pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

10 Medical Breakthroughs Unaccepted At First – Part One

July 23, 2017

Unfortunately, I’m in a profession where egos flair at the drop of a hat either through overwhelming skepticism, inordinate caution, debilitating fear of being wrong or as yet some unknown neurological or psychiatric condition.

I wish I was smart enough to write a definitive article on that, it would do the world a favor.

But I’m not, so this is not about that; it’s about the unfortunate result of all that—the often adolescent refusal to accept new knowledge when it is presented.
Medical breakthroughs often meet resistance from ‘within.’
As pathetic as it sounds, a person’s tolerance or consideration of new information (even the true kind) hangs upon where or even who it is coming from, or how far it departs from what you already think you know.

Medical history is chock full of wonderful, game-changing, world-shattering, profession-altering breakthroughs which met with stiff—and often downright vile—opposition instead of the thoughtful consideration they deserved.

This article is about that.

Medical Breakthroughs Initially Ridiculed or Rejected

As a general rule, pediatricians are a bit more accepting of new information, procedures, techniques and circumstances than the rest of the lot—at least that’s what I’ve seen.

Perhaps it’s because growth, development and change is our specialty. Perhaps it’s because the specialty is continually developing. Or, perhaps it’s because we specialize in the care and nurturing of teenagers who constantly remind all of us that we “just don’t have a clue.”

Whatever it is, we’re constantly on the lookout for evidence that something else works better than what we are doing, even if we’ve been doing it for a hundred years—we don’t let babies sleep on their belly’s any more do we?

That being said, here are some of the major “egg on your face” moments—which I can (luckily and gratefully) say I had no part of.

Antiseptic Handwashing

Ignatz Semmelweis ridiculed for using antiseptic handwashing

Does the name Ignaz Semmelweis mean anything to you? He doesn’t to most people; but I became intimately acquainted with the guy’s work in medical school and have spoken of him many times since.

Not only did he find a truth and speak it, he endured substantial ridicule for something which is now universally accepted as mere common sense, namely: doctor’s should wash their hands between surgeries!

The good doctor was working in a maternity ward in Vienna in the middle of the 19th century and noticed that “childbed fever” (puerperal fever) seemed to be weirdly “contagious-like.”

Back then there wasn’t even knowledge about things such as “germs”; but, he saw over and over where students and doctors were going from autopsies and dissections directly into caring for expectant mothers and contaminating them during exams.

I suppose what really tipped him off was his (hyperacute, probably “psyc-like” or “monk-like”) noticing that the lazy, slovenly physicians produced more “contagion” than those we would today call more hygienic. Not having a better word, he called them “cadaverous particles” which were being passed around.

He simply advocated that his colleagues wash their hands following autopsies and between patients and you would have thought he had slapped them in the face and challenged them all to a duel!

This bizarre rejection of something so minor and obvious to him was completely unexpected by Semmelweis and he took it as a personal insult; because, in the clinic where he had some authority, his hand-washing policy immediately cut puerperal fever 90%—from 18.3% of women to 2% in only 2 months!

Still, his novel idea of hand-washing was NOT widely adopted; which, led him to write some fairly condemning (and if honest a bit vitriolic) “open letters” against his critics.

Increasingly isolated and unpredictable (and whether meaning to or not) his detractors saw to it that Semmelweis was admitted against his will to a Viennese insane asylum, where he was severely beaten… and died after only 2 weeks.

Newborn Incubators

Stéphane Étienne Tarnier displaying newborn incubators

In my 4th year of medical school, a professor with whom I was studying was summoned to the local Zoo to care for an unexpected newborn orangutan whose birth had caught all the keepers off guard.

Their consultant advised them to forego a vet and call a pediatrician who should “treat it just like an infant human in every way… including baby shots.”

We adjourned to the zookeepers house schlepping an old isolette from storage where we did just as we were asked to do. My point is that even back then the isolette was the basic emblem of care for premature newborns in their first hours and weeks. It’s just what we did.

I’m sure it will surprise you that for FORTY years after they were invented, and because of the reasons outlined above, the only place you could find a baby in an isolette was at an amusement park like Coney Island! No kidding!

At the end of the 19th century, isolettes were invented in France by doctor Stéphane Étienne Tarnier and refined throughout Europe.

In 1896 an American doctor, Martin Arthur Couney, saw one at the Berlin Exposition and decided to import them to the U.S.. Trying for six years he could not find one hospital or clinic that would utilize one!

So, from 1903 to the 1940s, he set up his own “newborn ICU” of sorts at Luna Park on Coney Island in New York and charged visitors 25 cents to view the premature babies he and his nurses were caring for; which completely financed their medical care so their parents didn’t have to!

That wasn’t just a short temporary fix used until hospitals wised up—it continued for FOUR DECADES, nearly half a century, on the Coney Island Boardwalk treating 8,000 children and saving 6,500 lives.

It wasn’t until 1939 that New York hospital finally initiated a premature baby training and research center, the first in the U.S., eventually removing the novelty factor.

Couney died in relative obscurity in 1950 receiving only the personal memories of his life’s work for final vindication of his claims—and the courage he had shown.

Balloon Angioplasty

Catheter used in balloon angioplasty

Take all the millions of surgeries performed in US hospitals every year (for example 2011 cause I know the figures) and what do you think the most common are?

Percutaneous Transluminal Coronary Angioplasty, known as PTCA for short, is number 4 from the top—literally hundreds of thousands of procedures (if not millions) and its doggedly-obsessed inventor was ridiculed, publicly, for thinking it was possible. [Fourth behind cesarean section, circumcision and knee arthroplasty if you’re interested]

Even though accounting for almost 4% of all surgical procedures done these days, German cardiologist Andreas Roland Grüntzig was told over and over (in increasingly ridiculing manner) that it couldn’t be done, it was a “fools errand” and he was the fool who was wasting his time. And it was not only the rank and file but the top cardiologists in the world who were his detractors.

He’d already spent years developing the concept and initial device in his kitchen when he merely presented the idea at the American Heart Association meeting in 1976; then, had to basically go it on his own because of the high positions of his detractors.

Fortunately for all of us “type A” people who now need to avail of his invention, it was only his absolute single-minded obsession which allowed him to return to the same meeting of the AHA the very next year and present the results of his first four cases of angioplasties in humans.

And fortunately for him, unlike other physicians I’m writing about, he was actually able to see vindication when the audience gave him a standing ovation.

Viruses and Cancer

Viruses which cause cancer

In 1911 Dr. Francis Peyton Rous demonstrated an absolutely game-changing phenomenon to the medical world. He had found and verified the transmission of cancer… by a virus!

Like the meticulous scientist he was, the finding was so unusual when he saw it that he just had to make double and triple sure it wasn’t some fluke happening and/or result of something other than the virus. It verified to be the virus; so, he reported it to his colleagues and awaited a careful examination and replication by others… which never came.

Instead, he was bombarded by such criticism, blame, excuses, finger-pointing and accusations that he threw up his hands in complete disgust and quit studying cancer altogether—FOR 20 YEARS! Armchair pontificators came out of the woodwork with absurd alternative explanations but not one had the integrity to merely do his experiments themselves to see if they were true.

Microscopes of the time could not see actual viruses, only the tell-tale signs of their work. The critics went so far as to claim that Rous’s tumor wasn’t cancer at all but merely a granuloma like a wart.

That ego-caused disbelief caused a SIXTY-YEAR delay in the next step of cancer research and the discovery of the first viral oncogene! Peter Duesberg and Peter Vogt vindicated Rous by finding the actual gene in the virus which caused the cancer.

Today the tumor carries the name of its discoverer—the Rous Sarcoma; and 55 years after he announced his discovery the Nobel Prize committee finally honored him with a medal. It was the “longest incubation period” of a Nobel Prize in the history of the prizes.

Helicobacter pylori

Helicobacter Pylori causing ulcers

A gastrointestinal specialist in Western Australia, Dr. Barry Marshall, nearly followed the exact same footprints as Dr. Rous 70 years earlier; except for thinking a bit more out of the box which short-circuited the whole nay-sayer/hater thing.

In the mid-’90s, Marshall was ready to describe his “against-the-grain” discovery that bacteria had a much more direct relationship with ulcers than all of us realized. In fact, he proposed, they caused them; which, brought the now-familiar heaping of ridicule and condescending detractors.

By then I had finished medical school and residency and was in practice, and I have to say that I had never heard anything about ulcers except for the fact that stress, spicy foods and acid made it worse when you had them and probably were the cause too. I never heard anything about Marshall either, it just didn’t gain traction in the US medical literature.

In fairness it must be recognized that there was no war going on at the time so, unlike Rous, Marshall was less inclined to merely throw up his hands in disgust and leave the field in favor or war efforts.

His personality was more inclined to dig in his heels and make waves. “Everyone was against me. But I knew I was right,” he said and promptly swallowed a Petri dish full of millions of H pylori bacteria being specially cultured for the purpose.

Within a week after contaminating himself, he began experiencing symptoms of an ulcer which then could be readily and openly diagnosed by even the most vitriolic detractor! [That showed them boy!] Biopsies showed severe damage to the lining of his stomach which had never seen an ulcer before.

His “lay-it-on-the-line” approach cut short the extended vitriol by decades and led to a Nobel prize in 2005.

In his biography, written for the prize, he said: “If I was right, then treatment for ulcer disease would be revolutionized. It would be simple, cheap and it would be a cure. It seemed to me that for the sake of patients this research had to be fast-tracked.” [Which it did… in spades!]

☤

Lest you think there are no more breakthroughs which could possibly have been torpedoed when they were announced, we’re not even half-way through those that I can think of—let alone all that there actually were.

I’ve got five more upcoming in part two.