Many Doctors Care More About Their Egos Than Saving Lives

State of the Heart by Haider Warraich ends with these words:

This means that if science continues to advance, perhaps half this book will one day be proven false. Perhaps one day, a historian will cite these words snidely to reflect how ignorant we were and how far we have come since. That thought gives me a lot of joy, and the sooner we can break the untouchable idols of today, the sooner we can strip the masters of dogma, the sooner we can focus on the sum of our organs.

Being proven wrong about his scientific understanding may make Warraich joyful, but many other people in a position of power in medicine and public health would rather cause many deaths than admit mistakes.

History is full of examples. Take for example, Ignaz Semmelweis, who found evidence that washing hands before helping women give birth greatly reduced deaths.

That said, it was Dr. Semmelweis who ordered his medical students and junior physicians to wash their hands in a chlorinated lime solution until the smell of the putrid bodies they dissected in the autopsy suite was no longer detectable. Soon after instituting this protocol in 1847, the mortality rates on the doctor-dominated obstetrics service plummeted.

“In 1850, Ignaz Semmelweis saved lives with three words: wash your hands” by Dr. Howard Markel, PBS News Hour

Did other obstetricians rejoice because they had a simple method to increase the survival rate of their patients? Nope.

Unfortunately, Semmelweis’s ideas were not accepted by all of his colleagues. Indeed, many were outraged at the suggestion that they were the cause of their patients’ miserable deaths.

The same thing happened in the United States when Oliver Wendell Holmes Sr. advocated that doctors wash their hands.

These “doctors” didn’t care about evidence or saving lives. Or at least, they cared less about that than the insults about their unwashed hands’ uncleanliness. To them, it was better than more of their patients die painful deaths than that they go through the inconvenience of washing their hands.

You might also know about the story of John Snow and cholera.

Warraich describes an example prioritizing their egos over following evidence or saving lives I hadn’t heard of before.

In the early 20th century, doctors regarded high blood pressure as a good thing. Some believed it was an effect of aging with no bearing on health, others believed that the higher the blood pressure, the better.

I can say two things in defense of doctors in the very early 20th century: nobody had collected evidence that high blood pressure is dangerous, and the only method they had to reduce blood pressure was extreme salt restrictions.

Then someone gathered and published evidence that high blood pressure is deadly: life insurance companies.

In 1925, the Actuarial Society of America published a report which noted a correlation between high blood pressure and earlier death. While doctors were dismissing the need for blood pressure readings, life insurance companies pushed to have it measured and factored into their policies.

The doctors and scientists ignored this.

In various parts of the book, Warraich describes the various pressures to conform to authority and hierarchy in science and medicine. In a top-down hierarchy, you get ahead by pleasing the people of higher rank. Saving many lives might impress the people of higher status, but a more reliable means to get ahead is to flatter them and not embarrass them. It’s safe to agree with the medical authorities even when they’re wrong, but it’s risky to point out their errors.

Life insurance companies are predictive markets of human death. They bet they can collect more money from living customers than money they spend on the dead. When their bets are accurate, they make money. When their bets are inaccurate, they lose money. Given a choice between conforming to people of high status in medical and scientific hierarchies and understanding reality, they choose to understand reality.

Then the Framingham study began in 1947. It tracked the lives of people in the town of Framingham, Massachusetts to better understand human illness and health. Warraich says, “when the Framingham study was threatened with its funding being cut, life insurance companies helped bail it out, seeing how important the actuarial benefits of the study were.”

The first report published on the Framingham study showed a strong correlation between high blood pressure and heart attacks, as well as high blood pressure and strokes.

Warraich says:

The Framingham study investigators thought their job was done after they began publishing their landmark findings but quickly realized they had run into a wall—that wall was their fellow physicians. The overwhelmingly strong data they had generated failed to change the practice of either the most preeminent doctors of their time or those running mom-and-pop-style clinics in the country. And all this time, people continued to die of untreated high blood pressure by the millions—after the Second World War, every other person died in part due to hypertension. Even in the 1970s, when some medical textbooks started to recognize the importance of blood pressure, they focused on the lower number, the diastolic blood pressure, even as the Framingham investigators continued to show that it was the systolic blood pressure that mattered a lot more. Yet it wasn’t until the 1980s and 1990s, after large clinical trials proved them right, that the medical community fully embraced the findings from Framingham that had been published sequentially over many decades and had long before been supported by the life insurance companies.

(I hope to write a post about what life insurance companies say about Covid-19. Until then, the tl;dr is that life insurance companies are still uncertain about how to adjust their policies.)

To be fair to the doctors of the 1950s and 1960s, they had no way to safely reduce blood pressure other than restricting salt. The first reliable medication for reducing blood pressure was discovered in 1975—though perhaps if scientists had taken blood pressure more seriously, the medication would’ve been discovered sooner (it came from pit viper venom of all places—the viper’s bite causes victims’ blood pressure to drop so low they faint, but a small dose of a chemical in the venom only causes a small decrease in blood pressure).

Today, we have Dr. Anthony Leonardi. Do I believe Dr. Leonardi is 100% correct? No, because scientists are rarely 100% correct. Dr. Leonardi himself would probably admit that he can make mistakes. However, he has predicted the course of the covid-19 pandemic more accurately than the ‘experts’ who claimed that an infection would grant lasting immunity, then claimed that the first generation vaccines would end the pandemic, then claimed hybrid immunity would end the pandemic. In predictions about the future of the covid-19, I think Leonardi is more likely to be right than the WHO or the CDC.

Contemplating this history gives me another perspective on the healthcare workers of today who refuse to wear masks, even around vulnerable patients indoors.

Or maybe, the healthcare workers who refuse to mask even when their patients beg them too has given me a new perspective on the obstetricians in the mid-19th century who, even after encountering Semmelweis’ evidence that handwashing saves lives, continued to touch women in childbirth with unwashed hands.

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