investigation in the 18th century. N Engl J Med 2002;347:692-692
   Full Text | Web of Science | Medline

2. 2

   Boylston AW. Clinical investigation in the 18th century. N Engl J Med 2002;347:692-692
   Full Text | Web of Science

3. 3

   Boylston AW. Clinical investigation of smallpox in 1767. N Engl J Med 2002;346:1326-1328
   Full Text | Web of Science | Medline

4. 4

   Lind J. A treatise of the scurvy: in three parts, containing an inquiry into the nature, causes, and cure of that disease: together with a critical and chronological view of what has been published on the subject. London: A. Millar, 1753.
   

5. 5

   Daniel 1:11-16. In: The Holy Bible. Revised standard version. New York: American Bible Society, 1995.
   

Author/Editor Response

I acknowledge Dr. Lewis's successful search for an earlier clinical trial, one that was performed a couple of thousand years ago and described in the Book of Daniel. Now, the health benefits of a vegetable diet and exercise seem to be continually rediscovered for the benefit of magazine publishers. In his Medical Aphorisms, Maimonides quotes Hippocrates: “The maintenance of health depends upon the avoidance of satiation and the abandonment of laziness for any exertion.”

The following text was inadvertently omitted from my earlier letter, in the quoted passage from James Lind's 1753 report on a shipboard trial involving patients with scurvy: “Two others had each two oranges and one lemon given them every day. . . . They continued but six days under this course having consumed the quantity that could be spared.” The most sudden and visible effects were perceived from the use of the oranges and lemons.

Frank J. Lepreau, M.D.
74 Old Harbor Rd., Westport, MA 02790

Citing Articles (2)

Citing Articles

1. 1

   (2010) CardioPulse Articles * EP-Europace, a recent addition to the family of ESC journals * The future of medical trials in the 21st century. European Heart Journal 31:7, 757-763
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2. 2

   Andrew Booth. (2006) Counting what counts: performance measurement and evidence-based practice. Performance Measurement and Metrics 7:2, 63-74
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