¿The first clinical trial?

Dr. Humberto Reynales MD. MSc. PhD

¿What is the first known clinical trial? It is said that of James Lind in 1753 in which the treatment for scurvy was evaluated in a group of sailors. However, there is information about what could be considered the first «clinical trial» and found in the book of Daniel in the Bible, which says:

Daniel and his companions in Nebuchadnezzar’s court

In the third year of the reign of Jehoiakim, king of Judah, Nebuchadnezzar, king of Babylon, came to Jerusalem and besieged it. The Lord gave Joaquim, king of Judah, and a part of the objects of the House of God into his hands. Nebuchadnezzar took them to the country of Senaar, and deposited the objects in the treasury of his god. The king ordered Ashpenaz, chief of his eunuchs, to select from among the Israelites of royal line or noble family, some young men without any physical defect, of good appearance, versed in all kinds of wisdom, endowed with knowledge, intelligent and apt. to serve in the king’s palace, to be instructed in the literature and language of the Chaldeans. The king assigned them for each day a portion of his own delicacies and of the wine that he drank. They were to be educated for three years, and at the end of those years they would put themselves in the service of the king. Among them were Daniel, Ananias, Misael, and Azariah, who were Jews.

But the chief of the eunuchs gave them other names: he called Daniel Beltasar; to Ananias, Shadrach; to Mishael, Meshach, and to Azariah, Abed Denied. Daniel was determined not to contaminate himself with the king’s delicacies and the wine he drank, and he pleaded with the chief eunuch not to force him to contaminate himself. God caused him to gain the affection and sympathy of the chief eunuch. But he said to Daniel: “I fear my lord the king, who has assigned food and drink to you; if he sees your face more haggard than that of young people of the same age, you would endanger my head in front of the king.

For this reason, Daniel said to the guard, to whom the chief of the eunuchs had entrusted the care of Daniel, Ananias, Misael and Azarías: “Please put your servants to the test for ten days; that they give us vegetables to eat and water to drink; then compare our faces with that of the young men who eat the king’s delicacies, and act with your servants according to what you see. He accepted the proposal, and put them to the test for ten days. At the end of those days, it was seen that they had a better countenance and were more rosy than all the young men who ate the king’s delicacies. Since then, the guard withdrew the delicacies and the wine that they should drink, and gave them vegetables.

God gave these four young men science and intelligence in everything related to literature and wisdom, and Daniel could understand visions and dreams of all kinds.

At the end of the days that the king had set for the young men to be presented to him, the chief of the eunuchs brought them to Nebuchadnezzar. The king conversed with them, and among them there was no other like Daniel, Ananias, Misael, and Azarias. They remained in the king’s service, and in everything the king asked them about matters of wisdom and discernment, he found them ten times superior to all the magicians and fortune-tellers in his entire kingdom. So Daniel continued until the first year of King Cyrus.

Outline of the clinical study

This “clinical trial” compares two groups of young people (sample) who each receive one of two diets (intervention) for ten days: one rich in vegetables and water and the other with the delicacies of the King, including a good wine. The result is evaluated according to the countenance of the young people (dependent variable) evaluated by the guard (researcher) in charge. The results (without a statistical analysis reported) favor the group that receives water and vegetables and also leads to an application of the conclusions obtained, such as eliminating delicacies and wine from the diet of others.

That this first «clinical trial» is related to adequate nutrition is very timely in our time when we know the importance of healthy lifestyles in reducing the risk of cardiovascular disease.