I’m reading a box recommended by a friend: Super Crunchers written by Ian Ayres which deals with statistical analysis and numbers. In it he discusses Austrian physician Ignaz Semmelweis who noted, in the 1840’s, that at Vienna General Hospital maternity patients were much more likely to die when treated by doctors who had recently left the autopsy room. He concluded that there was a connection even though germs were unknown. He did a detailed statistical study of the situation. His study indicated that mortality rates declined if doctors and nurses washed their hands in chlorinated lime before seeing the next patient. When he proposed this practice, he was ridiculed by the other physicians. They refused to believe they had any role in causing patient deaths and they felt washing hands several times a day was a waste of their time. At the time surgeons prided themselves on wearing blood stained white gowns to show their experience in surgery. Doctors just didn’t believe something they couldn’t see or prove was a factor or a problem. The controversy resulted in Semmelweis being fired. After a nervous breakdown he ended up in a mental hospital and died at forty seven. His study ultimately resulted in confirming germ disease.
Ayres writes about the benefit of relying upon data supported medical decisions over medical judgment. He referred to an article in the New England Journal of Medicine where a case involving an allergy was presented on rounds. It involved an unusual rash on an infant and the attending physicians and house staff, after long discussions, couldn’t reach a consensus to the right diagnosis. When the resident was asked, she named a rare syndrome which fit the symptoms perfectly. She was asked how she arrived at the diagnosis and she said she had entered the symptoms in Goggle which came up with this diagnosis. There is a software program "Isabel" which allows physicians to enter symptoms and receive a list of the most probable causes. It is capable of analyzing whether the use of over 4000 drugs might be involved. The data base has some 11,000 specific illnesses as well as an enormous data base of information. When I read this I thought of the Merck Manual which has been around forever. This thick small book is arranged by symptoms which are connected with specific disease and syndromes.