When was the first clinical trial conducted?
Clinical trials are basically a test drive for a new treatment or medicine. The first recorded trial dates back to ancient Babylon, while the first controlled trial - much like what we rely on today - was held as early as 1747!
Many of you may be familiar with the concept of clinical trials: the effect of interventions (e.g., drugs, surgical techniques) is tested in human subjects in a scientifically and ethically responsible manner. Believe it or not, the first record of one is in the Book of Daniel in the Bible. King Nebuchadnezzar of Babylon wished to keep his people in good physical health and thought that meat and wine were the way to go. Yet several men of royal origin expressed their preference for vegetables and water. The King allowed them to follow this rebellious idea for 10 days. At the end of the trial period, the health of the meat-lovers and the veggie-rebels was compared and the latter won. The King consequently allowed them to continue with their lifestyle and so ends the oldest written story of a public health decision guided by the results of an experimental setting.
The first controlled clinical trial (similar to the ones conducted nowadays) was organized by the physician James Lind on May 20th in 1747. His preoccupation was curing scurvy (i.e., vitamin C deficiency), that was afflicting many sailors in the British fleet. Lind believed that acid could cure “the putrefaction” of the body. When disease hit the Salisbury ship at sea, Lind tested his theory on 12 afflicted sailors. In contrast to the dietary trial of king Nebuchadnezzar, in Lind’s trial the participants were divided into groups that were very similar in lifestyle and health, and who had developed signs of scurvy in the same time period. They all shared the same housing conditions and the same diet, except for one ingredient: either cider, sulfuric acid, vinegar, sea water, two oranges and one lemon, or “an electary (ie., drug mixed with water or honey into a paste) recommended by a hospital surgeon” were given to pairs of two sailors per testing group. After several days, the first to be cured were in the oranges and lemon group, followed by the cider group. Unfortunately, due to a strong belief that scurvy was due to putrefaction inside the body, physicians were reluctant to accept the idea that vitamin C deficiency was the actual cause of scurvy. Scientific literature at that time was also written in an ambiguous way that made it rather unattractive to read, and the quality and reliability of scientific observations was also less than ideal. To make things worse, the costs of citrus fruit were high and the availability low. All in all, it wasn’t until after 1800 (more than 50 years later) that lemon juice was introduced to the diet of British sailors as standard prevention for scurvy.
Want to know more? The James Lind Library offers a historical and theoretical guide to fair testing in health care.