A current article in the New Yorker, while long, is fascinating and will appeal to students, physicians, and anyoine interesrted in the spread of ideas and global health.
Annals of Medicine:
New Yorker, July 23, 2013
Slow Ideas: Some innovations spread
fast. How do you speed the ones that don’t?
by Atul Gawande
Keywords: health; medicine; innovation; surgeons; nurses;
childbirth; babies; Bangldesh; cholera; oral rehydration
"Why do some
innovations spread so swiftly and others so slowly? Consider the very different
trajectories of surgical anesthesia and antiseptics, both of which were
discovered in the nineteenth century.
The first public demonstration of anesthesia was in Boston in1846. The idea spread like a contagion, travelling
through letters, meetings, and periodicals. By mid-December, surgeons were
administering ether to patients in Paris and London. By February, anesthesia
had been used in almost all the capitals of Europe, and by June in most regions
of the world. Within seven years,
virtually every hospital in America and Britain had adopted the new discovery.
Sepsis—infection—was
the other great scourge of surgery. It was the single biggest killer of
surgical patients, claiming as many as half of those who underwent major operations.
Infection was so prevalent that suppuration—the discharge of pus from a
surgical wound—was thought to be a necessary part of healing.
In the
eighteen-sixties, the Edinburgh surgeon Joseph Lister read a paper by Louis
Pasteur laying out his evidence that spoiling and fermentation were the
consequence of microorganisms. Lister became convinced that the same process
accounted for wound sepsis. During the next few years, he perfected ways to use
carbolic acid for cleansing hands and wounds and destroying any germs that
might enter the operating field. The result was strikingly lower rates of
sepsis and death. You would have thought that, when he published his
observations in a groundbreaking series of reports in The Lancet, in
1867, his antiseptic method would have spread as rapidly as anesthesia.
Far from it. It was a generation before Lister’s
recommendations became routine and the next steps were taken toward the modern
standard of asepsis—that is, entirely excluding germs from the surgical field,
using heat-sterilized instruments and surgical teams clad in sterile gowns and
gloves."
A major thrust of
this important article deals with how oral rehydration therapy for diarrheal
diseases is only slowly spreading in the countries where it is most
needed. “In the nineteen-sixties,
scientists discovered that sugar helps the gut absorb fluid. Two American
researchers, David Nalin and Richard Cash, were in Dhaka during a cholera
outbreak. They decided to test the scientific findings, giving victims an oral
rehydration solution containing sugar as well as salt.” This cut the death rate from 30% to ~
3%. But 40 years later it is only just
starting to be taught on a large scale.”
It gives one hope – but this simple, inexpensive therapy is just not
sticky enough. Progress has been slow
Gawande’s article has much more of interest
is an important read for anyone interested in global health, public health, and
the spread of medical innovations.
See attached:
Download Slow Ideas Gawande
