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Comment by bookofjoe | Hacker News Reader

Somewhat OT but interesting: "When [Kurt] Semm introduced laparoscopic surgery at the University of Kiel, he had to undergo a brain scan at the request of coworkers as 'only a person with brain damage would perform such laparoscopic surgery.' On September 13, 1980, Semm performed the first laparoscopic appendectomy, opening up the path for a much wider application of minimally invasive surgery. At first, his operation was severely criticized. Initial attempts to publish it were rejected, and the American Journal of Obstetrics and Gynecology stated that his technique was 'unethical.' The president of the German Surgical Society demanded that Semm be suspended from medical practice."—Wikipedia

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You’d be surprised to learn what happened to the person who suggested it is better if the surgeons wash their hands between patients (Ignaz Semmelweis)

I just looked this up and oh wow, and I don't perceive that this situation could have only happened back then.

In the modern day, a lot of people with a lot of education will scoff at anything that hasn't been produced by science, or even anything that simply wasn't taught to them in medical school. Meanwhile, the medical system is full of inefficiencies and outdated practices because of politics and resistance to accepting or learning newer scientific findings. Worthwhile questions about simple ways to improve things often go unanswered, because nobody has been able or willing to do a large, randomized trial about it.

A recent example: Drs. Barry Marshall and Robin Warren, who discovered that gastritis, gastric ulcers, and stomach cancer are caused by the bacteria H. pylori. "In 1983 they submitted their findings so far to the Gastroenterological Society of Australia, but the reviewers turned their paper down, rating it in the bottom 10% of those they received in 1983."—Wikipedia. Marshall and Warren were awarded the Nobel Prize in Physiology or Medicine in 2005 for their discovery.

Hey! We must read similar things.

https://news.ycombinator.com/item?id=17952107

Looking back I could have talked about Zika here. How many childhood viruses are we sure don't cause down-the-road issues like cancer? Most of the time when you get a random virus, the doctor has no clue which one it is and doesn't test to find out. I can remember being told by nurses at the school "there's a virus going around," and that's all we knew: there was some virus, and everyone was getting it. We just assume that these things are harmless and irrelevant once you recover from them.

I really look forward when the premise of Theranos becomes technically viable. Cheap continuous medical tests.

So much in medical diagnosis is just a very coarse decision tree and it is uneconomical to investigate every sickness.

Imagine doctors having more time per patient. Imagine many diseases detected before there are symptoms.

I got carried away here, but medicine looks so much more promising then CS sometimes.

There is huge room for medicine to be improved, but actually the reason for that is there is a lot of resistance to changing things in major ways despite all the things that could be done. A lot of software companies know that their key to staying on top is to improve things fast enough that a group of founders in a co-working space won't put them out of business. Hospitals don't have this pressure at all; they just have to keep providing the acceptable services that they always have, and people will still go there. I've been pressured into unnecessary procedures and even given (multiple!) sales pitches for surgeries that I haven't needed or wanted, because the hospital makes huge amounts of money from it, and consumers aren't savvy enough to know when their doctor is just trying to pad his profitability figures.

Plus, when you write software that disrupts an industry, your employees are still software developers who work and function like software developers. If you want to change healthcare, you need to change how the doctors operate.

> I've been pressured into unnecessary procedures and even given (multiple!) sales pitches for surgeries that I haven't needed or wanted, because the hospital makes huge amounts of money from it, and consumers aren't savvy enough to know when their doctor is just trying to pad his profitability figures.

That's called Fee-For-Service (FFS) and is there is active effort to replace it with quality-based schemes. Providers still get paid for individual services but the rate depends on quality metrics of their overall population. (Source: worked in software for Population Health)

The inefficiencies you describe are less from the clinical side and more from the administrative side. Many of these admin-level people are doing what they can in an incredibly complex maze of processes, most of which started for a good reason. But they are process bees, and unable to make any changes: there's a huge barrier to change as of course nobody wants to be responsible for worse outcomes / deaths due to failure to respect process—yet they are immune from repercussions if poor outcomes are cause by said process.

More to the point, clinicians live in a constant grey zone: everything is a risk tradeoff and they do what they can to get the best outcome. The adminstrative folk see things in black and white. Here's a real example: outpatient office has slightly expired meds that are life-saving if a procedure goes bad, but new meds are not available because factory got damaged by hurricane. Common-sense is that a med does go from perfect to useless overnight and a few weeks is no big deal, especially when there is no alternative. Administrative view is the meds can't be used and must immediately be discarded because having them around the office will expose them to liability during audits... yet of course doesn't understand why that means all procedures of that type would get cancelled.

I'm a retired neurosurgical anesthesiologist with 37 years of experience. Medications one day after their so-called expiration dates are just as effective as they were 24 hours earlier. Loss of potency and therapeutic efficacy over time varies tremendously depending on storage conditions: drugs kept refrigerated and in the dark will likely work just fine for YEARS after their expiration date. Pharmaceutical companies have noted that they are extremely conservative when it comes to expiration dates, much preferring to err on the side of caution. Dept. of eating your own dogfood: I had an anaphylactic/allergic reaction of unknown etiology in late 2015, my first ever; I had to go to the ER for IV steroids and Benadryl for treatment. No recurrence since. I immediately bought two Epi-Pens, one for my house and one for my car. Their expiration date was March 2017. I am completely comfortable not having purchased new ones, especially considering their now inflated prices even after all the bad publicity that focused on their markup. So I have bet my life on my belief that these "expired" epinephrine injectors will save my life should I ever have another anaphylactic/allergic reaction. However — if someone asked me for advice, I would tell them to get up-to-date ones; as a former practicing physician, this is one of those cases where what you advise is quite different from what you yourself would do.

We also assume that we only get a virus when we notice it.

The reality is probably more like: You're exposed to millions of different viral antigens over the course of your lifetime; Many of them don't have a mechanism to really hurt you, and nearly all of them are dealt with efficiently by your immune system.

Not only do they not cause symptoms, we don't even have a mechanism to identify them unless we already know what we're looking for.

"Ancient Viruses Are Buried in Your DNA":https://www.nytimes.com/2017/10/04/science/ancient-viruses-d...

Side note, my daughter was born at Semmelweis hospital in Vienna. My wife was studying in Vienna at the time. That's when I heard of Semmelweis and read up all about him.

It's weird in retrospect.

When my grandfather had his gall bladder removed (late 1960s, I think), he spent about 4-6 weeks in hospital and another couple of weeks at home recovering; last year, I had my gall bladder removed, they sent me home after three days. Now that's progress!

It is indeed progress, all that time spend among the sick and not moving around is very hurtful to the human body. It is mainly that realization that causes the difference, and not better surgical techniques I think.

Mmmh, one large scar across your abdomen (~20cm, I think in case of my grandfather) vs. four incisions about 1cm each makes a huge difference.

Being able to get up and move around on the next day vs. having to lie in bed for weeks certainly makes a difference psychologically, but the laparoscopic procedure does put a much smaller burden on the body, too.

I was home the next day after having mine out. It sucked for a couple of days as my body absorbed the gases they pumped my body up with, but then it was fine.

I had my gallbladder out in 2010, three day stay as well, and while I took a few days to get back to being able to walk comfortably (this was pre-lifting so I was a scrawny weak guy generally so took longer to recover) it was still amazing how quickly you could bounce back from having an organ removed.

My GF had a laparoscopy a few years ago where they removed a 10cm cyst. She was home the next day, and that was only because they had a slight concern. She had another one a few weeks ago, first one under the knife, home the same day.

Still 4-6 weeks of recovery, but that's mostly due to them having to inflate the abdominal cavity to be able to see / work and a bit of bruising and shifting of stuff.

My gallbladder removal 5 years ago was outpatient surgery. I went in around 7am and was home on the couch by mid afternoon. Gave up the serious pain meds the next day since the side effects (zero attention span) were more annoying than the bit of pain. It's amazing how far we've come for some medical treatments.

>> Gave up the serious pain meds the next day since the side effects (zero attention span) were more annoying than the bit of pain.

Next time you can try Ibuprofen + Tylenol, to avoid mentioned side effects.

Ibuprofen Plus Acetaminophen Equals Opioid Plus Acetaminophen for Acute Severe Extremity Pain: https://www.aafp.org/afp/2018/0301/p348.html

I was a little disappointed I did not get any opioid analgesics after the procedure, but on the plus side, I did not need it. I got Metamizole (https://en.wikipedia.org/wiki/Metamizole) on the first day and was told I could ask for more on the second day, but the pain was negligible, so I did not ask for more.

But also - how much of that is medical progress, and how much of that is ballooning costs coupled with insurance companies refusing to cover more than the absolute minimum (and in some cases much less than what really should be the minimum for the sake of safe recovery)?

Good question. I think the medical progress is tremendous. My grandfather needed weeks before he could sit up again without serious pain, and he had a scar that went all across his abdomen. I had four small incisions (the largest was about 2cm long) and was on my legs and walking around without trouble the next day. I did not even need or get serious pain medication. As long as I stayed in the hospital, the doctor looked at the incisions every day to see if there was any sign of inflammation or infection. About the only serious discomfort I had was from the gas they used to inflate my abdominal cavity; but that was not so much painful as uncomfortable.

As far as I can tell, gall bladder removal is a fairly routine procedure by now, and the risks and possible complications are well enough understood that a competent surgeon can tell after three days if the procedure went well or if there are any problems. (Also, they told me to come back immediately if I experienced any pain or fever, or the incisions appeared not to heal properly.)

I Germany, hospitals usually get flat fee per case depending on the diagnosis, so there is an incentive to release patients as soon as possible. But all the doctors and nurses I have met so far take the health of their patients very seriously, and I do not believe they would release somebody who was still in need of medical care. Plus, ethical considerations aside, that might incur legal repercussions for the hospital and the doctor ordering the release, even in Germany.

Tells you a thing or two about the social nature of applied sciences.

The "Semmelweiss reflex" https://en.wikipedia.org/wiki/Semmelweis_reflex

That the laparascopic pioneer's name is Semm is unreal. You couldn't make it up.

Wow, given the context, I just immediately assumed it was coined because of the story OP detailed. An incredible coincidence!

to paraphrase randall munroe, what are the odds that we would have two unrelated US presidents whose names both started with T-R-U-M ?

I found this definition very strange, from its choice of words and mentioning “undeveloped planets”?!

"Mob behavior found among primates and larval hominids on undeveloped planets, in which a discovery of important scientific fact is punished"

It was irony.

The article concedes that it is a "polemical definition" -- it may still be the first documented usage.

This effect is currently happening on Alzheimer's research: people, including veteran experts, are rejecting the viral theory because it's so crazy.

Maybe in a few years we'll lament that...

An aspect of this that is seldom remembered is that Semmelweiss was a HUGE jerk, which didn't help adoption. Instead of telling or showing other doctors how things could be better, he called them barbarian murderers for not washing their hands. It was a decade before he'd even have a civil conversation about it, or publish for peer review.

There's a lesson in that...sometimes being right isn't enough on it's own.

Semmelweis also couldn’t explain why his procedure supposedly worked. Again that’s hugely problematic: a sound theory requires an explanatory framework. Otherwise it’s just not convincing.

Are there examples of other fields being so staunchly/abusively conservative? I'm struggling to imagine a physicist, engineer, or attorney being forced to undergo a mental examination for suggesting a radical new theory or procedure.

Presumably they had a brain scan machine (scanner?) nearby, ready to go. Everyone likes a joke with a prop.

"I hold that space cannot be curved, for the simple reason that it can have no properties. It might as well be said that God has properties. He has not, but only attributes and these are of our own making. Of properties we can only speak when dealing with matter filling the space. To say that in the presence of large bodies space becomes curved, is equivalent to stating that something can act upon nothing. I for one, refuse to subscribe to such a view."—Nikola Tesla

Perhaps he will be validated when we develop/discover a deeper theory.

After all, we have physicists going around now (e.g. Nima) saying 'spacetime is doomed'

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