Dear Mark: The Semmelweis Reflex

Dear Mark,

I’ve been following the PB for a year and a half now and am proud to consider myself a diehard. I’m stronger, fitter, leaner, and for the first time in years feel energized throughout the day. My problem is this: I have a brother who’s an MD and seems to take my bucking of conventional wisdom personally. Whether it’s dogging my diet or my workout, he’s never got a shortage of offhand comments every time we get together with the family. I stopped arguing with him a few months ago because it just seemed useless and I frankly don’t want to make tensions worse for my family. Care to show up at one of these dinners to take on my brother’s resentments? Barring that, do you have any advice for getting him off my back? Thanks and Grok on!

In early 19^th century Vienna, one of the world’s largest and most well-known clinics in the world was among the worst institutions plagued by a widespread and puzzling “childbed fever” epidemic. The aggressive disease at one point killed 1 in 6 delivering mothers in his clinic. Pregnant women came in perfectly healthy but following childbirth were dead within a few days or less. For decades, the pandemic panicked women and eluded hospital staff, who responded to the continuing scourge by increasing ventilation and treating patients with practices like blood letting, leeching and mercury tonics (the discovery of germs not having been made yet).

Finally, an obstetrician and assistant administrator of the hospital, Ignac Semmelweis, made a startling connection. The proverbial light bulb went off when a colleague at the clinic died with the same fever symptoms after cutting himself while performing an autopsy. Semmelweis theorized that the professor’s cut was invaded by harmful “particles” from the corpse and eventually died from their effects. He then made the connection that medical students participated in autopsies the same days they helped deliver babies in the clinic. From there, he examined the rates of the adjoining midwife clinic, where the staff didn’t conduct postmortem examinations. The mortality rate in the midwife clinic was only a third of the mortality rate in the medical student wing. Upon investigating his theory with the implementation of new sanitation requirements, the mortality rate in the medical student clinic fell to that of the other clinic in only a month’s time. Clearly, hand washing and sanitization with a chlorine solution was the key to preventing the spread of disease. The discovery instilled a sense of relief but also the shocking revelation that doctors themselves had unwittingly caused so many patients’ deaths.

However, what happened afterward was the most surprising. A head administrator, Johann Klein, took Semmelweis’s discovery personally and renounced his findings. Klein believed Semmelweis’s argument was an attack on him, since he had instituted medical students’ participation in autopsies and had changed vaginal examination guidelines for obstetric patients. Semmelweis, a man whose efforts and scientific scrutiny had in essence discovered germ theory in its rudimentary parts and saved thousands of women’s lives, was discredited and pushed out of the clinic. His career continued for a time in Pest, Hungary, but never fully rebounded.

Semmelweis, for his part, had done relatively little to publicize his discovery. Although he and his students sent letters to well known obstetricians throughout much of Europe, he didn’t publish his findings until years later and only then attached to scathing personal criticisms of particular physicians and administrators. Victim to developing psychosis in his later years, Semmelweis was eventually institutionalized through his wife’s efforts and died from physical trauma after being beaten to death in the asylum.

It’s a dramatic story, to be sure, but an instructive one I think. This man had statistical evidence, scientifically sound support on his side, but the politics of the situation stalled progress. The threat of questioning authority and compromising professional reputations was finally too much to swallow. Semmelweis’s findings not only diminished the stature of the hospital administration, it brought down to earth the position – and astuteness – of physicians themselves. History has frequently revealed a sacrificial pattern when one person’s discovery takes on accepted wisdom. In short, it’s a game of kill the messenger.

In this reader’s case, I imagine it’s a similar phenomenon. Clearly, his brother has invested countless hours, thousands of dollars and invaluable credibility in his conventional medical education. He’s personally invested in the standard mindset of the medical establishment. Whether it’s a conscious realization or not, his professional integrity and authority are being questioned by his brother’s example – by his success, by his willingness to discern and embrace a health philosophy that diverges from conventional teaching.

My advice to Evan and all of us who meet with this kind of resistance is this: have patience and don’t take the bait. We don’t have to take the tension as personally as the other person does. Understand that our success upends their thinking, their lifelong efforts and maybe their sense of professional or personal expertise.

That said, let’s not make the same mistake as Semmelweis did in being overly modest in publicizing our genuine health discovery. There’s a difference in arguing to protect one’s own turf or pride and illuminating and sharing practices that can mean better health and well-being for people we know and love. Let your success and vitality speak for themselves, but by all means share your secret.

How do all of you share the love, so to speak? Tell your stories and offer your advice for Evan and others in the same boat. As always, thanks for the great questions and comments and keep ‘em coming!