Franklin’s Forgotten Triumph: Scientific Testing

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On August 11 they issued their unanimous report to the king. Benjamin Franklin’s signature stood first, and such was his preeminence that throughout Europe and America scientists and laypeople alike felt that it had been he who had settled the issue. Ever after, history has known this study as the Franklin Commission. Mesmerism was dead, and Mesmer soon left Paris. He was lucky. Ten years later Lavoisier would lose his head to the guillotine, and Dr. Guillotin just barely missed going under its blade too. Mesmer ended up in Switzerland, largely forgotten, and years later he died there in poverty.

Although Mesmerism itself died out, the importance of Franklin’s blind protocol was not lost. In 1799 the English physician John Haygarth took the next step with the development of true placebo treatments. The Franklin protocol had compared treatment and no treatment, under blind conditions. Haygarth refined the idea when he was asked to evaluate a medical device invented by a Connecticut doctor, Elisha Perkins. Like Mesmer’s treatments, Perkins’s were based on the manipulation of a mysterious energy.

Perkins’s apparatus consisted of two rods, one iron, the other brass, about three inches long. The rods were stroked over the body at the site of the affliction. Perkins theorized that they removed a harmful magnetic field. In considering how to go about testing them, Haygarth quite consciously followed Franklin’s lead. He created a second set of rods that looked exactly like the metal ones but were made of wood, which is of course nonmagnetic, and he gave treatments to subjects who were blind to which rods were being used. As Haygarth explained it, what he did was “prepare a pair of false, exactly to resemble the true, tractors.” He added: “Let the secret be kept inviolate. Let the efficiency of both be impartially tried. ”

In another set of experiments, Haygarth coated rods with wax, also making them nonconductors. As the result of using Franklin’s blind protocol and adding his contribution of a deliberately sham treatment, he could report a conclusion much like Franklin’s two decades earlier: “The whole effect undoubtedly depends upon the impression which can be made upon the patient’s Imagination.”

Stuart Green, a surgeon and medical professor on the faculty of the Department of Orthopaedic Surgery at the University of California, Irvine, has traced Franklin’s influence through the history of medicine. He describes what happened next: In a few decades “came numerous placebo-controlled inquiries, in Europe and America, into the professed benefits of [Samuel] Hahnemann’s homeopathic remedies, which cited the Franklin Commission’s strategies. Other blind assessments followed, scrutinizing everything from rheumatic fever and psychologic illnesses to testicular extract injections and cocaine.”

Franklin began the idea of the blind protocol in science, and Haygarth added the concept of the identical sham treatment. However, the statistical understanding of their day had not evolved enough to supply the final piece necessary for modern medical research, and it would not come for more than a century. It was finally provided by the English mathematician and statistician Sir Ronald Aylmer Fisher. Beginning in 1919, Fisher began a several-year effort that would redefine the field of statistics. Franklin and Haygarth had made observations about differences between real and sham or no treatment but could provide no statistical assessment of the power of their conclusions. Fisher figured out how to do that, augmenting Franklin’s blind protocol with the idea of randomization, calculations of probability, and what he called “likelihood.”

As Dr. Green explains, “The final step in creating a thoroughly modern method of verifying the benefit of a particular treatment followed statistician R. A. Fisher’s insistence that randomly assigning subjects to a treatment group or a control [placebo] group permits valid statistical comparisons between the two groups to some definable level of confidence.”

With that addition, the trail blazed by Franklin and his commission has grown to become the roadway in science that largely determines what medicines we take, what chemicals can be used in our environment, and whether we can trust an experiment’s results.