ABC RADIO SYDNEY
MONDAY, 23 MARCH 2020
SUBJECTS: Randomistas and the history of hand washing.
RICHARD GLOVER, HOST: Dr Andrew Leigh is the Labor MP for the seat of Fenner. He's also somebody who's very interested in random studies and science and economics and all those sorts of things, and has written about the story of Dr Semmelweis in his book ‘Randomistas’, which is a book about radical researchers and how they've changed our world. Well, in his case - in Semmelweis’ case – it certainly took a while. Andrew Leigh joins us on the line. Good afternoon.
ANDREW LEIGH, SHADOW ASSISTANT MINISTER FOR TREASURY AND CHARITIES: Good afternoon, Richard. How are you?
GLOVER: Yeah, good. As we’re all spending so much time washing our hands, I thought we'd praise the man who kind of first got onto the idea of why it was so important.
LEIGH: Semmelweis was a wonderful pioneer, a quirky man who worked in the Vienna General Hospital. He noted this significant difference between the alternate days in which the births were delivered by female midwives and the days when they were delivered by male doctors. He noted that women were about twice as likely to die if they were admitted to the clinic on a day in which the doctors were doing the delivery rather than the midwives.
GLOVER: So his question was, the question in anyone's mind, what were the midwives doing that had such a great impact?
LEIGH: Exactly, and the mothers knew it. So there are these stories about women giving birth on the streets rather than go into the hospital on the days when the doctors were rostered on. They thought maybe it was something to do with the fact that the midwives were delivering babies on their side and the doctors on their backs, or because the priest was walking through ringing the bell and maybe that was troubling other women. Then Semmelweis had a friend who was poked by a scalpel and died, and he saw that the symptoms of the friend were quite similar to the symptoms of the women who were dying on the days when the male doctors were delivering the babies. The problem was many doctors were coming across from doing autopsies without washing their hands. So Semmelweis said ‘everyone's got to wash their hands’ and it's got to be done in the technique of the day, which was a chlorine wash. Terribly painful, and so the doctors were resistant to it. As soon as Semmelweis left the hospital they went back to not washing their hands again. It took literally decades for Semmelweis’ wisdom to be accepted right across hospitals.
GLOVER: But in the interim, when they were washing their hands, it had a dramatic impact right?
LEIGH: Huge. So you managed to save vast numbers of lives of women. But here's the interesting thing - this was an innovation which was good for patients, but painful for doctors. So its adoption took decades. The contrary example is anaesthetics, which are good for patients and very good for surgeons, because it's much more pleasant to operate on somebody who's got their eyes closed instead screaming their head off while you're slicing into them with a scalpel. So anaesthetics were accepted almost immediately by the surgical profession, handwashing took a very long time to get embedded.
GLOVER: Part of the problem was that even though Semmelweis in a way had a double blind study to show the efficacy of this, there was no theory of germs to back up why it worked. So yes, it worked but they couldn't understand why it worked, and so in a way it had to wait until there was a theory of germs that they could refer back to.
LEIGH: That's absolutely right, Richard. And so he had a theory about there being ‘cadaverous particles’ in the air, which is sort of right in a vague sense. But as you say, the germ theory of disease wasn't accepted. It's a bit like James Lind, who did these wonderful randomised trials discovering that citrus cured scurvy, but then had these hocus pocus ideas as to why. So it took again decades before ships started carrying oranges and lemons in order to ward off scurvy. These radical randomistas were quick with working out what worked, but because they didn't have the theory to back up the empirics, it took a while to get accepted. Now of course, we're all washing our hands like Lady Macbeth.
GLOVER: [laughter] Exactly. With all the restraint of Lady Macbeth. Semmelweis’ story ends so badly, doesn't it? Having discovered this thing that would in the end save millions of lives, he actually sort of died in penury, didn't he?
LEIGH: Oh, it's such a sad story, yes. So he's consigned to an asylum, where it appears that he was beaten and may even have died from an infected wound, at age 47. So in his lifetime he was shunned. So goes the story of so many sort of great pioneers through history, sadly.
GLOVER: That's right, and such a simple thing. Such an effective thing, and yet it took so long for it to be used. At least we all know how to do it today. Andrew, thank you.
LEIGH: Can I add one more aspect of handwashing, which is that the temperature of the water turns out not to matter – we've had randomized studies looking at whether hot or cold water works. One of the interesting reasons that soap works is not only that it acts as a lubricant but also it makes us wash longer. The very fact of needing to get the soap off causes us to increase the duration of the washing, which is which is one of the things that really matters.
GLOVER: Okay, so the soap is good in itself, but it's also takes a while to get it off and so that's efficacious too.
LEIGH: That's right, yes. I mean, it's handy in the case of COVID-19, because there's a membrane protein around its outside that actually gets broken down by the soap. But in general, the duration matters significantly. Oh, and don’t worry about the antibacterial soaps – randomistas have shown that they have no more efficacious effect for regular people than non antibacterial soaps. Regular soap will do us just fine.
GLOVER: Ok. And, as Elyse knows, together with a rendition of Happy Birthday maybe once or twice.
LEIGH: Or the Bee Gees’ Stayin’ Alive. Make it up to the ‘Ah, ha, ha, ha’ bit and you’ve got exactly 20 seconds.
GLOVER: [laughter] Good on you. Thank you, Andrew.
LEIGH: Thank you, Richard.
Authorised by Paul Erickson, ALP, Canberra.