The Hungarian Doctor Who Pioneered Handwashing

Handwashing is easy to take for granted. It is one of the earliest and most basic forms of etiquette and hygiene we that we learn, not to mention a major pillar of our individual and collective health.

But like so many other “givens” in modern medicine and public health, hand washing was not always so accepted, even among health professionals. In fact, it practically came down to one person to discover and advocate the importance of washing one’s hands: NPR tells the story of Hungarian medical underdog Ignaz Semmelweis and his semi-successful attempts to improve the lives of millions through this deceptively simple practice.

Semmelweis was a man of his time, according to Justin Lessler, an assistant professor at Johns Hopkins School of Public Health.

It was a time Lessler describes as “the start of the golden age of the physician scientist,” when physicians were expected to have scientific training.

So doctors like Semmelweis were no longer thinking of illness as an imbalance caused by bad air or evil spirits. They looked instead to anatomy. Autopsies became more common, and doctors got interested in numbers and collecting data.

The young Dr. Semmelweis was no exception. When he showed up for his new job in the maternity clinic at the General Hospital in Vienna, he started collecting some data of his own. Semmelweis wanted to figure out why so many women in maternity wards were dying frompuerperal fever — commonly known as childbed fever.

He studied two maternity wards in the hospital. One was staffed by all male doctors and medical students, and the other was staffed by female midwives. And he counted the number of deaths on each ward.

When Semmelweis crunched the numbers, he discovered that women in the clinic staffed by doctors and medical students died at a rate nearly five times higher than women in the midwives’ clinic.

But why?

Like any rational, scientifically-minded individual, Semmelweis carefully assessed the data and sought out some empirical basis for this pattern.

“What Semmelweis had discovered is something that still holds true today: Hand-washing is one of the most important tools in public health. It can keep kids from getting the flu, prevent the spread of disease and keep infections at bay.

Semmelweis kept trying to convince doctors in other parts of Europe to wash with chlorine, but no one would listen to him.

Even today, convincing health care providers to take hand-washing seriously is a challenge. Hundreds of thousands of hospital patients get infections each year, infections that can be deadly and hard to treat. The Centers for Disease Control and Prevention says hand hygiene is one of the most important ways to prevent these infections.

Over the years, Semmelweis got angrier and eventually even strange. There’s been speculation he developed a mental condition brought on by possibly syphilis or even Alzheimer’s. And in 1865, when he was only 47 years old, Ignaz Semmelweis was committed to a mental asylum.

The sad end to the story is that Semmelweis was probably beaten in the asylum and eventually died of sepsis, a potentially fatal complication of an infection in the bloodstream — basically, it’s the same disease Semmelweis fought so hard to prevent in those women who died from childbed fever.”

An ignoble and cruelly ironic end to a man whose findings are now the bedrock of public health and sanitation worldwide. Semmelweis was ridiculed, marginalized, and ultimately forgotten because his observations conflicted with the established scientific and medical opinions of the time; indeed, many doctors took offense at the idea that they should wash their hands — at the cost of their patients’ lives.

It was only two decades after his sad death that Semmelweis’s recommendations gained widespread acceptance: Louis Pasteur’s confirmation of the germ theory of disease, followed by Joseph Lister’s use of hygienic methods during surgery both validated the Hungarian doctor, who lacked the scientific means to explain his findings.

But given his dedication to the well being of patients, I would like to imagine Semmelweis would be pleased to see his ideas become conventional wisdom. He might also be amused that his name is used for the eponymous “Semmelweis reflex” or “Semmelweis effect”, which describes a tendency for new evidence or knowledge to be viscerally rejected because it contradicts established norms, beliefs, or paradigms.

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Hero Highlights: Project Prakash

Of the world’s 1.3 million blind children, India is home to the world’s largest population, with estimates ranging from 200,000 to 700,000. As in many developing countries, a child born blind faces enormous social and economic hurdles: in addition to being stigmatized and marginalized in their communities, the vast majority of blind children are unable to get an education or a job. Many face physical and sexual abuses. At least half do not survive to adulthood.

In addition to regressive social attitudes, a lack of medical care access, and little to no disability-friendly institutions and infrastructure, the problem is made worse by the pervasive idea that, once a child reaches seven or eight years of age, their blindness is irreversible and untreatable. Yet the prevailing cause — congenital cataracts — is an otherwise easily treatable condition in the developed world. Imagine a lifetime of being disadvantaged and ostracized for something beyond your control and which could easily be addressed if there was the will and money. It is a disease of poverty.

Enter Project Prakash, founded in 2002 by Dr. Pawan Sinha, an Indian-born graduate of MIT. Named after the Sanskrit word for “Light”, he started the organization after a trip to rural India, where he witnessed the first hand the scale and severity of child blindness. After obtaining a grant from the U.S. National Eye Institute, he assembled team of about 20 clinicians, scientists, and outreach personnel to provide cataract surgery for as little as $300 per patient (though those too poor to pay get it for free). He tells the story in great detail Scientific American (sorry for the paywall.) Continue reading

The Impact of Vaccines

Most of developed world take vaccines for granted. Indeed, there is a growing number  of people in wealthy countries, often the most privileged, who outright fear and dislike vaccines. Yet the data are overwhelming: vaccines have not only been pivotal to virtually extinguishing all sorts of previously common diseases (measles, polio, pertussis, etc.), but they have continued to reap dividends for the millions of human who live in the developing world, where public health otherwise remains weak.

As reported in IFLS:

Vaccines are well regarded as one of the most cost-effective health care actions that a country can pursue, and since 2001 the United Nations has been running a program in 73 low and middle-income countries to prevent 10 diseases. It is now expected that when the project is completed in 2020, it will have resulted in averting around 20 million deaths, while at the same time saving a staggering $820 billion.

“Our examination of the broader economic and social value of vaccines illustrates the substantial gains associated with vaccination,” explained Sachiko Ozawa, who led the research, in a statement. “Unlike previous estimates that only examine the averted costs of treatment, our estimates of the broader economic and social value of vaccines reflect the intrinsic value that people place on living longer and healthier lives.”

And these economic benefits, it turns out, are huge. The researchers have calculated that when the vaccination program comes to an end in 2020, it will have saved around $350 billion when it comes to health, but overall this balloons to an astonishing $820 billion across the 73 low and middle-income countries in which Gavi is operating.

This is not only through reduced health care costs as diseases are prevented before they become an issue, but also due to those who are vaccinated being healthier and so working for longer and thus increasing productivity in these nations over their entire lifetimes.

Social and economic benefits aside, the most important results are the human ones: the prevention of over 500 million illnesses, 20 million child deaths, and 9 million cases of long-term disabilities. So much pain and suffering and loss will be unknown — and unfortunately unappreciated — because of such a cheap and relatively easy intervention.

Nearly Half of All Americans Avoid Health Care Due to Costs

Courtesy of Forbes comes a depressing yet not entirely surprising report:

Cost continues to be a barrier to treatment with 40% of Americans who say they “skipped a recommended medical test or treatment in the last 12 months due to cost.”Another 32% were “unable to fill a prescription or took less of a medication because of the cost,” the West Health/NORC poll of more than 1,300 adults said.

“The high cost of healthcare has become a public health crisis that cuts across all ages as more Americans are delaying or going without recommended medical tests and treatments,” West Health Institute chief medical officer Dr. Zia Agha said in a statement accompanying the poll results. The survey is being released at this week’s American Society on Aging 2018 Aging in America Conference in San Francisco.

The West Health-NORC poll is the latest national survey showing Americans continued frustration with high healthcare costs even as the U.S. spends more than $3.3 trillion annually on healthcare.

Note that those who skipped doctor’s visits and medication did so despite being sick or injured — such is the state of both the U.S. healthcare system and the national economy.

Also consider the following comparative analysis of maternal healthcare from The Economist:

In 2015, the Lindo Wing [where the third royal baby was born] charged £5,670 ($8,900) for 24 hours in a deluxe room and a non-Caesarean delivery. A survey in the same year by the International Federation of Health Plans found that the average fee for such a delivery in the United States was $10,808. That rises to roughly $30,000 after accounting for care given before and after a pregnancy, according to Truven Health Analytics. Insurers cover most of the cost, but parents are still left with an average bill of about $3,000. In many European countries, free maternity care is available.

A visual of this disparity really drives the point home:

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With all the wealth and economic potential of our $18 trillion-plus economy, one would think we could figure out a way to make having a baby, or getting routine treatment at a clinic, more accessible and affordable.

When Helping People Isn’t “Sustainable”

Count on America’s venal financial class to engage unironic self parody.  According to a recent CNBC report, Goldman Sachs, one of the largest financial institutions in the world, asked whether the use of cutting-edge genetic therapy to cure patients is a “sustainable business model”: Continue reading

Lessons from Senegal on Regulating Sex Work

When it comes to public health innovations, Senegal rarely come to mind as a role model. But as the The Economist recently reported, the country is an outlier on the continent (and indeed much of the world) in treating sex work as a public health matter. Continue reading

Why Do Millions of Children Have to Die?

It is fitting that following my previous post on the growth in the global millionaire community, I decide to reflect on the moral travesty that is child mortality. I say moral because it is a problem that need not still exist to the degree that it does, and that only persists because our global economic system are not sufficiently guided by ethical principles.

Historically, around 43 percent of children died before the age of five; as fairly recently as the 19th century, every second or third child would perish, even in relatively developed Western countries. Although child mortality has declined rapidly over recent decades — down to 4.3 percent globally, compared to 8 percent in 2000 and 18 percent in 1960 — it is still far higher than it should be.

Nowadays, anywhere from 6 to 9 million children die before their fifth birthday, and nearly half of them die within a month of their birth. (This does not include millions more that die before adulthood.) About 42 countries, mostly in sub-Saharan Africa, account for 90 percent of these deaths. Two-thirds of these children die from causes that are easily preventable, namely diarrhea, pneumonia, malnutrition, and malaria. Continue reading

Living Longer and More Prosperously

Never before have so many humans enjoyed longer and healthier lives. Across the world, even in some of the poorest countries, deaths from most infectious diseases are declining precipitously, while every region is seeing increased longevity. The data are resoundingly clear:

25508081_10159789044430472_6163396239419175882_n Continue reading

The End of Smallpox

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Yesterday, December 9th, came and went like any other day. But on that day in 1979, one of the most groundbreaking endeavors in human history was accomplished: a group of eminent scientists commissioned by the United Nations World Health Organization (WHO) certified the global eradication of smallpox, the only human disease thus far to have been completely eliminated from nature. The WHO officially confirmed and announced this momentous achievement a few moments later:

Having considered the development and results of the global program on smallpox eradication initiated by WHO in 1958 and intensified since 1967 … Declares solemnly that the world and its peoples have won freedom from smallpox, which was a most devastating disease sweeping in epidemic form through many countries since earliest time, leaving death, blindness and disfigurement in its wake and which only a decade ago was rampant in Africa, Asia and South America.

Less than a decade before, the end of smallpox would have seemed the remotest possibility. As recently as 1967, the WHO had estimated that 15 million people contracted the disease, and that two million had died that year alone — the average number of annual deaths since the turn of the century. Continue reading

The Countries With the Highest Well-Being

It is safe to say that most people want greater well-being in their lives, but as with concepts like happiness or success, it is often loaded and subjective — albeit up to a point. Wealth is certainly a big factor, if not the biggest, but so are — generally speaking — civil rights, a healthy environment, personal safety, and social support.

Predicating well-being on these and other inputs, the Boston Consulting Group (BCG) conducted the “Sustainable Economic Development Assessment” (SEDA), which measures which countries in the world provide the most well-being to their inhabitants. The results were based on over 50,000 data points spanning three broad metrics and ten “dimensions of well-being”: economics (which includes income, economic stability, and employment); investment (health, education, and infrastructure) and sustainability (socioeconomic inequality, civil society, governance, and environment). Continue reading