Bloodletting in Mongolia | Hacker News Reader

Bloodletting in Mongolia

press-files.anu.edu.au

30 pointsThevet14 comments

I took logic courses from a professor who happened to be an expert on history and philosophy of medicine. He had the interesting tidbit that nearly every culture has had bloodletting in medicinal usage, even though it doesn't help health-- the reason is that the drop in blood pressure makes the patient feel a bit better initially, even though it harms them overall. That's what I remember from it anyways, that was over a decade ago.

It's amazing the amount of historical medicine that was either completely ineffective or actually harmful and hastened the demise of the patient.

In 2018 a story about Anthony Mancinelli, the oldest living barber, made the rounds. https://www.nytimes.com/2018/10/07/nyregion/worlds-oldest-ba... When he first began barbering he had to learn how to apply leeches and (AFAICT) cupping. (Mancinelli died last year: https://www.nytimes.com/2019/09/26/nyregion/anthony-mancinel...) The use of leeches seems very fringe today, but here in California Kaiser Permanente insurance covers cupping. In my neighborhood there's a local acupuncturist that does Hijama, aka "wet cupping"[1], which is literally bloodletting. Though advertised as an Islamic technique such bloodletting was (is?) widely practiced the world over and his clientele seem to be similarly diverse. (Many Chinese and Russians in my neighborhood, among others.)

As far as I understand, insurers are slowly embracing acupuncture, cupping, etc as a cheaper alternative to patients using valuable physician time. Also, AFAICT there's a subset of chiropractors that basically apply modern physical therapy techniques (providing a reverse placebo effect?), and so medical doctors seem to be increasingly comfortable referring patients to chiropractors. Though, the distinctions among different types of chiropractors aren't distinguished in the medical literature so the quack chiropractors (i.e. the ones who diagnose everything as a spinal disorder, do regular x-ray imaging, and charge hundreds of dollars for tapping a couple of vertebrae) seem to be benefiting from the improved legitimacy.

[1] As opposed to regular cupping, which uses suction to break capillaries, bruising the skin.

I believe we lacked the epistemological and statistical techniques to do good medicine until really late. In fact, computer science may precede modern medicine. It's a close thing, in either case.

I think part of the reason these techniques persisted for so long is to some degree the harmful effects can be mitigated by an expert carefully adjusting things to the patient’s needs.

Of course the careful ad hoc adjustments and countermeasures were rarely written down and depended heavily on the expert’s honed intuitions. And people with less talent and knowledge inevitably tried to follow the incomplete instructions.

This meant you had just enough cases of real success to justify the existence of doctors even though the value of an average medical expert historically was questionable (with the probable exception of nursing care which usually did less active harm).

That’s just my theory anyway

This is a dubious explanation, considering that high blood pressure by itself is largely symptom-free.

Consider that if bloodletting had benefits, we would be unlikely to find out about it in our system.

I follow the practice of bloodletting all the time, at the blood bank! For serious reasons though, it's a win-win for both the donor and recipient. Donating blood is especially good for men who have high iron. There's no good way of lowering this besides good 'ole blood removal.

> it's a win-win for both the donor and recipient. Donating blood is especially good for men who have high iron

Donating blood isn't really a win-win for most people - some people with certain conditions benefit - see: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957680/

Most healthy people will gain no benefit from it. In these cases it is simply not significantly harmful.

They may gain from it mentally (psychologically) feeling what they have done may well save someone.

I wonder if inducing small injuries can cause repair pathways to turn on, promoting overall healing if the initial damage was little. Like how mild exercise causes DNA damage which stimulates overall repair, and you can come out ahead as long as the damage isn't too great (don't exercise too much at once).

Influence of Acute Exercise on DNA Repair and PARP Activity before and after Irradiation in Lymphocytes from Trained and Untrained Individuals https://sci-hub.st/10.3390/ijms20122999

This effect is called hormesis [1] and is quite established for various kinds of stressors. For example also in the context of oxygen depriving breathing exercises and cold baths [2] (which is how I came across the term only this week).

On the topic of bloodletting and blood donations, I found these interesting considerations [3]. There is a correlation of less cardiovascular disease among people who donate blood. Of course there are lots of confounding factors here. The article summarizes them nicely.

[1] https://en.wikipedia.org/wiki/Hormesis

[2] https://news.ycombinator.com/item?id=24676116

[3] https://joshmitteldorf.scienceblog.com/2015/11/09/does-donat...

Amusingly, the high you get from spicy food is supposedly similar (I've only read this on the Internet where everyone ultimately links back to a source that isn't particularly authoritative).

Somewhat related: a couple of months ago HN discussed an article about diluting blood plasma reverses some effects of aging in mice. Other related ideas to humans were discussed: https://news.ycombinator.com/item?id=23556209

Perhaps there was some value in bloodletting after all?

My hometown in Shanxi China had this practice as well. It's often to see children with star shaped red mark on their forehead, hands; when they experienced mild fever or headache. It's quite painful when pinched at the beginning. I am not sure if they are actually helpful to relieve the symptoms.

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