James V. McConnell

I read with great delight Lewis Thomas's "The Medical Lessons of History" (July 3). It is good to know that such a wise and scholarly physician believes that we can learn from our past mistakes, and that he has some hope for the future of the medical sciences. It is a pity, however, that Dr. Thomas seems not to have learned the real lesson that history offers us — namely, that the "great breakthroughs" in any technology are always preceded by a radical change in how we view ourselves, and how we behave.

Take penicillin, for example. As Dr. Thomas points out, its benefits were denied us for a decade after its discovery by Sir Alexander Fleming. Dr Thomas holds that the medical doctors failed to put penicillin to use because they "disbelieved" it could do what plainly it did. Well, that’s a nice way of explaining matters. But in truth Fleming's colleagues ignored him for 10 years because they refused to accept scientific data showing that penicillin "worked". Just as a century earlier, the medical leaders in Vienna refused to accept Semmelweiss's studies showing that the death rate for childbed fever1 could be cut from about 26% to about 2% if the attending physicians would only wash their hands before delivering babies.In fact, medical doctors (like most of us) are highly reluctant to judge their actions solely in terms of the objective consequences of what they do. Like most other humans, MDs usually prefer that they be evaluated according to their intentions and feelings. Any reader who doubts my contention might remember that, in malpractice suits, the physician's defense typically is, "I followed standard medical procedure," rather than,"I did what was necessary to cure the patient." Just ask your own family physician some time what his or her own particular "cure rate" is for a given medical problem --- and demand statistical evidence to backup the claim. My guess is that you will shortly be dismissed as a patient.