Question

1. Describe the Importance of Hippocrates' Hypothesis and,

2. how it differed from the common beliefs of the time?

Answer 1

Importance of Hippocrates

Hippocrates was born on the Greek island of Kos in the 5th century BCE, and he became the most famous physician in antiquity. He established a medical school on the island, wrote many treatises on medical matters, and is, through his systematic and empirical investigation of diseases and remedies, credited with being the founder of modern medicine.    

Biographical Details

Information regarding Hippocrates is patchy and unreliable. He was perhaps born c. 460 BCE, but details of his life were speculated upon even in ancient times. One of the oldest sources is the Life of Hippocrates credited to Soranus of Ephesus, himself a physician, who lived in the 1st and 2nd centuries CE. Soranus’ method of quoting from now lost earlier texts has been an invaluable source of information on ancient medicine. He states that Hippocrates knew several 5th-century sophists, notably Gorgias of Leontini, and was taught medicine by both his father and Herodicus of Selymbria, a gymnastic trainer. We also know that Hippocrates set up and ran a school of medicine on Kos.

Plato mentions Hippocrates in his Protagoras, suggesting that he worked for fees and believed the body should be treated as a whole (Phaedrus). The Roman scholar and medical writer Cornelius Celsus claims that Hippocrates was the first to separate medicine from philosophy, and other ancient sources also suggest that Hippocrates believed in the importance of diet and exercise for a healthy body. Soranus goes on to inform us that Hippocrates travelled throughout his life and died at Larissa in Thessaly, c. 370 BCE.

HIPPOCRATES WAS THE FIRST TO SEPARATE MEDICINE FROM PHILOSOPHY & HE BELIEVED IN THE IMPORTANCE OF DIET & EXERCISE FOR A HEALTHY BODY.

In antiquity, many legends arose of Hippocrates’ great talents but most of these are likely pure invention. He reportedly discovered that King Perdiccas II of Macedon’s health problems were down to lovesickness, he eliminated the plague that hit Athens in 430 BCE by burning fires everywhere, and he treated the philosopher Democritus whom everybody thought mad (not without some justification). Hippocrates had three sons who carried on his work - Thessalus, Dracon, and Polybus.    

Hippocratic Corpus

Hippocrates has long been credited with writing a large number of ancient treatises, speeches, and letters on medicine, collectively referred to as the Hippocratic Corpus (Corpus Hippocraticum), which was compiled in the Hellenistic period in Ptolemaic Alexandria. Modern scholars consider that, on stylistic grounds alone, these texts must actually have been written by multiple authors and point out that there is no reference to Hippocrates ever writing anything in sources contemporary with his lifetime. Scholars, therefore, hold the position that some of the texts were written by Hippocrates but exactly which ones are still debated.

The 3rd-century BCE Corpus was edited again in the 1st century CE by the scholars Dioscurides and Capiton. Several ancient writers, often famous physicians themselves, frequently wrote commentaries on works attributed to Hippocrates, amongst the most notable are Herophilus of Chalcedon (4th-3rd century BCE), Apollonius of Citium (1st century BCE), and Galen (2nd-3rd century CE).

The Hippocratic texts deal with all manner of medical topics but can be grouped into the four main categories of diagnosis, biology, treatment and general advice for doctors. There are over 60 treatises, each on specific topics, for example, joints, therapy, regime, surgery, physiology, the progression of diseases, purging remedies, and gynecology. The issues of ethics and medicine’s relation to other subjects, especially philosophy, are also discussed.

The Hippocratic Oath

The famous Hippocratic Oath probably appeared after Hippocrates’ lifetime and was reserved for a select group of doctors. It was actually a religious document ensuring a doctor operated within and for community values. With the Oath the practitioner swore by Apollo, Hygieia, and Panacea to respect their teacher and not to administer poison, abuse patients in any way, use a knife, or break the confidentiality between patient and doctor. Modern versions of the oath, or similar such statements, are still today sworn by many medical students around the world.

Conclusion

Hippocrates is credited by historians with moving the subject of medicine away from the previously supernatural and religious approach, which had been closely linked to the Greek god of healing Asclepius, towards a modern approach of observation, classification, causes and effects, and so on. Even if others before him, such as Alkmaion of Kroton, had also begun to approach medicine in a rational manner and the details of his life and work are few, Hippocrates has, nevertheless, come to be known, just as he was in the ancient world, as the father of modern medicine.

Importance of Hypothesis

There is an increasing familiarity with the principles of evidence-based medicine in the surgical community. As surgeons become more aware of the hierarchy of evidence, grades of recommendations and the principles of critical appraisal, they develop an increasing familiarity with research design. Surgeons and clinicians are looking more and more to the literature and clinical trials to guide their practice; as such, it is becoming a responsibility of the clinical research community to attempt to answer questions that are not only well thought out but also clinically relevant. The development of the research question, including a supportive hypothesis and objectives, is a necessary key step in producing clinically relevant results to be used in evidence-based practice. A well-defined and specific research question is more likely to help guide us in making decisions about study design and population and subsequently what data will be collected and analyzed.1

Objectives of this article

In this article, we discuss important considerations in the development of a research question and hypothesis and in defining objectives for research. By the end of this article, the reader will be able to appreciate the significance of constructing a good research question and developing hypotheses and research objectives for the successful design of a research study. The following article is divided into 3 sections: research question, research hypothesis and research objectives.

Research question

Interest in a particular topic usually begins the research process, but it is the familiarity with the subject that helps define an appropriate research question for a study.1 Questions then arise out of a perceived knowledge deficit within a subject area or field of study.2 Indeed, Haynes suggests that it is important to know “where the boundary between current knowledge and ignorance lies.”1 The challenge in developing an appropriate research question is in determining which clinical uncertainties could or should be studied and also rationalizing the need for their investigation.

Increasing one’s knowledge about the subject of interest can be accomplished in many ways. Appropriate methods include systematically searching the literature, in-depth interviews and focus groups with patients (and proxies) and interviews with experts in the field. In addition, awareness of current trends and technological advances can assist with the development of research questions.2 It is imperative to understand what has been studied about a topic to date in order to further the knowledge that has been previously gathered on a topic. Indeed, some granting institutions (e.g., Canadian Institute for Health Research) encourage applicants to conduct a systematic review of the available evidence if a recent review does not already exist and preferably a pilot or feasibility study before applying for a grant for a full trial.

In-depth knowledge about a subject may generate a number of questions. It then becomes necessary to ask whether these questions can be answered through one study or if more than one study needed.1 Additional research questions can be developed, but several basic principles should be taken into consideration.1 All questions, primary and secondary, should be developed at the beginning and planning stages of a study. Any additional questions should never compromise the primary question because it is the primary research question that forms the basis of the hypothesis and study objectives. It must be kept in mind that within the scope of one study, the presence of a number of research questions will affect and potentially increase the complexity of both the study design and subsequent statistical analyses, not to mention the actual feasibility of answering every question.1 A sensible strategy is to establish a single primary research question around which to focus the study plan.3 In a study, the primary research question should be clearly stated at the end of the introduction of the grant proposal, and it usually specifies the population to be studied, the intervention to be implemented and other circumstantial factors.4

Hulley and colleagues2 have suggested the use of the FINER criteria in the development of a good research question (Box 1). The FINER criteria highlight useful points that may increase the chances of developing a successful research project. A good research question should specify the population of interest, be of interest to the scientific community and potentially to the public, have clinical relevance and further current knowledge in the field (and of course be compliant with the standards of ethical boards and national research standards)

Adapted with permission from Woltehereas the FINER criteria outline the important aspects of the question in general, a useful format to use in the development of a specific research question is the PICO format — consider the population (P) of interest, the intervention (I) being studied, the comparison (C) group (or to what is the intervention being compared) and the outcome of interest (O).3,5,6 Often timing (T) is added to PICO (Box 2) — that is, “Over what time frame will the study take place?”1 The PICOT approach helps generate a question that aids in constructing the framework of the study and subsequently in protocol development by alluding to the inclusion and exclusion criteria and identifying the groups of patients to be included. Knowing the specific population of interest, intervention (and comparator) and outcome of interest may also help the researcher identify an appropriate outcome measurement tool.7 The more defined the population of interest, and thus the more stringent the inclusion and exclusion criteria, the greater the effect on the interpretation and subsequent applicability and generalizability of the research findings.1,2 A restricted study population (and exclusion criteria) may limit bias and increase the internal validity of the study; however, this approach will limit external validity of the study and, thus, the generalizability of the findings to the practical clinical setting. Conversely, a broadly defined study population and inclusion criteria may be representative of practical clinical practice but may increase bias and reduce the internal validity of the study.

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