Monday, May 28, 2018

Invisible and Delayed

From Freakonomics Radio: The Most Ambitious Thing Humans Have Ever Attempted, guest: Atul Gawande.

DUBNER: Good ideas often take a really long time to catch on in medicine. Why do you think that is? 
GAWANDE: Yeah, I got really fascinated by this thinking about two examples. Both of them transformed surgery in the nineteenth century: anesthesia and the discovery of anti-sepsis. Preventing infections, the biggest killer there was. Anesthesia was discovered and within two months — 
DUBNER: In Boston, right? 
GAWANDE: In Boston, yeah. Massachusetts General Hospital. And within two months of publishing the result that a gas could render people insensible to pain, it was being used in every capital in Europe. There’s no internet. You had to send news by boat and horse. And within two months people were using it in the capitals of Europe, and by six years later there wasn’t a hospital in the country that was not delivering anesthesia care. By contrast, anti-sepsis, Joseph  Lister discovered that if you used antiseptic solution, clean the instruments, your hands, did all that stuff, you could cut infections by 80 percent. And a generation later, you still haven’t gotten to half of the profession doing it. And when I broke it down, I realized there’s a difference between a visible and immediate effect that they had in anesthesia that could be recognized right away, and tackling invisible delayed effects of germs.
So an example from today: the fastest selling drug in history was Viagra. Immediate and visible effect. And it was very good for the doctors too. My dad was a urologist at the time, and he tripled the number of patients he had in his practice within weeks. And so that was just a tremendous win-win. Surgery checklist: harder to sell. Cuts deaths — we just showed in South Carolina, hospitals that adopted it got a 22 percent reduction in death compared to the hospitals that didn’t complete the process. Because it’s making an investment now for a gain later for many problems which are often not immediately visible to people.
DUBNER: It’s interesting, in both of your examples it was the prevention that people ignore and the intervention that of course people gravitate toward.
As I was listening to this episode in the car yesterday, this particular section leapt out at me. I tucked it away in my mind, knowing I’d be using it at a later date. I just didn’t know it would be so soon.
What happened in Ellicott City yesterday was horrific. We all know that more than money and property have been lost here. As I write there are reports of a missing person: someone who was assisting with rescue. The spirits of many who rebuilt after the 2016 flood are broken or close to it. This kind of catastrophic loss and its ensuing grief leaves a mark on each human life it touches. 
A friend of mine said last night, “This is tragic, but it is a tragedy of human creation.”
And then I rembered Steven Dubner’s words:
It’s interesting, in both of your examples it was the prevention that people ignore and the intervention that of course people gravitate toward.
Stormwater management in a time of increasing climate change has been the unsexy prevention that many have chosen not to champion. And so, yet again, we are forced to be reactive because there was not the political will to be proactive. 
Today and the days and weeks (and months) to come will be about reaching out to those in need and doing whatever we can to help. I encourage my readers to participate in whatever way they can. But as the local election season gears up, what can we do to turn the discussion to responsible stormwater management policies and the proactive investments now that will prove their value later?
Ideas? Post them here:
Or you just might catch me in person here this afternoon.

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