Starting from George Washington’s 1799 death after heavy bloodletting, an ICU physician argues past doctors used accepted theory in good faith—and that today’s confident treatments (surrogate-fixing drugs, tight ICU glucose after later NICE-SUGAR harm, radical mastectomy vs. later trials) can look the same to 2076.

Cited reversals include CAST (encainide/flecainide suppressed PVCs but raised deaths), Prasad’s 146 contradicted practices, and Covid distancing/mask rules that outran mixed observational and randomized evidence; the point is uncertainty, not that those tools never helped.

Guidelines and EHR protocols should stay guides, not commandments: act when lives depend on it, but treat humility as a clinical skill and keep asking whether the patient—not the number or the checklist—is better.

On December 12, 1799, George Washington returned to Mount Vernon after several hours on horseback in snow, hail, and freezing rain. The next day he developed a sore throat and hoarseness, and in the early morning of December 14 he awoke struggling to breathe and swallow. Doctors were called, and what happened next is now one of the most talked-about medical cases in American history.

Washington did not lack medical care. In fact, he received a lot of attention from three skilled physicians, who used the treatments they thought best for someone as sick as he was, such as repeated bloodletting and other methods meant to reduce inflammation and restore balance. Late that night, Washington died.

Even now, more than 200 years later, we are not sure exactly what disease killed Washington. Some experts have suggested acute bacterial epiglottitis, severe pharyngitis, peritonsillar infection, or other causes of upper-airway blockage [1]. What is clear is that Washington lost a large amount of blood, by most estimates about 80 ounces, through repeated bloodletting while he was already very sick. His doctors did not mean to harm him. They thought removing blood would control the inflammation, but it made him worse. Their actions followed a long-standing medical tradition, supported by accepted theories, experience, and the authority of many generations of doctors.

It is easy to look back at this story and feel superior because of our modern knowledge. Today, we understand things like oxygen delivery, blood volume, shock, infections, airway care, IV fluids, antibiotics, and advanced life support. Washington’s doctors did not have this knowledge. But calling them primitive misses the real point. They were trained doctors using the best knowledge they had to try to save their patient. The real question is not why doctors in 1799 believed bloodletting would help. Instead, we should ask which treatments we use today with the same confidence that future doctors might find hard to believe.

Medicine’s Graveyard of Good Ideas

Medicine has always operated between what we know and what we do not. Patients get sick now, but clear scientific answers can take years or even decades to find. Doctors have to watch, guess, treat, and adjust as they go. This process has led to some of our greatest achievements. Anesthesia made surgery possible. Antibiotics turned deadly infections into treatable ones. Insulin changed the outlook for type 1 diabetes. Intensive care, organ transplants, dialysis, cancer treatments, and heart procedures now save people who would not have survived in the past. Admitting mistakes in medicine does not mean ignoring the real progress made.

But history also shows many treatments once thought to be good medicine that are now known to be harmful. Bloodletting is the most famous example because it now seems clearly wrong. For centuries, it fit into the accepted theory that illness came from an imbalance of bodily fluids, so removing blood was supposed to help. Some patients got better after bloodletting simply because many illnesses get better on their own, and these cases made the practice seem effective. When patients died, doctors often blamed the severity of the illness, not the treatment. Without proper studies, doctors’ experiences kept confirming what they already believed.

Mercury provides another sobering example. Mercury compounds were used for centuries to treat syphilis and other diseases despite their substantial toxicity. Records show that mercury was used in many ways, including ointments, pills, injections, and even fumes [2]. Patients often suffered from too much saliva, mouth sores, lost teeth, nerve damage, and other serious problems. Still, some of these side effects were seen as proof that the treatment was working.

The use of mercury lasted so long not because doctors were unintelligent, but because accepted theories, tradition, authority, and stories from practice all supported it. When a practice is new, its advocates must answer the question: why should it be adopted? After widespread adoption, the burden shifts, and skeptics must instead prove why it should be abandoned. Practice becomes habit, habit becomes a standard, and the standard eventually acquires moral and institutional authority.

The physician who follows prevailing practice appears responsible even when evidence is incomplete, while the physician who questions it may appear reckless. That asymmetry helps explain why medical practices can persist even after their scientific foundations begin to weaken.

When More Treatment Meant Better Treatment

Few episodes demonstrate the seductive logic of aggressive treatment better than the history of breast cancer surgery. For much of the 20th century, the Halsted radical mastectomy represented the dominant surgical approach to breast cancer. The procedure removed the breast, pectoral muscles, and extensive regional lymphatic tissue. Within the prevailing model of cancer biology, the reasoning seemed compelling: if cancer spread progressively outward from a primary tumor, then removing more tissue should provide better local control and therefore better survival.

The surgery was impressive anatomically, but it was very hard on patients. Women often ended up with severe disfigurement, loss of function, swelling, pain, and emotional trauma. The real question was not whether the radical mastectomy removed more tissue (it clearly did) but whether taking out more tissue actually led to better results for patients.

Randomized trials eventually challenged the assumption. The National Surgical Adjuvant Breast and Bowel Project B-04 trial compared radical mastectomy with less extensive approaches, and at 25 years of follow-up investigators found no significant survival advantage from the radical procedure in the populations studied [3]. The NSABP B-06 trial subsequently demonstrated that breast-conserving surgery followed by irradiation could provide long-term survival comparable to mastectomy for appropriately selected women with invasive breast cancer [4]. Long-term findings from the Milan trial similarly demonstrated that breast-conserving surgery could achieve survival comparable to radical mastectomy in women with small breast cancers [5].

This lesson applies to much more than breast cancer. Medicine has often mixed up doing more with doing better. We still fall into this trap. More tests can lead to false alarms and unnecessary findings. More drugs can cause side effects and bad interactions. Pushing for stricter targets can create new problems. More invasive procedures can harm patients without helping them live longer or better. Medicine has limits, and sometimes the smartest move is to recognize that more treatment is not always better.

When the Monitor Improved and the Patient Died

Perhaps the clearest modern example of an intervention successfully correcting a physiological abnormality while worsening the outcome comes from cardiology. Physicians recognized that premature ventricular depolarizations after myocardial infarction were associated with an increased........

© Eurasia Review