by Macy Osborne-Frazier
Oh no, it looks like you’ve caught the flu this season! You should go to your doctor for a Tamiflu prescription and grab some Tylenol on the way home. Have you ever thought about how we know Tamiflu and Tylenol will help you feel better, or how we know what dosage of those drugs to take? That’s where clinical trials come in. Clinical trials are specialized research studies that allow doctors and researchers to test and develop new drugs and disease treatments. Clinical trials have been in practice for thousands of years. In fact, historians think the first ever clinical trial recorded in human history is in the “Book of Daniel” in The Bible. However, modern clinical trials are very different from early versions of clinical trials, and now involve defined experimental controls to make sure we understand how well a new drug or treatment actually works.
Image of James Lind (image source)
The first modern, controlled clinical trial was conducted by James Lind in 1747. Lind became a surgeon for the Royal Navy in the 1730s and noticed that a large number of sailors became sick with scurvy. Scurvy was a widespread disease among sailors, especially on long sea voyages. Sailors with scurvy would become increasingly tired and begin bleeding from their gums and sores along their arms and legs. Eventually, many sailors would die from scurvy-related heart problems.
Drawing of scurvy symptoms (image source)
Lind hypothesized that scurvy was caused by the poor diet of sailors on long sea voyages. Before modern refrigeration, sailors were forced to only take food aboard ships that wouldn’t easily spoil. This meant that sailors would often go months at a time on a ship without eating any fruits or vegetables. Lind had read reports from other sailors and doctors describing how adding various foods and drinks to the sailors’ diets cured scurvy. The problem with these reports was that they all said something different. Lind decided to test all of the suggested diets and compare the results to determine which diet actually cured scurvy in sailors.
Lind waited for the sailors on a sea voyage to start showing symptoms of scurvy. He found 12 men on his ship with similar symptoms and divided them into 6 groups. He gave each group a different diet that had been reported to help cure scurvy. For example, one group was given half a pint of seawater to drink a day, while another group was given 6 spoonfuls of vinegar a day. From his scurvy trial, Lind discovered that when men ate oranges and lemons everyday, they were able to recover from scurvy. Lind was able to publish his discovery that the best way to cure scurvy was to feed sailors citrus fruits. This paper eventually resulted in an order that every sailor be given lemon juice daily, which drastically reduced the number of people contracting scurvy on long sea voyages. We now know that scurvy is caused by a lack of vitamin C, and that citrus fruits are high in vitamin C.
Lind’s publication describing how to treat scurvy (image source)
Modern clinical trials are much more regulated than Lind’s scurvy trial was, but the scurvy trial is still very similar to clinical trials that are done today. Just like Lind, modern doctors and researchers divide test subjects into different groups. Each group will receive a different treatment so that doctors can determine which treatment works best for a disease. Not only can we thank James Lind for discovering how to cure scurvy, we can also thank him for developing the framework for modern clinical trials.
Lind treating sailors by feeding them lemons (image source)
