

The Doctor Who Championed Hand-Washing and Briefly Saved Lives - Hooke
http://www.npr.org/blogs/health/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives

======
richardwigley
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_...](http://en.wikipedia.org/wiki/Contemporary_reaction_to_Ignaz_Semmelweis)

~~~
jerf
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.

~~~
dpark
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.

~~~
kbutler
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...](https://naturaltothecore.wordpress.com/2013/02/14/revisiting-
sids-and-back-sleeping-part-1/)

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](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.

~~~
jerf
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.

------
im2w1l
>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.

~~~
bainsfather
His statements and arguments were correct - that _ought_ to be all that
mattered.

~~~
soneca
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.

~~~
bainsfather
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').

~~~
Spooky23
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!

~~~
bainsfather
>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'.

~~~
soneca
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?

~~~
beagle3
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.

------
leni536
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/](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](http://hungarian.imdb.com/title/tt0045136/?ref_=fn_al_tt_6)

Also I found by accident this link:
[http://www.imdb.com/title/tt1440757/](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.

------
pella
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](http://en.wikipedia.org/wiki/Semmelweis_reflex)

~~~
pella
Aaron Swartz himself wrote about this kind of situation:
[http://www.aaronsw.com/weblog/semmelweis](http://www.aaronsw.com/weblog/semmelweis)

------
lsiebert
Not that Dr. Who.

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

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

~~~
anonymfus
The problem is that it's still normal:

[http://en.wikipedia.org/wiki/Letter_case#Headings_and_public...](http://en.wikipedia.org/wiki/Letter_case#Headings_and_publication_titles)

 _> 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"_

~~~
justincormack
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...](http://gawker.com/reader-poll-big-letters-in-headlines-or-little-
letters-900331797)

------
tptacek
This story was discussed on HN a few years ago:

[https://news.ycombinator.com/item?id=4438828#up_4439503](https://news.ycombinator.com/item?id=4438828#up_4439503)

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

~~~
atlbeer
Doctor? Doctor Who?

------
mherrmann
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...](http://media.npr.org/assets/img/2015/01/08/aakh-1784_enl-4530a6c3ec67d4263450f41dced729c8192f889b-s1200.jpg)

------
ada1981
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.

------
hn_user2
> 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.

~~~
bainsfather
This article gives the general idea:

[https://news.yahoo.com/clean-hands--vanderbilt-s-hand-
washin...](https://news.yahoo.com/clean-hands--vanderbilt-s-hand-washing-
initiative-172312795.html)

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

[http://www.newyorker.com/magazine/2007/12/10/the-
checklist?p...](http://www.newyorker.com/magazine/2007/12/10/the-
checklist?printable=true)

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

------
heeton
This is all I saw.

[http://cl.ly/image/2a0z2Q1T2S2C](http://cl.ly/image/2a0z2Q1T2S2C)

[http://images2.fanpop.com/image/photos/10300000/Doctor-
Who-T...](http://images2.fanpop.com/image/photos/10300000/Doctor-Who-The-
Classic-Series-classic-doctor-who-10355782-500-375.jpg)

