The Doctor Who Championed Hand-Washing and Briefly Saved Lives | Hacker News Reader

The Doctor Who Championed Hand-Washing and Briefly Saved Lives

npr.org

64 pointsHooke41 comments

His work was ignored, ironically, through a lack of scientific reasoning - by which the critics meant there was no theoretical basis for his evidence. It was taken seriously when Pasteur provided the theory, however, the failure to recognise the idea advanced evidence-based medicine - which is where we are today. So, ignoring him actually advanced science ;-)

Contemporary reaction to Ignaz Semmelweis

Semmelweis's critics claimed his findings lacked scientific reasoning. The failure of the nineteenth-century scientific community to recognize Semmelweis's findings, and the nature of the flawed critiques outlined below, helped advance a positivist epistemology, leading to the emergence of evidence-based medicine. [1]

[1] http://en.wikipedia.org/wiki/Contemporary_reaction_to_Ignaz_...

The perversion of science that believes an observation must be accompanied by a theory (preferably acceptable to the current mainstream) is still alive and well, even in medicine, positivist epistemology or no. Once you start looking for it you'll see it at least once a month even in popular press articles.

But a perversion it still is. It is eminently scientific to simply document and even publish an inexplicable observation, and only later hope that somebody can incorporate it into a testable theory.

To watch a putative scientist discard evidence because it has no theory with it boggles my mind, but even here on HN I've seen articles about papers getting rejected for this reason in the last year, so it's a real problem even today.

A modern-day analogue to this would be the "back is best" campaign for putting infants to sleep on their backs as a way to reduce SIDS. The evidence is overwhelming that putting infants to sleep on their backs (vs stomachs or sides) reduces the rate of SIDS significantly. We have no idea why, but that doesn't really matter.

It's hard to understand how a scientist could be arrogant enough to dismiss legitimate evidence simply because the underlying mechanism isn't understood.

The key is testing the behavior and theory.

There are often lots of confounding factors - in the SIDS case, much of the decrease in SIDS rate can be attributed to changes in factors (continuing the decrease from before the "back to sleep" campaign, generally safer sleep areas, changes in cause-of-death coding, etc.) https://naturaltothecore.wordpress.com/2013/02/14/revisiting...

When you don't have the correct theory or mechanism, it's easy to do the wrong thing - like when the British navy thought acidity prevented scurvy and shifted from using lemon juice to more-acidic lime juice processed with copper tubing that destroyed the vitamin C... http://en.wikipedia.org/wiki/Scurvy

Rather than just following a statistical anomaly, you need to devise and perform tests that will invalidate your theory, as was done with the other theories (e.g., the priest bell in the article). This is perilous when people's lives or global economies are at stake, and so anomaly hunting and cargo cult science can persist in high-stakes, difficult to test environments.

I would observe that A: nothing I said precludes any of that; certainly "science's" job is not done with the mere observation of facts and B: nothing about any of that is helped by including spurious theories in the observation of a brute, unexplainable fact.

Also, I'd happily set the bar higher on correlations to be reported in this manner... then again, I consider 0.05 to be a mistake anyhow that should simply be rectified as that has been concretely demonstrated to not be enough, IMHO.

I agree with your overall point, but I would walk it back just a notch by pointing out that being forced (or at least encouraged) to have a theory first helps to prevent correlation "fishing". If you accidentally stumble upon some really interesting relationship, then that is great and ideally would be shared with the world. But if that sort of thing is allowed to be published without any scrutiny, the incentive becomes to just throw tests at a dataset until it yields something that appears interesting. If you perform enough random tests on a dataset, you are very, very likely to eventually find something "unusual" or "interesting".

Sure. Anyone with the most basic stats knowledge knows that if you dig long enough you'll find random correlations. That's solved by demanding evidence be repeatable rather than requiring the evidence fit into a nice theory.

But asking for a theory can help the situation, that was my point. Of course demanding a theory even in the face of repeated findings isn't helpful, but encouraging a theory, or giving "bonus points" for a theory is, I think, a perfectly reasonable thing to do.

>He publicly berated people who disagreed with him and made some influential enemies.

This piqued my curiosity. Managed to dig up this quote attributed to him by "Forgotten Ideas, Neglected Pioneers"

>In this massacre you, Herr Professor, have participated. The homicide must cease, and with the object of bringing this homicide to an end, I shall keep watch, and every man who dares to spread dangerious errors regarding puerperal fever will find me an active opponent. For me there is no other means for checking the murder than to unsparingly unmask my opponents.

I can kind of see why people didn't like him.

His statements and arguments were correct - that ought to be all that mattered.

Your italics are telling. Messages never, ever exist in a vacuum; if they did, RMS would not alienate people with his usually-correct but often-irrationally-irate rants.

Communication is not just about your message, it's about the interpretation of your message. If you don't take that into account, you can be right all day long, but you may fail to be constructive or effective, and you share that failure with the person who -- perhaps reasonably -- fails to take your poorly-conveyed criticism well.

You are right, I was saying how things ought to be, not how they often are.

In this case, many people were being killed due to the doctors' actions. Despite the very good evidence, the doctors preferred to play politics, and continue to kill/murder their patients rather than lose face.

A most extreme example of the triumph of self-interest over reason and honesty.

I'm of two minds. Sure, it would be great if scientists were able to ignore the personality and tone of the person making an observation or advancing a theory. But it would also be even better if everyone (including people with big, lifesaving ideas) could exercise a little self-restraint and show some respect for the emotions of others, if only because that's the way you get other human beings to listen to you (but also, hopefully, just because it's the right thing to do).

You know now that they are correct. The other doctors didn't know for sure then. I think is undeniable that, even with the doubt of that being correct, they (the other doctors) should have behaved more scientifically about it. But when you are not sure if the statements are correct, it doesn't help if the proponent attracts antipathy.

In the end, I believe the veredict is, with justice, that the medical society at the time failed as a whole. But we might have had a different outcome if Dr. Semmelweis had more political skills. I don't want to acuse the man of anything in here, and of course this a personal, subjective, unfounded opinion; but it might be that his proud about being correct was more important to him than his wish to save more lives. Even unjusticed heroes have flaws, especially vanity related ones.

I am sounding like devil's advocate here, but I really don't want to blame Dr. Semmelweis of nothing here, nor discredit his accomplishments. I just want to give some perspective here, a human perspective. Science is a lot about humanity. Both in the human beings learning about a major scientific breakthrough and the human beings responsible for the breakthrough. If you want to change the world, you have to make sacrificies. Sometimes in your pride.

Several points:

(1) "doctors didn't know for sure" - that is a usual state for a doctor - e.g. 'the symptoms of this patient strongly suggest x, but it could also be y or z. Given the data, the best course of action is ...'. Do you imagine that a doctor even today, examining a patient with e.g. persistent headaches, or chest pains, or ..., knows 'for sure'?

(2) I am not a medic. But a few times I have helped people in critical condition (accidents etc) - in all cases, I did my absolute best to save the persons' lives. If paramedic's had shown up saying 'you xxxxing idiot, you ought to be doing xyz' I would have been happy to accept their advice, no matter how they 'presented' it. I hope you would also.

(3) In farming work in the past, I have often made mistakes (either ignorance or error) when caring for animals, sometimes those animals died due to my mistakes. Being told 'you xxxx xxxx why didn't you do xyz' afterwards, meant that I did better next time. I sure as hell didn't think 'oh, I don't like the way that is being presented, I think I'll just ignore it'.

To be clear, I am condemning the doctors of the time.

I am not necessarily disagreeing with you about whether or not Semmelweis could have been more tactful - I don't know enough to really comment (e.g. it might be that he was tactful initially, but as time went on and he was ignored, he 'turned up the volume').

Your example is different because you're a layman and you're going to pay attention to someone who knows what they are talking about.

If you were the subject matter expert, and some guy appears and tells you that you're doing it all wrong, ego tends to play a bigger role!

>Your example is different because you're a layman and you're going to pay attention to someone who knows what they are talking about.

For (2), yes. The 'it must be presented to me in a way that does not make me lose face' part still applies.

For (3), not really. My 'patient' has just died - I cannot hide from the fact that there is probably something better that I could have done - and the other (lay) person has more experience of this situation than me. I would not say 'hey, I've known farming for 10 years, I'm not going to listen to you'.

This is not a conscious boycott due to ego protection. This is not simple hollywood villains, these doctors are humans. Much more complex than that.

The situation is more about someone coming to you, a person who take care of your animals for 20 years now, saying that a particular fruit that just grow in mountains can save your animals when they eat before noon. And to support this he ponts out that his animals have much better survival rates.

Imagine that the reality is that just eating that fruit, grown wherever, any time of day, already improve your animals health.

Sure, the right thing to do is keep testing the different hypothesis until you understand why his animals have better health. But if the guy comes yelling at you, very arrogant and calling you ignorant and stupid; it might be just too natural to realize that fruits growing on mountains are the same that grows everywhere; so everything the guy says must be bullshit. F* that guy, who he think he is?

The guy was arrogant, yes. But he had the numbers to support him. Furthermore, the death rate of mothers at the hospital where they did all the autopsies was so horrible and so well known that soon-to-give-birth mothers would fake illness near the other hospital in town just so they wouldn't need to give birth over there. (Don't have the reference handy, I've read it in several places).

But the general response was not "well, that's a theory worth testing". It was "This guy is crazy. Gentlemen do not pass disease". I have read no record of an alternative theory of the high mortality rate that anyone else had advanced - one might have existed, and was lost in the myst of time. But I find it just as likely that there were, in fact, no competing theories.

I have unfortunately witnessed a modern day case applying to a much smaller population. Not much has changed. I know a doctor who has literally (and provably) saved at least ten lives based on his understanding of a disease, which he cannot support with statistics yet - his statistics keep improving with every case, but still not at the publishable 0.05 threshold. And this is an extremely rare disease (in the order of 1/1,000,000), so it might take 10 more years until he has a rigorous proof. (Alas, giving more details would basically be naming him and myself, which I do not wish to do)

His theory is a lot easier to accept than the prevailing theory about said disease, except that accepting it proves incompetence of many in the field, including editors of medical journals -- which, indeed, is the case, but those cases are dismissed as occasional random misses rather than the systemic incompetence that it is.

It is possible this doctor will retire before they have enough evidence to publish their results. And despite the amazing results so far, when I went for a second opinion after talking to this doctor, 4 others told me that he is making a mouse out of a molehill, and that it's almost impossible that he is right. Luckilly, imaging results proved he was right, and another life was saved. And you know what? Of those 4, only two realized they need some introspection, and the other two dismissed this as a "lucky guess".

The more things change, the more they stay the same.

P.S: Said doctor is extremely humble, and communicates very clearly.

How you deliver information is often as important as the information itself. It's never just about the facts.

I believe the point of the comment you are replying to you is to say that ideally, that shouldn't matter and people should simply pay attention to the message... especially when it's something as important as people dying. As you note, however, that's not the case. People's precious feelings are sensitive and must be approached with tact.

You're correct. When Buffet talked about "coddling" the super rich, I realized that word describes how we treat physicians. We coddle them. I work with physicians on a daily basis, and you have to treat them like children. You can't talk bad about them, you can't imply they are doing something wrong (they have to come to that conclusion), you have to act like you think they know everything. For a group that relies on hard facts and science, you can't just say to them "You guys don't wash your hands, here is the data". They will literally get up and walk out of the room.

I realize that I am just as guilty, but we coddle physicians.

> I can kind of see why people didn't like him.

I think you are completely mistaken here. His personality (as evidenced by this quote) is actually why you have heard of him.

People didn't like him because he claimed they were doing wrong. And they disliked him even more because he had the statistics to prove it. Had he been humble, they would have disliked him just as much, but would have found him easy to ignore - and you would likely not have heard of him.

I have detailed a modern case in an answer below [0]. Had semmelweis provided a good scientific explanation, some of his opponents would have probably conceded defeat, but I'm quite sure others would have found something else to latch on to.

It still happens. See e.g. Atkins (of the Atkins diet fame). See, e.g. Shechtman (recent noble laureate, of the quasi crystal fame). You've heard of them because they did not shut up. But that's not the reason people didn't like them.

[0] https://news.ycombinator.com/item?id=8901440

There are old Hungarian movies about him[1]. He is described as the "savior of mothers" here in Hungary.

[1]I have seen this one, but I'm sure it's impossible to find English subtitles for it: http://hungarian.imdb.com/title/tt0033035/ There is an other one, I didn't see it and they say that the older was better: http://hungarian.imdb.com/title/tt0045136/?ref_=fn_al_tt_6

Also I found by accident this link: http://www.imdb.com/title/tt1440757/ I don't have IMDBpro so I can't see any relevant info on this one, I hope this will be good.

and check -> The Semmelweis reflex or "Semmelweis effect"

"The Semmelweis reflex or "Semmelweis effect" is a metaphor for the reflex-like tendency to reject new evidence or new knowledge because it contradicts established norms, beliefs or paradigms. .. "

http://en.wikipedia.org/wiki/Semmelweis_reflex

Aaron Swartz himself wrote about this kind of situation: http://www.aaronsw.com/weblog/semmelweis

Not that Dr. Who.

Indeed. It took me a couple of tries to parse this headline, thanks to that mistake on my part.

I wouldn't call that a mistake on your part; it's over-use of capitalization in the headline.

The problem is that it's still normal:

http://en.wikipedia.org/wiki/Letter_case#Headings_and_public...

>As regards publication titles it is, however, a common typographic practice among both British and U.S. publishers to capitalise significant words (and in the United States, this is often applied to headings, too). This family of typographic conventions is usually called title case. For example, R. M. Ritter's Oxford Manual of Style (2002) suggests capitalising "the first word and all nouns, pronouns, adjectives, verbs and adverbs, but generally not articles, conjunctions and short prepositions"

It is normal in the US. In the UK title case has been obsolete for decades. Apparently USA Today and Washington Post already switched[1]. It makes US newspapers look very old fashioned to me, well along with the rest of their retro styling.

[1] http://gawker.com/reader-poll-big-letters-in-headlines-or-li...

This story was discussed on HN a few years ago:

https://news.ycombinator.com/item?id=4438828#up_4439503

Yes but which Doctor Who championed hand-washing and briefly saved lives?

Doctor? Doctor Who?

It's funny I live two minutes from this place [1]. It's now no longer a hospital but a campus for the University of Vienna, and houses many nice restaurants.

1: http://media.npr.org/assets/img/2015/01/08/aakh-1784_enl-453...

When I was helping launch Peter Thiel's MetaMed.com, I came across all sorts of stats like this.. It's amazing how many hundreds of thousands of lives might be saved if doctors did simple things like wash their hands.

> Even today, convincing health care providers to take hand-washing seriously is a challenge.

Really? Such an interesting article, and then this gets dropped in.

This article gives the general idea:

https://news.yahoo.com/clean-hands--vanderbilt-s-hand-washin...

This article is very good - it covers doctors' hand-washing plus other things.

http://www.newyorker.com/magazine/2007/12/10/the-checklist?p...

(I read it a few years back and just re-found it now)

This is a real issue Today.

This is all I saw.

http://cl.ly/image/2a0z2Q1T2S2C

http://images2.fanpop.com/image/photos/10300000/Doctor-Who-T...

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