Monday, January 12, 2015

You Have A Great Idea That Will Save Many Lives - But No One Listens

This blog, deep down, is about how we know what we know.  And how people know things that are simply wrong and believe their wrongs deeply.  WHY?

NPR this morning had the story of Ignaz Semmelweis,  a Hungarian doctor in Vienna in 1846  who wondered why five times more women in one clinic got a fever and died after childbirth than in another clinic.

 In the deadlier clinic, the birthing mothers were treated by all male doctors and med students.  In the other clinic they were treated by female midwives.

The story emphasizes that doctors were just beginning to have science education and Semmelweis started gathering data.  He began with the death statistics that showed the big difference between the two clinics.  Why the difference?  What caused it? 

Hypothesis 1:
In the women run clinic, women birthed on their sides, not on their backs as they did in the male run clinic.  When they changed that in the doctors' clinic, it didn't have any effect. 

Hypothesis 2:
The priest who walked through the doctors' ward ringing a bell, terrified the women and caused them to get the fever.  But they still got fever when they changed the priests route and got rid of the bell.

Semmelweiss took a break.  When he came back a doctor had died after he did an autopsy.  From the NPR piece: 

"This often happened to the pathologists," Duffin says. "There was nothing new about the way he died. He pricked his finger while doing an autopsy on someone who had died from childbed fever." And then he got very sick himself and died."
Before this, they thought the fever was restricted to birthing women, but Semmelweiss realized the doctor died of the same things the women were dying.  A big revelation.

Semmelweiss then realized another difference between the two clinics:  the doctors were all doing autopsies, but the midwives weren't.  Was it something about the autopsies?

Hypothesis 3:
"So Semmelweis hypothesized that there were cadaverous particles, little pieces of corpse, that students were getting on their hands from the cadavers they dissected. And when they delivered the babies, these particles would get inside the women who would develop the disease and die.  If Semmelweis' hypothesis was correct, getting rid of those cadaverous particles should cut down on the death rate from childbed fever."

Semmelweis got the doctors to wash their hands and instruments with chlorine water and the deaths dropped dramatically.

Victory!?  Unfortunately, not.  As the piece continues:
"You'd think everyone would be thrilled. Semmelweis had solved the problem! But they weren't thrilled. For one thing, doctors were upset because Semmelweis' hypothesis made it look like they were the ones giving childbed fever to the women. And Semmelweis was not very tactful. He publicly berated people who disagreed with him and made some influential enemies. Eventually the doctors gave up the chlorine hand-washing, and Semmelweis — he lost his job."
This doesn't dissect the resistance too deeply, but gives us two factors:

  1. ego - the doctors didn't like being seen as the cause of the problem
  2. public relations - (and this one is also ego related)  Semmelweis didn't do a good job of marketing his finding
In fact, things didn't go well for Semmelweis after this.

Stories like this tend to make readers smug.  Oh this is terrible!  How could those doctors be so stupid and selfish?  

It makes listeners/readers feel so superior.  But my interest is in the truths all of us listening to this story are rejecting just as the doctors rejected the truth facing them.  Without introspection about what I should reevaluate in my own life, this story has no value.  In fact it could cause harm by making me think I'm superior to those doctors.  I'm not.  We're not.  We all reject inconvenient truths.  Some rejections are trivial.  Some mainly hurt ourselves.  Other rejected truths cause other people serious harm, even death.  


  1. Semmelweis is cited by philosophers as proposing a major paradigm shift, which is why people didn't listen to him. Though there is a good argument that #2 is closer to what happened: "What I will argue in the next section is that, in fact, Semmelweis simply did not produce a very good case for the monocausality thesis, something that was pointed out time and again by his contemporaries. Taking this into account, there is no puzzle about why his views were rejected: they simply did not hold up to scrutiny" (Dana Tulodziecki, Shattering the Myth of Semmelweis pg 1080).

  2. Ah, you remind me that I fell for the NPR story without double checking Semmelweis.

    But your brief citation from page 1080 (I hope that's an article, not a book) suggests ("[his views] didn't hold up to scrutiny") that he was wrong about the relationship between the autopsies and the deaths and the benefits of cleanliness. It sounds like you're saying it was more Semmelweis' poor promotion skills, but you also suggest resistance to the paradigm shift played a role too. I'd be curious to see whether Tulodziecki is saying he was wrong or just didn't make his case well. The NPR piece does say that Semmelweis was a terrible advocate for his theory. I would add that ego is part of the resistance to a paradigm shift.

    I forgot to finish the date when I posted this, but NPR said it happened in 1846. Pasteur was 24 that year. A University of Arizona page on Germs has this quote: " In 1872 Pierre Pachet, Professor of Physiology at Toulouse made the statement 'Louis Pasteur’s theory of germs is ridiculous fiction'" which supports, I think, the paradigm shift notion. Unless this quote is bogus. :)


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