How medical innovation is often delayed. Terrible story.

Another major innovation from outside the medical community was the discovery of streptomycin, the first drug that could cure tuberculosis and other gram-negative infections. Albert Schatz was a PhD candidate in microbiology working in the lab of Selman Waksman, an agricultural microbiologist who studied soil bacteria and decomposition processes. His lab discovered a range of the early antibiotics, also including neomycin, clavacin, etc. Waksman was awarded the 1952 Nobel Prize in Physiology and Medicine for his antibiotic contributions.

The Medical community is traditionally adverse to innovations that challenge long-held sacred cows. A classic example is the bitter attacks on Ignaz Semmelweiss for his discovery that if doctors and midwives simply wash their hands the mortality rate for post-partum infections plummet. The attacks on the Hungarian doctor were so nasty and intense that they led to his suicide.

Likewise, there was significant resistance to the findings of Barry Marshall and Robin Warren that the major cause of stomach and upperduodenal ulcers was an infection by Heliobacter pylori, NOT simply stomach acidity. While the ammonia the bacteria produces in response to lower pH contributes to damage to the gastrointestinal lining, the primary cause of damage to the lining is due to proteases, phospholipases, and Cytotoxin A produced by the bacteria. As a result, the existing therapies of antacids coupled with surgery for persistent ulcers was revealed as inferior to treatment with antibiotics and antacids, which threatened a revenue stream for gastrointestinal surgeons.

The medical community can even be resistant to evidence-based innovation from within. A classic example is that of US Army Surgeon General William Hammond, who had been an Army surgeon before the war – where he was considered a troublesome eccentric for conducting research and publishing two papers on the effects and treatment of invenomation by snakebite. He left to become a professor of medicine at the University of Maryland, and returned to service during the war. Surgeon General Clarence Finley at first attempted to shunt him to a backwater as Brigade Surgeon for Rosecrans’ Brigade in the Department of the Ohio, but he was promoted to Brigadier General and Surgeon General of the Army in April 1862. He immediately initiated a series of reforms – higher standards for appointment to surgeon billets (my state of Indiana was notorious for lax standards – the future legislator who wrote our first medical licensing law and public health law was commissioned a surgeon, found he liked medicine, and after the war decided to actually attend medical school), redesigned evacuation hospitals with an eye on sanitation and ventilation, reformed the ambulance and casualty evacuation system, reformed purchasing of medical supplies, instituted smallpox vaccination, established training materials for surgeons on sanitation, preventive medicine, etc., and, crucially, ordered the removal of calomel (mercuric chloride) from army medical chests on the grounds that the chemical did more harm than good. This caused a backlash among the long-term regular Army surgical officers, most of whom were intellectually stagnant and failed to keep up with medical innovation. This led to a rebellion that poisoned his relationship with Secretary of War Stanton, leading to his court-martial on charges of “purchasing irregularities” regarding his response to the clinical crisis after the battle of Gettysburg (when the Army of the Potomac left in pursuit of Lee’s army, leaving 23,000 Union and Confederate wounded on the field while taking most of the Army’s medical supply train and surgeons with them), for which he was convicted based on perjured testimony and dismissed from service. In 1878 the conviction was overturned, he was restored to the rank of Brigadier General, and allowed to retire honorably from the Army. Hammond went on to a distinguished career as one of the pioneers of neurology and neuropsychiatry, a founder of the American Neurological Association, and one of the movers behind the founding of the first modern medical school at Johns Hopkins University.

From How to Stop the Bleeding at Powerline.