[Lessons from the history of therapy--therapeutic optimism and its pitfalls]

If we are to help patients effectively, our understanding of diseases and our therapeutic potential should, again and again, just be somewhat better than they actually are. Throughout the ages this has been the fundamental situation in medical practice. The response on the physician's part has nearly always been an attitude of therapeutic optimism. At all times physicians--and patients also--have relied on therapeutic principles and remedies based on professional experience and medical theory. In conjunction with the (generally recognized) healing powers of nature, and of (unrecognized) autosuggestion, this has led to many satisfactory and even remarkable cures. Examples from antiquity to the 19th century are quoted, and the snags of an over-optimistic attitude become evident, viz. a rational therapy is no better than the underlying pathogenetic theory; exaggerated therapeutic activity may cause useless torment to the patient (a point already made by Hippocrates); the optimistic physician or the enthusiastic pioneer of a new remedy may be blind to toxic side effects or the development of addiction. To sum up: therapeutic optimism is fine--but don't overdo it!