History is replete with figures of immense accomplishment, who literally changed the course of human progress, yet are forgotten by subsequent generations. One such figure is Joseph Lister, a British surgeon who practiced in the latter half of the nineteenth century Lister is considered to be the “Father of Modern Surgery” and the “greatest surgical benefactor to mankind,” but who is now perhaps best remembered as the inspiration for the name “Listerine.”
There's a very good book on this subject called 'The Century of the Surgeon'. Jurgen Thorvald, 1957. It addresses two major developments in 19th century surgery, sterile procedure and the use of anesthesia. Any bookworm who appreciates this article should enjoy it. I've read it twice, once about 50+ years ago again this year.
Also reminds me of the sad story of the Hungarian doctor who promoted the idea of doctors washing hands before delivering babies. He published a book with data, but was mocked. Died in an insane asylum after being beaten by guards and getting gangrene. Science driven by flawed people may take some wrong turns. Personalities and egos are elements in real world progress and diversions. https://en.m.wikipedia.org/wiki/Ignaz_Semmelweis
There is an adage in medicine "statistics does not apply to the individual". The reason is that each person has an idiosyncratic response to external stimuli, such as medication. The result is usually a bell-shaped curve but sometimes there is marked skew. Every anesthesiologist knows that red=heads are highly resistant to anesthesia and require additional dosing. The reason for this (the clinical observation) is not yet known (by science) but speculation suggests that there is linkage in genetics that relates to processing of the chemical. Similarly, not everyone becomes addicted to oxycontin but there is a segment of the population that becomes addicted with one dose. Observation and science allows us to predict this when a certain set of genes are identified but why this is the case i not fully elucidated. In the 1950's. the thalidomide disaster taught a very stern lesson: giving a pregnant woman a medication during pregnancy could result in severe developmental abnormalities for her child or increased propensity to develop a rare form of vaginal cancer, 20 years later.
And then there are areas that we do not fully understand at the mechanistic level. This is extremely true of the immune system, where its sophistication is awe-inspiring and its secrets still not fully elucidated. Vaccination against smallpox, the disease that ravaged so many, whose outbreak was feared by all, was welcomed with open arms by the medical community and the lay community. But the pandemics of the 1860's taught the heavy lesson that one does not vaccinate in a pandemic. The reason was not known but the effects were clear: a high mortality rate among children.
1918 brought the Spanish Flu epidemic and wiped out a large percentage of the world's population. The same strain came back in the 1960's with an unusual result: The disease made the young sick and spared the old. The exact opposite of what was expected. This led to the insight that those who survived 1918 were immunized. Vaccination against the swine flu brought an unexpected result: Guilliam Barre increased significantly. Clearly, the vaccine was negative for some patients due to their immune system.
Intensive investigation into the immune system brought marked advances i knowledge, including the marked variability in the population. At first, this was thought only to effect antibody production. Further knowledge led us to an understanding of the interferon system and that a portion of the population was variably deficient.
Parallel advances in knowledge taught us the value of vitamin D for optimal function of the immune system (both in preventing infection, cancer and autoimmune disease), the value of sunlight and its effect on the immune system in addition to vitamin D, and the need to ensure the circadian rhythm was respected.
Against such a backdrop, statistical evaluation is of limited value. The number of variables that must addressed are overwhelming and many may be hidden even to the most dedicated experimenter. Double blind, placebo-controlled studies rarely take in the full environmental effect. An experiment (aka, clinical trial) can be constructed so that it does not test the correct condition but confirms the bias of the clinician. This fallacy is well-known in science where one argues from the conclusion, rather than let the facts truly speak.
And hard lessons about vaccination taught us that the barrier for vaccination introduction is very high, as healthy people are being exposed to noxious agents. In some cases, the disease prevented is so devastating and so widespread it is a no-brainer. In some cases, the negative aspects of inoculation are so minimal that the disease prevented is worth the risk.
But in many cases, there risk/reward is not so clear-cut. And, as the Flexner reforms of the 1900's so clearly pointed out that monetary incentives may corrupt medical judgment and needed to be eliminated.
This brings us to the current state of affairs. Vaccines are very lucrative for the manufacturer. Vaccines added to the childhood schedule prevent liability and liability. Medicine has moved to a "key opinion leader" model, in which KOL are paid to promote a certain product. The takeover of the medical world by private equity has exacerbated the problem. Sponsorship of medical societies and medical journals, even prestigious ones, are beholden to big pharma advertising dollars to lead to an industry consensus that favors the big pharma position.
In such an environment, variant opinions are to be expected and encouraged, openly debated amongst those who have the expertise to debate and let the best argument win.
Absolute nonsense, because the state of science in 2022 is massively different from the state of science 150 years ago.
Modern statistics was just faintly being invented when Lister was trying to convince people of his methods. The first double-blind randomized, controlled trial didn't take place until World War II. Today we know that COVID misinformation is misinformation BECAUSE we have dozens of high-quality, double-blind, large-number controlled trials that give us FAR better information.
Arguing that today's scientific consensus on COVID is suspect because the medical establishment of Lister's day rejected his claims is kind of like arguing that we should drive across the country instead of fly because many of the early pioneers of aviation (early 1900s) died in airplane crashes.
There's a very good book on this subject called 'The Century of the Surgeon'. Jurgen Thorvald, 1957. It addresses two major developments in 19th century surgery, sterile procedure and the use of anesthesia. Any bookworm who appreciates this article should enjoy it. I've read it twice, once about 50+ years ago again this year.
Also reminds me of the sad story of the Hungarian doctor who promoted the idea of doctors washing hands before delivering babies. He published a book with data, but was mocked. Died in an insane asylum after being beaten by guards and getting gangrene. Science driven by flawed people may take some wrong turns. Personalities and egos are elements in real world progress and diversions. https://en.m.wikipedia.org/wiki/Ignaz_Semmelweis
Very similar to the consensus of the experts with continental drift theory in the early 20th century.
There is an adage in medicine "statistics does not apply to the individual". The reason is that each person has an idiosyncratic response to external stimuli, such as medication. The result is usually a bell-shaped curve but sometimes there is marked skew. Every anesthesiologist knows that red=heads are highly resistant to anesthesia and require additional dosing. The reason for this (the clinical observation) is not yet known (by science) but speculation suggests that there is linkage in genetics that relates to processing of the chemical. Similarly, not everyone becomes addicted to oxycontin but there is a segment of the population that becomes addicted with one dose. Observation and science allows us to predict this when a certain set of genes are identified but why this is the case i not fully elucidated. In the 1950's. the thalidomide disaster taught a very stern lesson: giving a pregnant woman a medication during pregnancy could result in severe developmental abnormalities for her child or increased propensity to develop a rare form of vaginal cancer, 20 years later.
And then there are areas that we do not fully understand at the mechanistic level. This is extremely true of the immune system, where its sophistication is awe-inspiring and its secrets still not fully elucidated. Vaccination against smallpox, the disease that ravaged so many, whose outbreak was feared by all, was welcomed with open arms by the medical community and the lay community. But the pandemics of the 1860's taught the heavy lesson that one does not vaccinate in a pandemic. The reason was not known but the effects were clear: a high mortality rate among children.
1918 brought the Spanish Flu epidemic and wiped out a large percentage of the world's population. The same strain came back in the 1960's with an unusual result: The disease made the young sick and spared the old. The exact opposite of what was expected. This led to the insight that those who survived 1918 were immunized. Vaccination against the swine flu brought an unexpected result: Guilliam Barre increased significantly. Clearly, the vaccine was negative for some patients due to their immune system.
Intensive investigation into the immune system brought marked advances i knowledge, including the marked variability in the population. At first, this was thought only to effect antibody production. Further knowledge led us to an understanding of the interferon system and that a portion of the population was variably deficient.
Parallel advances in knowledge taught us the value of vitamin D for optimal function of the immune system (both in preventing infection, cancer and autoimmune disease), the value of sunlight and its effect on the immune system in addition to vitamin D, and the need to ensure the circadian rhythm was respected.
Against such a backdrop, statistical evaluation is of limited value. The number of variables that must addressed are overwhelming and many may be hidden even to the most dedicated experimenter. Double blind, placebo-controlled studies rarely take in the full environmental effect. An experiment (aka, clinical trial) can be constructed so that it does not test the correct condition but confirms the bias of the clinician. This fallacy is well-known in science where one argues from the conclusion, rather than let the facts truly speak.
And hard lessons about vaccination taught us that the barrier for vaccination introduction is very high, as healthy people are being exposed to noxious agents. In some cases, the disease prevented is so devastating and so widespread it is a no-brainer. In some cases, the negative aspects of inoculation are so minimal that the disease prevented is worth the risk.
But in many cases, there risk/reward is not so clear-cut. And, as the Flexner reforms of the 1900's so clearly pointed out that monetary incentives may corrupt medical judgment and needed to be eliminated.
This brings us to the current state of affairs. Vaccines are very lucrative for the manufacturer. Vaccines added to the childhood schedule prevent liability and liability. Medicine has moved to a "key opinion leader" model, in which KOL are paid to promote a certain product. The takeover of the medical world by private equity has exacerbated the problem. Sponsorship of medical societies and medical journals, even prestigious ones, are beholden to big pharma advertising dollars to lead to an industry consensus that favors the big pharma position.
In such an environment, variant opinions are to be expected and encouraged, openly debated amongst those who have the expertise to debate and let the best argument win.
Absolute nonsense, because the state of science in 2022 is massively different from the state of science 150 years ago.
Modern statistics was just faintly being invented when Lister was trying to convince people of his methods. The first double-blind randomized, controlled trial didn't take place until World War II. Today we know that COVID misinformation is misinformation BECAUSE we have dozens of high-quality, double-blind, large-number controlled trials that give us FAR better information.
Arguing that today's scientific consensus on COVID is suspect because the medical establishment of Lister's day rejected his claims is kind of like arguing that we should drive across the country instead of fly because many of the early pioneers of aviation (early 1900s) died in airplane crashes.
The consensus on Covid 19 has changed considerably since 2019, one hopes that the CA law will be carefully thought out, fair and flexible.
Of course, one also hopes that politicians will be fair and honest, so hopes are rarely met.
An argument by analogy, with all the attendant problems.
A false equivalence wrapped in a disingenuous array of nonsense.
Great article. Very timely.
Excellent piece.