Ignaz Semmelweis: hand washing

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pages: 254 words: 61,387

This Could Be Our Future: A Manifesto for a More Generous World by Yancey Strickler

basic income, big-box store, Capital in the Twenty-First Century by Thomas Piketty, Cass Sunstein, cognitive dissonance, corporate governance, Daniel Kahneman / Amos Tversky, David Graeber, Donald Trump, Doomsday Clock, effective altruism, Elon Musk, financial independence, gender pay gap, global supply chain, housing crisis, Ignaz Semmelweis: hand washing, invention of the printing press, invisible hand, Jeff Bezos, job automation, John Maynard Keynes: Economic Possibilities for our Grandchildren, John Nash: game theory, Joi Ito, Joseph Schumpeter, Kickstarter, Louis Pasteur, Mark Zuckerberg, medical bankruptcy, new economy, Oculus Rift, off grid, offshore financial centre, Ralph Nader, RAND corporation, Richard Thaler, Ronald Reagan, self-driving car, shareholder value, Silicon Valley, Simon Kuznets, Snapchat, Social Responsibility of Business Is to Increase Its Profits, stem cell, Steve Jobs, The Wealth of Nations by Adam Smith, Thomas Kuhn: the structure of scientific revolutions, Travis Kalanick, universal basic income, white flight

Information on its history comes from several sources, including Bad Medicine: Doctors Doing Harm Since Hippocrates by historian David Wootton, which was invaluable for illuminating the long dark age of medicine, and The Emperor of All Maladies by Siddhartha Mukherjee, which was excellent for setting the larger context on the history of medicine generally and cancer specifically. died from postsurgical infections: Details on Ignaz Semmelweis, Joseph Lister, and that era came from The Doctors’ Plague: Germs, Childbed Fever, and the Strange Story of Ignaz Semmelweis by Sherwin B. Nuland, and from Bad Medicine by David Wootton. doubled in the twentieth century: According to the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (“Achievements in Public Health, 1900–1999: Healthier Mothers and Babies,” October 1, 1999). “fantasy of a science”: In Wootton’s Bad Medicine.

Bloodletting meant cutting into an artery (or, if you were fashionable, using leeches) and intentionally bleeding the patient, preferably until he or she passed out. This was thought to bring the body’s fluids into balance. Bleeding was the “take a Tylenol” of its day. And that day lasted for more than 2,000 years. But in the middle of the nineteenth century, this began to change. Three events stand out as catalysts. In Budapest, a doctor named Ignaz Semmelweis identified microbes on doctors’ dirty hands as the cause of a deadly form of childbirth fever. In Paris, a scientist named Louis Pasteur proved that germs existed, establishing a new idea called germ theory and discovering the actual microbes that Semmelweis theorized were the cause of illness. And in Glasgow, a doctor named Joseph Lister created the antiseptic method by applying the principles of germ theory to surgical care.

The transformation of health began with the invention of the printing press, which allowed physicians to easily compare techniques and outcomes. The printing press was followed by a long line of technologies, including the microscope, the stethoscope, the data table (for sharing experiment results), anesthesia, the computer, and other tools to help us better observe and influence the body’s processes. Next is measurement. Measurement was transformational even in its simplest forms. Ignaz Semmelweis discovered the cause of childbirth fever by counting the death rates of two maternity wards. The doctor John Snow helped stop a deadly cholera outbreak in London by counting where deaths occurred and finding a water pump that was infecting the population. Counting mortality rates led to the conclusion that bloodletting was harmful after 2,200 years of practice. Measurement removed the guesswork.


pages: 340 words: 94,464

Randomistas: How Radical Researchers Changed Our World by Andrew Leigh

Albert Einstein, Amazon Mechanical Turk, Anton Chekhov, Atul Gawande, basic income, Black Swan, correlation does not imply causation, crowdsourcing, David Brooks, Donald Trump, ending welfare as we know it, Estimating the Reproducibility of Psychological Science, experimental economics, Flynn Effect, germ theory of disease, Ignaz Semmelweis: hand washing, Indoor air pollution, Isaac Newton, Kickstarter, longitudinal study, loss aversion, Lyft, Marshall McLuhan, meta analysis, meta-analysis, microcredit, Netflix Prize, nudge unit, offshore financial centre, p-value, placebo effect, price mechanism, publication bias, RAND corporation, randomized controlled trial, recommendation engine, Richard Feynman, ride hailing / ride sharing, Robert Metcalfe, Ronald Reagan, statistical model, Steven Pinker, uber lyft, universal basic income, War on Poverty

Dubner, ‘Bad Medicine, Part 1: The Story of 98.6’, Freakonomics Radio, 30 November 2016. 21Vinay Prasad, quoted in Stephen J. Dubner, ‘Bad Medicine, Part 1: The Story of 98.6’, Freakonomics Radio, 30 November 2016. 22For the story of Semmelweis, see Ignaz Semmelweis, Etiology, Concept and Prophylaxis of Childbed Fever, University of Wisconsin Press, 1983 [1861]; Rebecca Davis, ‘The doctor who championed hand-washing and briefly saved lives’, NPR, 12 January 2015. Mortality rates in the two clinics fluctuated significantly – the 1 in 10 and 1 in 20 figures are approximate averages for the period before handwashing was introduced. 23Carter, K. Codell & Barbara R. Carter, Childbed Fever. A Scientific Biography of Ignaz Semmelweis, Transaction Publishers, 2005. 24Quoted in John Harley Warner, The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820–1885, Princeton: Princeton University Press, 2014, p. 33. 25Wootton, Bad Medicine, p. 2. 26See for example Gregory L.

And yet the clinics had very different health outcomes. In the clinic run by midwives, a mother’s chance of death was less than 1 in 20. In the clinic run by doctors, maternal mortality was 1 in 10: more than twice as high. Patients knew this and would beg not to be admitted into the doctor-run clinic. Some would give birth on the street instead of in the doctors’ clinic, because their chance of survival was higher. To Ignaz Semmelweis, the doctor in charge of records, the results were puzzling. Because the two clinics admitted patients on alternate days, the health of the patients should have been similar. Indeed, it was almost as though the Vienna Hospital had set up a randomised trial to test the impact of the two clinics – and discovered the doctors were doing more harm than good. In trying to uncover reasons for this, Semmelweis first observed that midwives delivered babies while women lay on their sides, while doctors delivered babies while women lay on their backs.

Petersburg Times 60 Stark, William 16 Stewart, Matthew, and The Management Myth 138 Stigler, Stephen 50 Street Narcotics Unit experiment 92–3 streptomycin trial 56 see also Austin Bradford Hill Sullivan, Andrew, and Pyrotron 14 Suskind, Dana 70 Syed, Matthew 142 teacher payment trial 111 see also Karthik Muralidharan Telford, Dick 201–2 text messages, and use of 9, 78, 82, 123, 154 textbook trial 123–4 see also Karthik Muralidharan The Battered Women’s Movement 89 the book of Daniel 22 ‘the brevia’ and ‘the scrutiny’ 181 the ‘gold standard’ 194 The Lancet 24, 55, 120 The Matrix 30 ‘the paradox of choice’ 195 the placebo effect see placebo effect ‘the Super Bowl impossibility theorem’ 140 Thirty Million Words initiative 79–80 ‘three strikes’ law’ 99, 101 ‘Triple P’ positive parenting program 68–9 ‘True Love Waits’ program 47 Trump campaign 154 Tseng, Yi-Ping 37 see also ‘Journey to Social Inclusion’ UK Department for International Development 103 unemployment 36, 44–6, 78, 103 see also German government unemployment incentive; job training programs; ‘universal basic income’ ‘universal basic income’ 46 University of Chicago, and ‘Science of Philanthropy Initiative’ 159 University of London 54 University of Queensland, and ‘Triple P’ positive parenting program 68 University of Wollongong 187 US Agency for International Development 103, 210 US Behavioural Insights Team 186 see also Elizabeth Linos US Congressional Budget Office 194 US National Academy panel 100 US Police Foundation 89 ‘verbal bombardment’ and Perry Preschool 67 Vienna General Hospital 24–5 see also Ignaz Semmelweis Vietnam war draft 42–3 Virgin Atlantic Airways 136 ‘virginity pledges’ in the US 46–7 Wagner, Dan 159 Waiting for Superman 79 Washington Post 7 Washington Times 60 Weikart, David 66–7, 71 West Heidelberg centre 71 What Works Clearinghouse 76–7, 208 Western Union 130 Wilson, James 184–5 Wootton, David 26, 203–4 and Bad Medicine 26 World Bank 103, 111 World Health Organization 112–13, 115, 199 World Medical Association 186 Wydick, Bruce 114–15 Yale University, and Innovations for Poverty Action 123 YouWiN!


pages: 588 words: 131,025

The Patient Will See You Now: The Future of Medicine Is in Your Hands by Eric Topol

23andMe, 3D printing, Affordable Care Act / Obamacare, Anne Wojcicki, Atul Gawande, augmented reality, bioinformatics, call centre, Clayton Christensen, clean water, cloud computing, commoditize, computer vision, conceptual framework, connected car, correlation does not imply causation, creative destruction, crowdsourcing, dark matter, data acquisition, disintermediation, disruptive innovation, don't be evil, Edward Snowden, Elon Musk, en.wikipedia.org, Erik Brynjolfsson, Firefox, global village, Google Glasses, Google X / Alphabet X, Ignaz Semmelweis: hand washing, information asymmetry, interchangeable parts, Internet of things, Isaac Newton, job automation, Julian Assange, Kevin Kelly, license plate recognition, lifelogging, Lyft, Mark Zuckerberg, Marshall McLuhan, meta analysis, meta-analysis, microbiome, Nate Silver, natural language processing, Network effects, Nicholas Carr, obamacare, pattern recognition, personalized medicine, phenotype, placebo effect, RAND corporation, randomized controlled trial, Second Machine Age, self-driving car, Silicon Valley, Skype, smart cities, Smart Cities: Big Data, Civic Hackers, and the Quest for a New Utopia, Snapchat, social graph, speech recognition, stealth mode startup, Steve Jobs, the scientific method, The Signal and the Noise by Nate Silver, The Wealth of Nations by Adam Smith, Turing test, Uber for X, uber lyft, Watson beat the top human players on Jeopardy!, WikiLeaks, X Prize

Much of medical practice will be conducted online, with online consultations routine.” —RICHARD SMITH, EDITOR, British Medical Journal2 “We can only see a short distance ahead, but we can see plenty there that needs to be done.” —ALAN TURING3 Profound change has not ever gone over well in the medical community. When Dr. Ignaz Semmelweis published findings in 1848 that hand washing could markedly reduce mortality, it was summarily dismissed by doctors who were offended at the suggestion they should wash their hands and saw no scientific explanation for the claim.4 Likewise, in 1990, there was strong opposition to the use of ultrasound during pregnancy. In the American Journal of Obstetrics & Gynecology (the leading medical journal of the specialty), in response to an article touting its use, Ewigman and colleagues wrote: “These authors’ ethical argument that patient autonomy justifies offering ultrasonography routinely would lead to unrealistic expectations of physicians and the health care system, cause an inappropriate legal liability, and may be harmful to patients.”5 Even the stethoscope, invented by Rene Laennec in 1816, was not received well by doctors, to put it mildly.

Schumpeter: A Theory of Social and Economic Evolution (New York, NY: Palgrave McMillan, 2011). 2. R. Smith, “Teaching Medical Students Online Consultation with Patients,” BMJ Blogs, February 14, 2014, http://blogs.bmj.com/bmj/2014/02/14/richard-smith-teaching-medical-students-online-consultation-with-patients/. 3. “Alan Turing,” Wikiquote, accessed August 13, 2014, http://en.wikiquote.org/wiki/Alan_Turing. 4. “Ignaz Semmelweis,” Wikipedia, accessed August 13, 2014, http://en.wikipedia.org/wiki/Ignaz_Semmelweis. 5. B. Ewigman et al., “Ethics and Routine Ultrasonography in Pregnancy,” American Journal of Obstetrics & Gynecology 163, no. 1 (1990): 256–257. 6. S. J. Reiser, Technological Medicine: The Changing World of Doctors and Patients (New York, NY: Cambridge University Press, 2009), 12. 7. H. J. West, D. deBronkart, and G. D. Demetri, “A New Model: Physician-Patient Collaboration in Online Communities and the Clinical Practice of Oncology,” Department of Thoracic Oncology, Swedish Cancer Institute, 2012, http://meetinglibrary.asco.org/sites/meetinglibrary.asco.org/files/Educational Book/PDF Files/2012/zds00112000443.pdf. 8.

in reporting on some hospitals that were publicly flogged for very serious or fatal errors but still could not get on track to avoid these subsequently.16 The patient perspective is especially poignant and well represented by Mary Brennan-Taylor, who works at the YMCA in upstate New York. Brennan-Taylor lost her mother and has become a national advocate for hospital safety. Her lessons of overriding medical paternalism, and the need to inspire patients to assert themselves are well stated: “I felt responsible for not being able to protect her. I was totally trusting. I never asked the doctors and nurses coming into her room to wash their hands. I never checked her medication.” In an article entitled “Survive Your Hospital Stay,” Consumer Reports rated 2,591 hospitals for safety, with quite striking findings.17 The differences in death rates for common diagnoses or surgery were analyzed as a function of low or high rating. The ratings factored in mortality, readmission to the hospital within thirty days from being discharged, infections, communications of the staff, and the use of medical scans.


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Hello World: Being Human in the Age of Algorithms by Hannah Fry

23andMe, 3D printing, Air France Flight 447, Airbnb, airport security, augmented reality, autonomous vehicles, Brixton riot, chief data officer, computer vision, crowdsourcing, DARPA: Urban Challenge, Douglas Hofstadter, Elon Musk, Firefox, Google Chrome, Gödel, Escher, Bach, Ignaz Semmelweis: hand washing, John Markoff, Mark Zuckerberg, meta analysis, meta-analysis, pattern recognition, Peter Thiel, RAND corporation, ransomware, recommendation engine, ride hailing / ride sharing, selection bias, self-driving car, Shai Danziger, Silicon Valley, Silicon Valley startup, Snapchat, speech recognition, Stanislav Petrov, statistical model, Stephen Hawking, Steven Levy, Tesla Model S, The Wisdom of Crowds, Thomas Bayes, Watson beat the top human players on Jeopardy!, web of trust, William Langewiesche

All they had to do was find an individual with a mild case of the disease, harvest their scabs, dry them, crush them and blow them into the nose of a healthy person.6 Or the medical golden age of the nineteenth century, as medicine adopted increasingly scientific methods, and looking for patterns in data became integral to the role of a physician. One of these physicians was the Hungarian Ignaz Semmelweis, who in the 1840s noticed something startling in the data on deaths on maternity wards. Women who gave birth in wards staffed by doctors were five times more likely to fall ill to sepsis than those in wards run by midwives. The data also pointed towards the reason why: doctors were dissecting dead bodies and then immediately attending to pregnant women without stopping to wash their hands.7 What was true of fifteenth-century China and nineteenth-­century Europe is true today of doctors all over the world. Not just when studying diseases in the population, but in the day-to-day role of a primary care giver, too.

, AMA Journal of Ethics, Virtual Mentor 13: 1, Jan. 2011, pp. 52–4, http://journalofethics.ama-assn.org/2011/01/msoc1-1101.html. 6. Joseph Needham, Science and Civilization in China, vol. 6, Biology and Biological Technology, part VI, Medicine, ed. Nathan Sivin (Cambridge: Cambridge University Press, 2004), p. 143, https://monoskop.org/images/1/16/Needham_Joseph_Science_and_Civilisation_in_China_Vol_6-6_Biology_and_Biological_Technology_Medicine.pdf. 7. ‘Ignaz Semmelweis’, Brought to Life: Exploring the History of Medicine (London: Science Museum n.d.), http://broughttolife.sciencemuseum.org.uk/broughttolife/people/ignazsemmelweis. 8. Quotations from Andy Beck are from personal communication. 9. Joann G. Elmore, Gary M. Longton, Patricia A. Carney, Berta M. Geller, Tracy Onega, Anna N. A. Tosteson, Heidi D. Nelson, Margaret S. Pepe, Kimberly H. Allison, Stuart J.

Contents A note on the title Introduction Power Data Justice Medicine Cars Crime Art Conclusion Acknowledgements Photograph Credits Notes Index A note on the title WHEN I WAS 7 YEARS old, my dad brought a gift home for me and my sisters. It was a ZX Spectrum, a little 8-bit computer – the first time we’d ever had one of our own. It was probably already five years out of date by the time it arrived in our house, but even though it was second-hand, I instantly thought there was something marvellous about that dinky machine. The Spectrum was roughly equivalent to a Commodore 64 (although only the ­really posh kids in the neighbourhood had one of those) but I ­always thought it was a far more beautiful beast. The sleek black plastic casing could fit in your hands, and there was something rather friendly about the grey rubber keys and rainbow stripe running diagonally across one corner. For me, the arrival of that ZX Spectrum marked the beginning of a memorable summer spent up in the loft with my elder sister, programming hangman puzzles for each other, or drawing simple shapes through code.


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The Half-Life of Facts: Why Everything We Know Has an Expiration Date by Samuel Arbesman

Albert Einstein, Alfred Russel Wallace, Amazon Mechanical Turk, Andrew Wiles, bioinformatics, British Empire, Cesare Marchetti: Marchetti’s constant, Chelsea Manning, Clayton Christensen, cognitive bias, cognitive dissonance, conceptual framework, David Brooks, demographic transition, double entry bookkeeping, double helix, Galaxy Zoo, guest worker program, Gödel, Escher, Bach, Ignaz Semmelweis: hand washing, index fund, invention of movable type, Isaac Newton, John Harrison: Longitude, Kevin Kelly, life extension, Marc Andreessen, meta analysis, meta-analysis, Milgram experiment, Nicholas Carr, P = NP, p-value, Paul Erdős, Pluto: dwarf planet, publication bias, randomized controlled trial, Richard Feynman, Rodney Brooks, scientific worldview, social graph, social web, text mining, the scientific method, Thomas Kuhn: the structure of scientific revolutions, Thomas Malthus, Tyler Cowen: Great Stagnation

There are well over a hundred of these biases that have been cataloged. . . . IN the 1840s, Ignaz Semmelweis was a noted physician with a keen eye. While he was a young obstetrician working in the hospitals of Vienna, he noticed a curious difference between mothers who delivered in his division of the hospital and those who delivered at home, or using midwives in the other part of the hospital. Those whose babies were delivered by the physicians at the hospital had a much higher incidence of a disease known as childbed fever, which often causes a woman to die shortly after childbirth, than the women delivering with midwives. Specifically, Semmelweis realized that those parts of the hospital that did not have their obstetricians also perform autopsies had similarly low amounts of childbed fever as home deliveries. Ignaz Semmelweis argued that the doctors—who weren’t just performing autopsies in addition to deliveries but were actually going directly from the morgue to the delivery room—were somehow spreading something from the cadavers to the women giving birth, leading to their deaths.

Ignaz Semmelweis argued that the doctors—who weren’t just performing autopsies in addition to deliveries but were actually going directly from the morgue to the delivery room—were somehow spreading something from the cadavers to the women giving birth, leading to their deaths. Semmelweis made a simple suggestion: Doctors performing deliveries should wash their hands with a solution of chlorinated lime beforehand. And this worked. It lowered the cases of childbed fever to one tenth the original amount. However, rather than being lauded for an idea that saved lives for essentially no cost, Semmelweis’s ideas failed to gain traction. Some of this was due to the fact that there was no germ theory at the time to explain the spread of the disease. Therefore, those who had a stake in the then-current theories refused to recognize that Semmelweis was making important points.

Specifically, it found a large cluster of genes related to something known as programmed cell death. Programmed cell death is not nearly as scary as it sounds. Our bodies often require the death of individual cells in order to perform correctly, and there is a set of genes in our cells tailored for this purpose. For example, during embryonic development, our hands initially have webbing between the fingers. But prior to birth the cells in the webbing are given the signal to die, causing us to not have webbed hands. Webbed hands and feet only occur when the signal is given incorrectly, or when these genes don’t work properly. What CoPub Discovery computationally hypothesized is that when these programmed cell death genes don’t work properly in other ways, a cascade of effects might follow, eventually leading to the condition known as Graves’ disease.


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A Short Guide to a Long Life by David B. Agus

Danny Hillis, Ignaz Semmelweis: hand washing, lifelogging, meta analysis, meta-analysis, Murray Gell-Mann, personalized medicine, placebo effect, risk tolerance, the scientific method

Although technically not a discovery on par with penicillin and the smallpox or polio vaccines, the mid-nineteenth-century recognition of the importance of hand washing was a huge medical breakthrough that saved a lot of people long before vaccines and antibiotics were widely available. In 1847, while working at an obstetrics clinic in Vienna, Hungarian-born physician Dr. Ignaz Semmelweis noticed that fatal fevers among mothers of newborn children happened more frequently in birthings assisted by medical students than in those assisted by midwives. This prompted him to look closer at the clinic’s practices, and he soon noted that the medical students who aided in childbirth often did so after performing autopsies on people who had died from bacterial sepsis—a whole-body blood infection in which the inflammatory response to a blooming bacteria turns deadly. He then established a strict policy of hand washing with a chlorinated antiseptic solution, and lo and behold, mortality rates dropped ten- to twentyfold within three months.

Had civilization figured this out sooner, perhaps we could have avoided many of the deaths associated with plagues and epidemics that wiped out millions of people in earlier centuries. Even today, we are inclined to trivialize the simple act of hand washing and would do well to keep it at the top of our priorities on a daily basis. You’ll give yourself an advantage in avoiding germs that can make you sick, and you’ll help prevent the spread of germs to others. All you need is a dollop of soap and water. Antimicrobial soaps aren’t necessary; the standard stuff is just as good. But if you don’t have access to water, then use an alcohol-based hand sanitizer. Some studies have shown that people who washed their hands at least five times a day were 35 percent less likely to catch the flu than those who lathered up less. In addition to hand hygiene, maintaining general hygiene throughout your body will go a long way to protect you from the ick factor—think about head lice, bad breath, body odor, pinworms, and athlete’s foot.

Confusion or changes in mental status 6. Any sudden or severe pain 7. Uncontrolled bleeding 8. Severe or persistent vomiting or diarrhea 9. Coughing or vomiting blood 10. Suicidal or homicidal feelings Top 10 Things to Do During Cold Season 1. Get your flu shot if you haven’t already. 2. Wash your hands routinely. 3. Avoid sharing food and drinks with others. 4. Stay away from sick people. 5. Don’t go to work (and avoid public places) if you’re feeling ill. 6. Keep zinc lozenges on hand. 7. Avoid touching your face and eating with your hands. 8. Carry hand sanitizer. 9. Avoid stuffy rooms that have poor ventilation. 10. Keep common surface areas clean. Top 10 Reasons to Take a Walk 1. You’ll prevent weight gain and perhaps walk off weight. 2. You’ll reduce your risk of cancer. 3. You’ll reduce your risk of heart disease and stroke. 4.


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Originals: How Non-Conformists Move the World by Adam Grant

Albert Einstein, Apple's 1984 Super Bowl advert, availability heuristic, barriers to entry, business process, business process outsourcing, Cass Sunstein, clean water, cognitive dissonance, creative destruction, cuban missile crisis, Daniel Kahneman / Amos Tversky, Dean Kamen, double helix, Elon Musk, fear of failure, Firefox, George Santayana, Ignaz Semmelweis: hand washing, Jeff Bezos, job satisfaction, job-hopping, Joseph Schumpeter, Kickstarter, Lean Startup, Louis Pasteur, Mahatma Gandhi, Mark Zuckerberg, meta analysis, meta-analysis, minimum viable product, Nelson Mandela, Network effects, pattern recognition, Paul Graham, Peter Thiel, Ralph Waldo Emerson, random walk, risk tolerance, Rosa Parks, Saturday Night Live, Silicon Valley, Skype, Steve Jobs, Steve Wozniak, Steven Pinker, The Wisdom of Crowds, women in the workforce

“Timing is everything,” Medina’s colleague Susan Benjamin notes. “In that intervening period, it became obvious to even people who were real Luddites that we had to do things differently; the times called for it. It became difficult for anyone who had half a brain in their head not to listen to her, and agree that that was the direction in which to move.” In the 1840s, when Hungarian physician Ignaz Semmelweis discovered that having medical students wash their hands dramatically reduced death rates during childbirth, he was scorned by his colleagues and ended up in an asylum. It would be two decades before his ideas gained scientific legitimacy as Louis Pasteur and Robert Koch laid the foundations of germ theory. As physicist Max Planck once observed, “A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die.”

“If it didn’t look dorky”: Personal interview with Bill Sahlman, March 11, 2015. pioneers had lower survival rates: Stanislav D. Dobrev and Aleksios Gotsopoulos, “Legitimacy Vacuum, Structural Imprinting, and the First Mover Disadvantage,” Academy of Management Journal 53 (2010): 1153–74. “We had to wait for Amazon”: Personal interview with Neil Blumenthal, June 25, 2014. Hungarian physician Ignaz Semmelweis: Steven D. Levitt and Stephen J. Dubner, SuperFreakonomics: Global Cooling, Patriotic Prostitutes, and Why Suicide Bombers Should Buy Life Insurance (New York: William Morrow, 2009). “A new scientific truth”: Max Planck, Scientific Autobiography and Other Papers (New York: Philosophical Library, 1949). First-mover advantages: Marvin B. Lieberman, “Did First-Mover Advantages Survive the Dot-Com Crash?

Emphasizing consequences for others can motivate adults, too. In hospitals, to encourage doctors and nurses to wash their hands more often, my colleague David Hofmann and I posted two different signs near soap and gel dispensers: Over the next two weeks, a member of each hospital unit covertly counted the number of times that medical professionals washed their hands before and after each patient contact, while an independent team measured the amount of soap and gel used from each dispenser. The sign on the left had no effect whatsoever. The sign on the right made a significant difference: merely mentioning patients instead of you led medical professionals to wash their hands 10 percent more often and use 45 percent more soap and gel. Thinking about oneself invokes the logic of consequence: Will I get sick?


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10% Human: How Your Body's Microbes Hold the Key to Health and Happiness by Alanna Collen

Asperger Syndrome, Barry Marshall: ulcers, Berlin Wall, biofilm, clean water, correlation does not imply causation, David Strachan, discovery of penicillin, Drosophila, Fall of the Berlin Wall, friendly fire, germ theory of disease, global pandemic, hygiene hypothesis, Ignaz Semmelweis: hand washing, illegal immigration, John Snow's cholera map, Kickstarter, Louis Pasteur, Maui Hawaii, meta analysis, meta-analysis, microbiome, phenotype, placebo effect, the scientific method

In comparison with giving birth, often at home, in large areas of Africa, Asia and South America, giving birth in much of Europe, North America and Australasia is a highly medicalised, sterile process. Beds, hands and tools are all washed with antibacterial soaps and alcohol rubs before they come into contact with the labouring woman or her baby. Nearly half of American women are put on an anti biotic drip to prevent them from passing on harmful bacteria such as Group B strep to their babies. And all American babies receive a dose of antibiotics straight after they are born, just in case their mothers have gonorrhoea, which could, in rare cases, cause an eye infection. Ignaz Semmelweis would be pleased to see his antiseptic measures so thoroughly and effectively put into practice, and there’s no doubt that many thousands of mothers and babies are alive because of such hygiene.

Women suffered most as a result of the proliferation of hospitals, as the risks of labour and giving birth, rather than falling, actually rose. By the 1840s, up to 32 per cent of women giving birth in hospital would subsequently die. Doctors – all male at that time – blamed their deaths on anything from emotional trauma to uncleanliness of the bowel. The true cause of this horrifyingly high death rate would at last be unravelled by a young Hungarian obstetrician by the name of Ignaz Semmelweis. At the hospital where Semmelweis worked, the Vienna General, women in labour were admitted on alternate days into two different clinics. One was run by doctors, and the other by midwives. Every second day, as Semmelweis walked to work, he’d see women giving birth on the street outside the hospital doors. On those days, it was the turn of the clinic run by doctors to admit labouring women.

Muscles that should automatically follow the brain’s instructions seem to get multiple orders, and instead of smooth decisive actions, they produce Parkinson-like tremors. Routines are also messed with – turning the lights on, locking the doors, washing the hands. For those OCD sufferers who compulsively wash their hands, there’s an intriguing possibility. I mentioned earlier that some groups of bacteria become more abundant just after hand-washing, perhaps because they take the opportunity to bloom in the absence of their more vulnerable peers. I’ll save you the trouble of looking back: the streptococci are one such group. It’s by no means certain, but maybe these opportunistic pathogens gain enough ground on the hands and in the gut after a good hand-wash to persuade their host, via the habit-enforcing, reward-giving basal ganglia, to keep on washing. Perhaps it won’t come as a surprise that a number of ‘mental health’ disorders – more appropriately referred to as neuropsychiatric disorders – are connected to both basal ganglia dysfunction and to Streptococcus.


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Radical Uncertainty: Decision-Making for an Unknowable Future by Mervyn King, John Kay

"Robert Solow", Airbus A320, Albert Einstein, Albert Michelson, algorithmic trading, Antoine Gombaud: Chevalier de Méré, Arthur Eddington, autonomous vehicles, availability heuristic, banking crisis, Barry Marshall: ulcers, battle of ideas, Benoit Mandelbrot, bitcoin, Black Swan, Bonfire of the Vanities, Brownian motion, business cycle, business process, capital asset pricing model, central bank independence, collapse of Lehman Brothers, correlation does not imply causation, credit crunch, cryptocurrency, cuban missile crisis, Daniel Kahneman / Amos Tversky, David Ricardo: comparative advantage, demographic transition, discounted cash flows, disruptive innovation, diversification, diversified portfolio, Donald Trump, easy for humans, difficult for computers, Edmond Halley, Edward Lloyd's coffeehouse, Edward Thorp, Elon Musk, Ethereum, Eugene Fama: efficient market hypothesis, experimental economics, experimental subject, fear of failure, feminist movement, financial deregulation, George Akerlof, germ theory of disease, Hans Rosling, Ignaz Semmelweis: hand washing, income per capita, incomplete markets, inflation targeting, information asymmetry, invention of the wheel, invisible hand, Jeff Bezos, Johannes Kepler, John Maynard Keynes: Economic Possibilities for our Grandchildren, John Snow's cholera map, John von Neumann, Kenneth Arrow, Long Term Capital Management, loss aversion, Louis Pasteur, mandelbrot fractal, market bubble, market fundamentalism, Moneyball by Michael Lewis explains big data, Nash equilibrium, Nate Silver, new economy, Nick Leeson, Northern Rock, oil shock, Paul Samuelson, peak oil, Peter Thiel, Philip Mirowski, Pierre-Simon Laplace, popular electronics, price mechanism, probability theory / Blaise Pascal / Pierre de Fermat, quantitative trading / quantitative finance, railway mania, RAND corporation, rent-seeking, Richard Feynman, Richard Thaler, risk tolerance, risk-adjusted returns, Robert Shiller, Robert Shiller, Ronald Coase, sealed-bid auction, shareholder value, Silicon Valley, Simon Kuznets, Socratic dialogue, South Sea Bubble, spectrum auction, Steve Ballmer, Steve Jobs, Steve Wozniak, Tacoma Narrows Bridge, Thales and the olive presses, Thales of Miletus, The Chicago School, the map is not the territory, The Market for Lemons, The Nature of the Firm, The Signal and the Noise by Nate Silver, The Wealth of Nations by Adam Smith, The Wisdom of Crowds, Thomas Bayes, Thomas Davenport, Thomas Malthus, Toyota Production System, transaction costs, ultimatum game, urban planning, value at risk, World Values Survey, Yom Kippur War, zero-sum game

The English doctor Thomas Watson in 1842 recommended that doctors wash their hands in a chlorine solution to prevent the transmission of infection from one case to another. And in 1843 Oliver Wendell Holmes Sr (father of the great jurist whom we met in chapter 11 ) published a paper in the New England Quarterly Journal of Medicine entitled ‘On the Contagiousness of Puerperal Fever’ also arguing that the cause of so many fatalities was the spread of germs by doctors. Perhaps the most systematic study of the causes and prevention of puerperal fever was made by the Viennese physician Ignaz Semmelweis. In 1847, he discovered that the incidence of the infection was much lower for women giving birth at home than in hospital and that it was greatly reduced if doctors had washed their hands in chlorinated water. Semmelweis did not really know why this was so – he reasoned, partly correctly, that the transfer of ‘cadaverous particles’ was responsible. 11 All of these findings and advice were strongly resisted by the medical profession, for reasons that are easy to understand if not to sympathise with.

Both interpretations of risk are potentially relevant but the one maintained by the contractors reproduces the meaning of risk in ordinary language. And it is that interpretation – risk as failure to fulfil the central elements of the reference narrative – which we will continue to use, in this book and in our everyday lives. In earlier chapters we described some risk lovers who have changed society – Richard Branson, Winston Churchill, Steve Jobs, Elon Musk, George Orwell. Ignaz Semmelweis, whose dogmatic conviction of his own rightness drove him to insanity but helped save the lives of millions of women. Barry Marshall, who changed medical practice and won a Nobel Prize by infecting himself with bacteria. None of this behaviour has anything to do with the utility of wealth functions of these individuals. And as we learn more about neurophysiology, we may come to understand such behaviour better by monitoring activity in the prefrontal cortex and the handling of the chemical dopamine than by proselytising for axiomatic rationality.

The hegemony of optimisation as the goal of decision-making is made possible by ignoring radical uncertainty. Building on the success of probabilistic reasoning in illuminating games of chance, the approach of decision theory bifurcates uncertainty into the unknown and unknowable, and the unknown but capable of being characterised by a known probability distribution. The practitioners of this approach wash their hands of the former, describing the unknown and unknowable as ‘shifts’ and ‘shocks’, as unpredictable and inexplicable as the Yucatán asteroid. Other uncertainties are treated as resolvable. There is no room for radical uncertainty. But people routinely need to make decisions with imperfect information. Most of real life lies in between the opposing poles of randomness and black swans; we know something, but not enough, and the knowledge which is held collectively is widely and unequally distributed.


The Non-Tinfoil Guide to EMFs by Nicolas Pineault

Albert Einstein, en.wikipedia.org, Ignaz Semmelweis: hand washing, Internet of things, self-driving car, Silicon Valley, Skype, smart cities, smart grid, smart meter

Still killing 1.5-2M people a year from lung cancer alone326 And if you thought I just ruined your day with all this doom and gloom stuff, I’m sorry I have to share one more example I read in Elizabeth Plourde’s amazing book that shows how human nature tends to screw things up:327 “[In the 1840s], Dr. Ignaz Semmelweis identified that doctors going from autopsy to assisting in childbirth were responsible for the 20% of the women who were continually dying from childbed fever (puerperal infection). He arranged an experiment of washing hands between autopsy and assisting with childbirths. That simple act reduced the outrageously high number of mothers dying down to only 1%. But, because the bacteria could not be seen, doctors refused to believe they were infecting their patients and kept on killing 20% of our women for an additional 30 years before washing of hands was adopted as an essential, common sense answer that is necessary to save lives.” Unfortunately for your mental sanity, the end of the story is even worse… wait for it...

See ncbi.nlm.nih.gov/pubmed/18003202 Discussion between Lloyd Burrell and Girish Kumar, PhD, from the Indian Institute of Technology Bombay, as part of ElectricSense.com’s EMF Experts Solutions Club. More details at electricsense.com/ en.wikipedia.org © 2017 N&G Media Inc. 72 EMFs & Your Nervous System Martin Blank, PhD, reports that a series of 3 papers published between 2001 and 2006219 clearly demonstrated a direct link between cellphone use and the human nervous system: “The results indicated [EMF] exposure on the left side of the brain slows down the left-hand reaction time and that the same is true for right-hand reactions after exposure on the right side of the brain.” A 2014 review by Redmayne and Johansson220 confirmed this link and showed that EMFs can damage myelin sheaths — the protective fatty layer which protects your nerves — throughout your body. This might explain why some electro-hypersensitive people claim they are being affected on a very physical level by EMFs. When surveying residents of Maine after a smart meter got installed at their home, more than 25% of them said they experienced “ involuntary muscle contractions”.221 One study even concluded that sensitive people exposed to the EMFs emitted from a cellphone tower 30 km away from a road are affected so much they could be a problem for traffic safety.222 There are also very strong reasons to think EMFs might be a contributing factor in ALS (Lou Gehrig’s disease)223 and MS (multiple sclerosis).224 EMFs & Neurodegenerative Diseases With everything I’ve shared so far, it’s kind of obvious that some researchers have linked EMFs to Alzheimer’s disease and other neurodegenerative conditions (MS falls in that category too), and for a lot of reasons: • • 219 220 221 222 223 224 225 226 Alzheimer’s sufferers have been found to have 33% less GABA than healthy subjects225 — and EMFs deplete your GABA levels Some researchers think that Alzheimer’s might be caused by excess calcium in the brain226 — and EMFs cause excess calcium As reported by Dr.

Their grand plan is to provide every single human being with a 1 Mbps Internet connection. But at what cost? 302 303 304 medicalnewstoday.com gizmodo.com Blank, M., PhD. (2015). Overpowered: The Dangers of Electromagnetic Radiation (EMF) and What You Can Do about It. Seven Stories Press. © 2017 N&G Media Inc. 91 6) Should you have the legal right to tell your neighbor to turn off his wifi router at night, if it makes you unable to sleep? Should second-hand EMFs be treated like second-hand smoke? After all, just a few decades ago it was totally fine to smoke on airplanes, even if it made everyone basically cough black tar after their flight.305 In 1973, they even made “non-smoking” zones mandatory in airplanes.306 7) How can we properly study our EMF’ed population when virtually no one is un-exposed, AKA there’s no proper “control group”? I mean, even the Amish are getting on board!


pages: 262 words: 66,800

Progress: Ten Reasons to Look Forward to the Future by Johan Norberg

agricultural Revolution, anti-communist, availability heuristic, Bartolomé de las Casas, Berlin Wall, British Empire, business climate, clean water, continuation of politics by other means, Daniel Kahneman / Amos Tversky, demographic transition, desegregation, Donald Trump, Flynn Effect, germ theory of disease, Gini coefficient, Gunnar Myrdal, Haber-Bosch Process, Hans Island, Hans Rosling, Ignaz Semmelweis: hand washing, income inequality, income per capita, indoor plumbing, Isaac Newton, Jane Jacobs, John Snow's cholera map, Kibera, Louis Pasteur, Mahatma Gandhi, meta analysis, meta-analysis, Mikhail Gorbachev, more computing power than Apollo, moveable type in China, Naomi Klein, Nelson Mandela, open economy, place-making, Rosa Parks, sexual politics, special economic zone, Steven Pinker, telerobotics, The Wealth of Nations by Adam Smith, transatlantic slave trade, very high income, working poor, Xiaogang Anhui farmers, zero-sum game

The germ theory of disease was an enormous breakthrough that made more focused measures possible. It seemed impossible that microorganisms, things that were too small to see, could be a cause of disease and death. But natural experiments began to change the prevailing view. In the mid-nineteenth century, the Hungarian obstetrician Ignaz Semmelweis famously noticed a high incidence of puerperal fever among pregnant women who delivered with the help of physicians, whereas it was much lower among those helped by midwives. He connected this with the fact that the physicians had often come straight from autopsies, and made them wash their hands with chlorinated lime water, which reduced maternal deaths by almost ninety per cent. New microscopes had made it possible to see microorganisms. Especially important was the achromatic microscope, invented by Joseph Jackson Lister. The French chemist Louis Pasteur showed that microorganisms could spoil milk and wine, and invented a technique to prevent bacterial contamination – pasteurization.

But even a local health worker admits to using the flying toilet all the time: ‘At night, it is so dark in Kibera that you cannot dare to get out of your room since you are not sure if you will fall in one of the abandoned toilets and, as a woman, you can never be sure that you will not be raped.’16 But things are changing even here. Two water pipes have been constructed, so Kiberans do not have to rely entirely on the unsafe water from the dam and from the rain. Several modern sanitation blocs have been built by entrepreneurs and non-governmental organizations (NGOs), where Kiberans can go to a clean toilet and get a hot shower at a low cost, and hand-washing facilities have been introduced in several schools. Cases of typhoid, dysentery and hookworm infestations are on the decline, and at last, so is child and infant mortality. Sub-Saharan Africa achieved a twenty-percentage-point increase in the use of improved sources of drinking water from 1990 to 2015. During this period, 427 million more Africans gained access.17 The process may be too slow to make the news, but we must remember that it is happening much faster than it did in the world’s richest countries.

As knowledge about microorganisms began to take hold, it gave an extra urgency to attempts to improve sanitation and water supplies and vaccination became routine. The knowledge about germs in itself also made people change behaviour. Until the theory was established, hotels did not change bed linens between guests, doctors used instruments that weren’t sterilized, and water was not always boiled to kill bacteria. It took time before health personnel were convinced to wash their hands and sterilize equipment, but when it happened it had an amazing effect on maternal death. In countries that hold data, such as Sweden and Finland, around 1,000 mothers died per 100,000 child births in 1800. Those are shocking numbers: the mother died in every hundredth childbirth. Since mothers gave birth much more often than today, this would have been a regular occurrence in a family. And 100 years later, the number was still around 500 per 100,000 births.


pages: 243 words: 65,374

How We Got to Now: Six Innovations That Made the Modern World by Steven Johnson

A. Roger Ekirch, Ada Lovelace, big-box store, British Empire, butterfly effect, clean water, crowdsourcing, cuban missile crisis, Danny Hillis, germ theory of disease, Hans Lippershey, Ignaz Semmelweis: hand washing, indoor plumbing, interchangeable parts, invention of air conditioning, invention of the printing press, invention of the telescope, inventory management, Jacquard loom, John Snow's cholera map, Kevin Kelly, Live Aid, lone genius, Louis Pasteur, low earth orbit, Marshall McLuhan, mass immigration, megacity, Menlo Park, Murano, Venice glass, planetary scale, refrigerator car, Richard Feynman, Silicon Valley, Skype, Steve Jobs, Stewart Brand, the scientific method, transcontinental railway, Upton Sinclair, walkable city, women in the workforce

We also needed to understand what was happening on the scale of microorganisms. We needed both a germ theory of disease—and a way to keep those germs from harming us. — WHEN YOU GO BACK to look at the initial reaction from the medical community to the germ theory, the response seems beyond comical; it simply doesn’t compute. It is a well-known story that the Hungarian physician Ignaz Semmelweis was roundly mocked and criticized by the medical establishment when he first proposed, in 1847, that doctors and surgeons wash their hands before attending to their patients. (It took almost half a century for basic antiseptic behaviors to take hold among the medical community, well after Semmelweis himself lost his job and died in an insane asylum.) Less commonly known is that Semmelweis based his initial argument on studies of puerperal (or “childbed”) fever, where new mothers died shortly after childbirth.

Clearly some kind of infectious agent was being transmitted from the corpses to the new mothers; with a simple application of a disinfectant such as chlorinated lime, the cycle of infection could be stopped in its tracks. There may be no more startling example of how much things have changed in our understanding of cleanliness over the past century and a half: Semmelweis was derided and dismissed not just for daring to propose that doctors wash their hands; he was derided and dismissed for proposing that doctors wash their hands if they wanted to deliver babies and dissect corpses in the same afternoon. This is one of those places where our basic sensibilities deviate from the sensibilities of our nineteenth-century ancestors. They look and act like modern people in many ways: they take trains and schedule meetings and eat in restaurants. But every now and then, strange gaps open between us and them, not just the obvious gaps in technological sophistication, but more subtle, conceptual gaps.

(“You expect me to get into that and wet myself all over?” she protests. “Not me. I should catch my death.”) Harriet Beecher Stowe and her sister Catharine Beecher advocated a daily wash in their influential handbook, The American Woman’s Home, published in 1869. Reformers began building public baths and showers in urban slums around the country. “By the last decades of the century,” the historian Katherine Ashenburg writes, “cleanliness had become firmly linked not only to godliness but also to the American way.” Poster issued by the Central Council for Health Education (1927–1969), 1955 The virtues of washing oneself were not self-evident, the way we think of them today. They had to be discovered and promoted, largely through the vehicles of social reform and word of mouth. Interestingly, there is very little discussion of soap in the popular embrace of bathing in the nineteenth century.


pages: 219 words: 74,775

Liquid: The Delightful and Dangerous Substances That Flow Through Our Lives by Mark Miodownik

3D printing, airport security, clean water, Ignaz Semmelweis: hand washing, mass immigration, megacity, The Design of Experiments

As with smoking, the consequences of general uncleanliness were not just aesthetic. In the nineteenth century, it was still normal practice for doctors to travel from bedside to bedside without changing their clothes or washing their hands after examining women during childbirth. This practice caused incredibly high rates of maternal and infant mortality during childbirth. In 1847 a Hungarian obstetrician, Ignaz Semmelweis, mandated that physicians scrub their hands with a chlorinated lime solution before touching patients, and saw the death rate fall from 20 per cent to 1 per cent. Despite this evidence, doctors were still reluctant to accept that they might be carrying infections on their hands, and transferring them to their patients, thus causing an enormous number of deaths. It wasn’t until the 1850s when a British nurse, Florence Nightingale, took up her campaign for cleanliness that this attitude was really adopted, first in military hospitals, and then more widely.

Because the blob of oil or fat has now got a charged surface, it’s become polar, and so will dissolve happily in water. This is how soap cleans – it breaks up fat and oil residue on your hands and clothes into tiny spherical blobs, which can dissolve in water and be washed away. Soap cleans by the action of surfactant molecules, such as stearates. The fat-loving tail of the molecule is absorbed into oil, leaving the water-loving head sticking out. The cloud of water-loving heads surrounding the oil allows it to be dissolved in the water and so cleans a surface. The clean, dry feeling you get from washing your hands with soap comes from the soap removing oils from your skin. In contrast, soap is slippery precisely because of its own fatty nature – it’s basically modified fat. That’s why it slips out of your hand so easily. It is why soaps are used as lubricants, why, if you are trying to remove a ring off a swollen finger, soap can slip it right off.

There were similarly high rates across Europe and the United States, leading to a sharp increase in hospital mortality. By 2006, the UK had seen 2,000 deaths due to MRSA and hospitals were struggling to deal with spread of the bacterium. Fortunately, thanks to stricter hand-washing regimes – in particular, requiring nurses and doctors to wash their hands after contact with patients – the rate of death has gone down in the past decade. Outside the hospital, though, a public-health campaign began, extolling the benefits of clean hands, and it hinged on the promotion of antibacterial soaps, which, along with sodium lauryl sulphate and its cousin molecules, contain agents like triclosan, an antimicrobial molecule. These soaps were marketed as being better than traditional soap at preventing the spread of germs.


Quackery: A Brief History of the Worst Ways to Cure Everything by Lydia Kang, Nate Pedersen

Albert Einstein, complexity theory, germ theory of disease, helicopter parent, Honoré de Balzac, Ignaz Semmelweis: hand washing, Louis Pasteur, placebo effect, stem cell, the scientific method, traveling salesman, Upton Sinclair, wikimedia commons, Y2K

Instruments were often rinsed only in water, if at all, and surgeons’ hands mostly went unwashed. And the coat worn by the doctor? It was often so caked in layers of blood that it was stiff—a sign of a “good surgeon.” Even surgeons themselves were not exempt from the dangers that lurked at hospitals and medical schools. Professor Jakob Kolletschka died in 1847 from sepsis after he cut one of his own fingers during an autopsy. Medical students at the Vienna General Hospital in 1840 would bring their unwashed hands directly from autopsies to the obstetrics ward, killing one out of three mothers from childbed fever. In contrast, the ward manned by midwifery pupils had a 3 percent mortality rate. When the students switched wards, the horrible death rates followed the medical students and their bacteria-laden hands. The physician Ignaz Semmelweis, observing this, had the staff do something simple but miraculous: wash their hands with soap and a chlorine solution.

The seventeenth-century term for enema was clyster, perhaps a somewhat prettier word, which sprouted from the Greek word for “wash.” Throughout history, enemas have contained a range of agents, including water, herbal concoctions, milk, molasses, turpentine, honey, beer, soaps, wine, and oils. What did they treat? Just as colorful a range of ailments—tuberculosis, dropsy, hernias, appendicitis, depression, poor nutrition, headaches (Mozart’s father once famously said—“the arse cures the head”), obesity, sluggishness, breathing problems, fever-borne illnesses, sexual dysfunction, drowning, and coughing up blood. Somewhere in that rear cave of the ailment-addled human was a dark place that promised health, if it was simply power-washed with a deft hand. Spanish vase, c. 1600s. The inscription states, “I am Don Joaquin Hernandez’s jar.

This added to the fear that inner feces alone made people sick, instead of being the end product of a healthy physiologic process. Rectal cleanliness could fix it all, for if filth was the root cause of disease (true, in many cases), then internal colonic cleanliness could prevent it. One little problem, though—the ptomaine theory was wrong. Bacteria and their toxins, not ptomaines, actually cause food poisoning, so the theory fell out of use. Washing hands? A great way to prevent infections. Washing colons? Not so much. In addition to autointoxication was the pervasive humoral theory. For multiple centuries, “clyster, bleed, purge” was the treatment for everything, particularly if the black bile/melancholic humor was out of sorts. Methods of cure that made bile flow out the anus ruled. The clyster was looked upon as a rectal savior for all things awry in the human body.


pages: 401 words: 93,256

Alchemy: The Dark Art and Curious Science of Creating Magic in Brands, Business, and Life by Rory Sutherland

3D printing, Alfred Russel Wallace, barriers to entry, basic income, Black Swan, butterfly effect, California gold rush, call centre, Captain Sullenberger Hudson, Cass Sunstein, cognitive dissonance, Daniel Kahneman / Amos Tversky, Dava Sobel, delayed gratification, Donald Trump, double helix, Downton Abbey, Elon Musk, Firefox, George Akerlof, gig economy, Google Chrome, Google X / Alphabet X, Grace Hopper, Hyperloop, Ignaz Semmelweis: hand washing, IKEA effect, information asymmetry, James Dyson, John Harrison: Longitude, loss aversion, low cost airline, Mason jar, Murray Gell-Mann, Peter Thiel, placebo effect, race to the bottom, Richard Feynman, Richard Thaler, Rory Sutherland, shareholder value, Silicon Valley, social intelligence, Steve Jobs, supply-chain management, the map is not the territory, The Market for Lemons, The Wealth of Nations by Adam Smith, ultimatum game, universal basic income, Upton Sinclair, US Airways Flight 1549, Veblen good

Until 1948, the Wright brothers’ Flyer was displayed not in the Smithsonian, but in the Science Museum in London. This might seem strange, but for years after the bicycle shop owners from Ohio had flown their manned heavier-than-air device on North Carolina’s Outer Banks, the US Government refused to acknowledge their achievement, maintaining that a government-sponsored programme had actually been first.* In 1847, when Ignaz Semmelweis decisively proved that hand-washing by doctors would cut the incidence of puerperal fever, a condition that could be fatal during childbirth, he was spurned. All too often, what matters is not whether an idea is true or effective, but whether it fits with the preconceptions of a dominant cabal.* I had always innocently assumed that after Edward Jenner discovered a vaccination against smallpox he would have presented his findings before sitting back to enjoy the acclaim.

A series of simple amendments could delay a letter or memo by a week, but the ownership and use of a typewriter was a signal that you were a serious business – any provincial solicitor who persisted in writing letters by hand became a tailless peacock. Take note that I have committed the same offence that everyone else does when writing about sexual selection: I have confined my examples to those occasions where it runs out of control and leads to costly inefficiencies, such as typewriters, Ferraris and peacocks tails.* This is unfair. In the early stages of any significant innovation, there may be an awkward stage where the new product is no better than what it is seeking to replace. For instance, early cars were in most respect worse than horses. Early aircraft were insanely dangerous. Early washing machines were unreliable. The appeal of these products was based on their status as much as their utility.

There are a few ways to counteract this: Radical honesty,* such as announcing that the product is, say, 4 per cent less powerful than previously, but 97 per cent better for the environment. Or alternatively, be explicit about a product’s weakness.* Deploy the ‘Goldilocks effect’ – the natural human bias that means that, when presented with three options, we are most likely to choose the one in the middle. Washing detergent manufacturers use language that normalises the lower and middle usage of the product, while implicitly stigmatising overdosing. For example, ‘Half a capful for light–normal wash’; ‘One capful for a full or heavy wash’; ‘Two capfuls for extreme soiling.’ This creates the impression that one would only use more than one capful if they had committed some brutal crime: as a result, even overdosers will likely use only one cap.* Change the format: it is hard to believe that a lower amount of powder or liquid will do the same job as before, but if the formulation is changed to a gel or tablets we are more likely to believe it.


pages: 371 words: 108,105

Under the Knife: A History of Surgery in 28 Remarkable Operations by Arnold van de Laar Laproscopic Surgeon

Albert Einstein, Ayatollah Khomeini, clean water, Ignaz Semmelweis: hand washing, Louis Pasteur, placebo effect, the scientific method, wikimedia commons

Cocaine has long since been replaced in local anaesthesia by derivative drugs that have the same effect locally, but without the stimulating side effects. Anaesthesia was a revolution in surgery; the next step was the introduction of hygiene. In 1847, the Hungarian Ignaz Semmelweis discovered that childbed fever – an infection contracted by mothers shortly after childbirth – occurred when medical students returning from the dissecting-room after practising anatomy on dead bodies did not wash their hands before assisting with births. No one believed, however, that something as simple as washing your hands could make the difference between life and death and Semmelweis was dismissed as mad. (It did not help that he unfortunately suffered from a neurological disorder that was gradually driving him insane.) Semmelweis’s basic principle of hygiene was not accepted until Louis Pasteur exposed bacteria as the cause of disease and Joseph Lister was the first, in 1865, to prevent the infection of a surgical wound by using an antiseptic.

Deviations from the normal anatomy of the body can be caused by natural differences (anatomical variations) or by an illness or disorder (pathological anatomy). Antisepsis, antiseptic The use of antiseptics (disinfectants) to remove bacteria from the skin, mucous membrane or a wound. The first disinfectants were wine and cognac. Carbolic acid was used later, but that was too harmful to bodily tissues. Today, chemicals containing iodine or chlorine are used. Simply washing with soap and water also disinfects to a certain extent, explaining why surgeons wash their hand so often. Not to be confused with asepsis/aseptic. Arteriosclerosis Inflammatory disease of the arteries. The inner wall of the artery is affected by accumulations of cholesterol, causing an inflammation. That creates scar tissue in which calcium carbonate can be deposited. It eventually leads to narrowing (stenosis) of the artery, which can gradually or suddenly be completely blocked (occlusion).

Easter Sunday eating disorders ec-: meaning ECG (electrocardiography) Edward VII Edward VIII EEG (electroencephalography) eels Egyptians, ancient Einstein, Albert elective surgery electric eels electricity electrocoagulation Elisabeth, Empress see Sisi, Empress embolism embryos emergence emergency treatment: ABC; primary tasks; risks emphysema end-of-life care; see also palliative care endocrinology endolymphatic shunt endoscopy enemas epidemiology epiploon see omentum epispasm Erasistratus erection E.T. (1982) ether eunuchs evidence-based evolution ex-: meaning examinations of patients excision expectative treatment; see also waiting exposure: definition extraterrestrials eyes facial prosthesis faeces containing blood Fagniez, Pierre-Louis fainting fallopian tubes falsifiability Fantastic Voyage (1966) Faraday cages Farinelli fast track post-operative care fat removal Félix de Tassy, Charles-François fever fibroblasts fiction Finney, Jack fistula: definition; Louis XIV; Pedoux, Jules; Pope Leo X; seton method Fitz, Reginald Flandrin, Georges fleam; see also bloodletting Fleischer, Richard fluctuation fluoroscopy foetal surgery folk tales food hygiene forceps foreskin fractures: ankles; early ancestors; healing; repositioning; scars; traumatology Francis, Pope Frankenstein, Viktor French Revolution Freud, Sigmund Friedrich III fruit as measurement funerals, Middle Ages Galen gall bladder: Halsted, William; laparoscopy; Pope John Paul II; Shah of Iran; surgical incisions; triad gall stones gamma rays gangrene: arteriosclerosis; cause; definition; Louis XIV; popes; process; septic shock Garibaldi, Giuseppe gas exchange gastrectomy gastric acid gastric bypass gastroenterologists gastrointestinal surgery gastrointestinal tract; see also intestines; oesophagus; stomach gastroscope gender balance in surgery General Internal Medicine (GIM) -genic: meaning George I George II George V George VI Gilbert, Scott gills Gilmore, James glasses Glenn, Frank gloves Glück, Themistocles gluttony -gnosis: meaning Go, Peter goitre Good Friday gout Graham, Evarts granulomas Gray, Tom Greek gods Greeks, ancient greenhouse gases Greenlees, James groin hernia GSV (great saphenous vein) guilds gynaecologists Habsburgs Hacker, Viktor von Hadrian haematemesis haem-: meaning haematoma haematuria: definition haematuris haemoptysis haemorrhoids Halsted, William hamburgers Hammurabi, Code of hand washing hands: anatomical snuffbox ‘happy milk’ Harrison, Michael Hartmann, Henri Harvey, Thomas Harvey, William healing: compared to curing; definition; see also wound healing health care policy heart: blood pressure; cardiac tamponade; cardiogenic shock; ECG; fibrillation; function; pacemakers; transplants; valve replacement; whales; see also cardiac surgery heart attack heart transplants heartburn Heliogabalus Heller, Thérèse hemi-: meaning Henchcliffe, Margaret hepatitis hepatosplenomegaly Heraclitus hernia: definition; diaphragmatic; etymology; evolutionary cause; femoral; groin; keyhole surgery; placebo operations; spinal discs; umbilical Herodotus Herophilus Hervey, John Hesiod Hill, John Hill, Rose hip, artificial Hippocrates Hippocratic oath HIV Hivites Holmes, Sherlock holy relics homeopathy homosexuality: Lully, Jean-Baptiste; Pope Leo X horror carnis hospital policies Houdini, Harry House, William hula hoops Hültl, Hümér Humes, James humours hygiene: bladder stones; clean underwear; development; phimosis hypertension hypospadias hypothalamus hypovolemic shock hysterectomies I & D see drain (verb) idiopathic: definition ileostomy ileus Illouz, Yves-Gerard imaging immune system impotence incidence: definition incision: definition; etymology; size incontinence: definition; eunuchs; stone-cutters indication: definition induction infarction; see also stroke infection: breathing rate; chronic; dissemination; surgeons; see also inflammation; pathogens; pus inflammation: appendicitis; definition; fever; indications; process overview; terminology; wound healing inguinal canal inguinal hernia Innocent VIII, Pope inspection instruments, surgical insufflation interleukin-6 intermittent claudication internists intestinal anastomosis intestines: anatomy; diagnosis; groin hernia; leakage; obstruction; peritonitis; strangulation; surgery; tumours; umbilical hernia intravenous drip intubation invasive treatment iodine deficiency ischaemia Islam -itis: meaning Jackson, Michael jargon ‘jeep seat’ Jenkins, M.


pages: 624 words: 104,923

QI: The Book of General Ignorance - The Noticeably Stouter Edition by Lloyd, John, Mitchinson, John

Admiral Zheng, Albert Einstein, Barry Marshall: ulcers, British Empire, discovery of penicillin, Dmitri Mendeleev, Fellow of the Royal Society, Ignaz Semmelweis: hand washing, invention of the telephone, James Watt: steam engine, Kickstarter, Kuiper Belt, lateral thinking, Magellanic Cloud, Mars Rover, Menlo Park, Olbers’ paradox, On the Revolutions of the Heavenly Spheres, placebo effect, Pluto: dwarf planet, trade route, V2 rocket, Vesna Vulović

It was first used to describe a harmful microorganism in 1871 but it wasn’t until 1875 that Robert Koch finally demonstrated that anthrax was caused by a particular species of bacteria. Thirty-five years earlier, Ignaz Semmelweis, a Hungarian doctor had set up the first hygienic hospital ward in Vienna General Hospital. He noticed that the death rate of poor women attended by the nurse midwives was three times less than that of the wealthier women attended by the doctors. He concluded that this was a matter of cleanliness – the doctors used to go directly from the morgue to the obstetrics ward without washing their hands. When he presented his findings, his fellow doctors rejected his theory, unable to believe in what they could not see. In recent years, however, the hygiene itself has come under scrutiny. There seems to be evidence that indiscriminate use of anti-bacterial agents might have damaging side effects, allowing those bacteria that do survive to mutate into even more virulent strains.

It was crude and cumbersome but effective. There was a small foot-pedal driven version and a large steam-driven one. The latter, able to wash and dry 200 dishes in two minutes, was the sensation of the 1893 Chicago World’s Fair, and won first prize for the ‘best mechanical construction for durability and adaptation to its line of work’. At $250 each, however, the machines were too expensive for home use, but enough were sold to hotels and restaurants to keep Cochran’s Crescent Washing Machine Company in business until her death in 1913. Other mechanical dishwashers had been developed (and patented) in the US between 1850 and 1865 (all of them, it seems, by women) but none of them really worked. A hand-cranked wooden machine was invented and patented in 1850 by Joel Houghton. In 1870, Mary Hobson obtained a dishwasher patent, but even then it contained the word ‘improved’.

In 1976, the Department of Health urged pregnant mothers to wear rubber gloves when peeling potatoes and more than a kilogram (2.2 lb) of potatoes eaten at a single sitting would be certain death. Fortunately for smokers, most of the nicotine in a cigarette is burned before it ever gets to the lungs. The other good news is, it doesn’t stain your fingers or your teeth or the ceiling of the pub. It’s not only colourless but soluble in water, so it comes off when you wash your hands. The stain on a smoker’s fingers is caused by tar. The scientific name for tobacco is Nicotiana tabacum. The name of the plant and the word nicotine derive from Jean Nicot (1530–1604), French ambassador to Lisbon, and the man who first introduced tobacco to France in 1560. He originally promoted it as a medicine, believing it healed wounds and cured cancers, and sent some, in the form of snuff, to Catherine de Medici, Queen of France.


pages: 462 words: 172,671

Clean Code: A Handbook of Agile Software Craftsmanship by Robert C. Martin

continuous integration, database schema, domain-specific language, don't repeat yourself, Donald Knuth, en.wikipedia.org, Eratosthenes, finite state, G4S, Ignaz Semmelweis: hand washing, iterative process, place-making, Rubik’s Cube, web application

It’s your job to defend the code with equal passion. To drive this point home, what if you were a doctor and had a patient who demanded that you stop all the silly hand-washing in preparation for surgery because it was taking too much time?2 Clearly the patient is the boss; and yet the doctor should absolutely refuse to comply. Why? Because the doctor knows more than the patient about the risks of disease and infection. It would be unprofessional (never mind criminal) for the doctor to comply with the patient. 2. When hand-washing was first recommended to physicians by Ignaz Semmelweis in 1847, it was rejected on the basis that doctors were too busy and wouldn’t have time to wash their hands between patient visits. So too it is unprofessional for programmers to bend to the will of managers who don’t understand the risks of making messes.

You can instrument your code and force it to run in different orderings by adding calls to methods like Object.wait(), Object.sleep(), Object.yield() and Object.priority(). Each of these methods can affect the order of execution, thereby increasing the odds of detecting a flaw. It’s better when broken code fails as early and as often as possible. There are two options for code instrumentation: • Hand-coded • Automated Hand-Coded You can insert calls to wait(), sleep(), yield(), and priority() in your code by hand. It might be just the thing to do when you’re testing a particularly thorny piece of code. Here is an example of doing just that: public synchronized String nextUrlOrNull() { if(hasNext()) { String url = urlGenerator.next(); Thread.yield(); // inserted for testing. updateHasNext(); return url; } return null; } The inserted call to yield() will change the execution pathways taken by the code and possibly cause the code to fail where it did not fail before.

This exposes the fundamental dichotomy between objects and data structures: Procedural code (code using data structures) makes it easy to add new functions without changing the existing data structures. OO code, on the other hand, makes it easy to add new classes without changing existing functions. The complement is also true: Procedural code makes it hard to add new data structures because all the functions must change. OO code makes it hard to add new functions because all the classes must change. So, the things that are hard for OO are easy for procedures, and the things that are hard for procedures are easy for OO! In any complex system there are going to be times when we want to add new data types rather than new functions. For these cases objects and OO are most appropriate. On the other hand, there will also be times when we’ll want to add new functions as opposed to data types. In that case procedural code and data structures will be more appropriate.


pages: 515 words: 117,501

Miracle Cure by William Rosen

Affordable Care Act / Obamacare, availability heuristic, biofilm, cognitive bias, cognitive dissonance, conceptual framework, Copley Medal, creative destruction, demographic transition, discovery of penicillin, Ernest Rutherford, experimental subject, Fellow of the Royal Society, Frederick Winslow Taylor, friendly fire, functional fixedness, germ theory of disease, global supply chain, Haber-Bosch Process, Ignaz Semmelweis: hand washing, Isaac Newton, James Watt: steam engine, Johannes Kepler, John Snow's cholera map, Joseph Schumpeter, Louis Pasteur, medical malpractice, meta analysis, meta-analysis, microbiome, New Journalism, obamacare, out of africa, pattern recognition, Pepto Bismol, randomized controlled trial, selection bias, stem cell, transcontinental railway, working poor

The oldest known medical texts record the dangers, and frequency, of fevers suffered by women within hours of giving birth. The risks of contracting such a fever, however, skyrocketed with the growth of hospital births during the nineteenth century. By the time the Hungarian physician Ignaz Semmelweis, then working at Vienna General Hospital, published a study of childbed fever in 1847, it was attacking as many as four new mothers in ten. Tellingly, Semmelweis discovered that the risks of childbed fever were significantly lower in home births than obstetrics wards. The cause, in the days before Lister, was the way physicians practiced their craft: never washing their hands.* Improved hygiene and antisepsis reduced the numbers of victims substantially, but did not eliminate the risk of disease. Though Semmelweis and others had made puerperal fever less common, their technique was prevention, not cure.

Describing the magnetized iron balls needed to mix the droplets under investigation, he wrote, “Steel-bearing balls, 1/16 in. in diameter, are given several coats of Bakelite varnish . . . the balls are then heated to 100° in paraffin wax for some minutes, the surplus wax being removed by rolling the balls on hot filter paper. . . . They are then rolled in the palm of a warm, but clean and dry hand with some well washed kaolin. . . .” The article was the first time the peculiar mix of talents of the Dunn team stood revealed. It also marked, or rather caused, a permanent breach in the relationship between Heatley and Chain. From that moment forward, at Heatley’s insistence, and with Florey’s tacit approval, all communication and direction for the young man from Kent would come from the Dunn School’s director, rather than its chief biochemist.

It took some experimental skill to demonstrate why. As he described in a now-classic paper written for the Lancet, Fleming exposed two sets of glass tubes to a highly concentrated bacterial soup. One set was left whole, while the other was broken to create a ragged edge that would simulate a battlefield wound. After both were washed with antiseptics, the unbroken test tubes were completely disinfected, but the bacteria in the broken tube’s hidden recesses stubbornly reappeared, even after washing in carbolic acid. Fleming had demonstrated experimentally why even unbloodied uniforms from soldiers with supposedly disinfected wounds remained rife with pathogens. Dangerous ones. Fifteen percent of battlefield wounds contained staph, 30 percent tetanus, 40 percent strep . . . and 90 percent were infected with the gangrene-causing C. perfringens.


pages: 322 words: 107,576

Bad Science by Ben Goldacre

Asperger Syndrome, correlation does not imply causation, experimental subject, hygiene hypothesis, Ignaz Semmelweis: hand washing, John Snow's cholera map, Louis Pasteur, meta analysis, meta-analysis, Nelson Mandela, offshore financial centre, p-value, placebo effect, publication bias, Richard Feynman, risk tolerance, Ronald Reagan, selection bias, selective serotonin reuptake inhibitor (SSRI), the scientific method, urban planning

Looking even further back, there was a strong anti-smallpox-vaccine movement in Leicester well into the 1930s, despite its demonstrable benefits, and in fact anti-inoculation sentiment goes right back to its origins: when James Jurin studied inoculation against smallpox (finding that it was associated with a lower death rate than the natural disease), his newfangled numbers and statistical ideas were treated with enormous suspicion. Indeed, smallpox inoculation remained illegal in France until 1769.* ≡ Disdain for statistics in healthcare research wasn’t unusual at the time: Ignaz Semmelweis noticed in 1847 that patients were dying much more frequently on the obstetrics ward run by the medical students than on the one run by the midwifery students (this was in the days when students did all the legwork in hospitals). He was pretty sure that this was because the medical students were carrying something nasty from the corpses in the dissection room, so he instituted proper handwashing practices with chlorinated lime, and did some figures on the benefits.

This water should be held in your mouth, they say, because then it can be absorbed directly from there into your brain. Is there anything else you can do to get blood and oxygen to your brain more efficiently? Yes, an exercise called ‘Brain Buttons’: ‘Make a ‘C’ shape with your thumb and forefinger and place on either side of the breastbone just below the collarbone. Gently rub for twenty or thirty seconds whilst placing your other hand over your navel. Change hands and repeat. This exercise stimulates the flow of oxygen carrying blood through the carotid arteries to the brain to awaken it and increase concentration and relaxation.’ Why? ‘Brain buttons lie directly over and stimulate the carotid arteries.’ Children can be disgusting, and often they can develop extraordinary talents, but I’m yet to meet any child who can stimulate his carotid arteries inside his ribcage.

If that sounds obvious, I should say they have an effect which has been measured, elegantly, in carefully designed trials. Gryll and Katahn [1978] gave patients a sugar pill before a dental injection, but the doctors who were handing out the pill gave it in one of two different ways: either with an outrageous oversell (‘This is a recently developed pill that’s been shown to be very effective…effective almost immediately…’); or downplayed, with an undersell (‘This is a recently developed pill…personally I’ve not found it to be very effective…’). The pills which were handed out with the positive message were associated with less fear, less anxiety and less pain. Even if he says nothing, what the doctor knows can affect treatment outcomes: the information leaks out, in mannerisms, affect, eyebrows and nervous smiles, as Gracely [1985] demonstrated with a truly ingenious experiment, although understanding it requires a tiny bit of concentration.


Super Thinking: The Big Book of Mental Models by Gabriel Weinberg, Lauren McCann

affirmative action, Affordable Care Act / Obamacare, Airbnb, Albert Einstein, anti-pattern, Anton Chekhov, autonomous vehicles, bank run, barriers to entry, Bayesian statistics, Bernie Madoff, Bernie Sanders, Black Swan, Broken windows theory, business process, butterfly effect, Cal Newport, Clayton Christensen, cognitive dissonance, commoditize, correlation does not imply causation, crowdsourcing, Daniel Kahneman / Amos Tversky, David Attenborough, delayed gratification, deliberate practice, discounted cash flows, disruptive innovation, Donald Trump, Douglas Hofstadter, Edward Lorenz: Chaos theory, Edward Snowden, effective altruism, Elon Musk, en.wikipedia.org, experimental subject, fear of failure, feminist movement, Filter Bubble, framing effect, friendly fire, fundamental attribution error, Gödel, Escher, Bach, hindsight bias, housing crisis, Ignaz Semmelweis: hand washing, illegal immigration, income inequality, information asymmetry, Isaac Newton, Jeff Bezos, John Nash: game theory, lateral thinking, loss aversion, Louis Pasteur, Lyft, mail merge, Mark Zuckerberg, meta analysis, meta-analysis, Metcalfe’s law, Milgram experiment, minimum viable product, moral hazard, mutually assured destruction, Nash equilibrium, Network effects, nuclear winter, offshore financial centre, p-value, Parkinson's law, Paul Graham, peak oil, Peter Thiel, phenotype, Pierre-Simon Laplace, placebo effect, Potemkin village, prediction markets, premature optimization, price anchoring, principal–agent problem, publication bias, recommendation engine, remote working, replication crisis, Richard Feynman, Richard Feynman: Challenger O-ring, Richard Thaler, ride hailing / ride sharing, Robert Metcalfe, Ronald Coase, Ronald Reagan, school choice, Schrödinger's Cat, selection bias, Shai Danziger, side project, Silicon Valley, Silicon Valley startup, speech recognition, statistical model, Steve Jobs, Steve Wozniak, Steven Pinker, survivorship bias, The Present Situation in Quantum Mechanics, the scientific method, The Wisdom of Crowds, Thomas Kuhn: the structure of scientific revolutions, transaction costs, uber lyft, ultimatum game, uranium enrichment, urban planning, Vilfredo Pareto, wikimedia commons

Gondwanian Bridges The work of Ignaz Semmelweis, a nineteenth-century Hungarian doctor, met a similar fate. He worked at a teaching hospital where doctors routinely handled cadavers and also delivered babies, without appropriately washing their hands in between. The death rate of mothers who gave birth in this part of the hospital was about 10 percent! In another part of the same hospital, where babies were mostly delivered by midwives who did not routinely handle cadavers, the comparable death rate was 4 percent. Semmelweis obsessed about this difference, painstakingly eliminating all variables until he was left with just one: doctors versus midwives. After studying doctor behavior, he concluded that it must be due to their handling of the cadavers and instituted a practice of washing hands with a solution of chlorinated lime.

You’ve probably heard the phrase If all you have is a hammer, everything looks like a nail. This phrase is called Maslow’s hammer and is derived from this longer passage by psychologist Abraham Maslow in his 1966 book The Psychology of Science: I remember seeing an elaborate and complicated automatic washing machine for automobiles that did a beautiful job of washing them. But it could do only that, and everything else that got into its clutches was treated as if it were an automobile to be washed. I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail. The hammer of decision-making models is the pro-con list; useful in some instances, but not the optimal tool for every decision. Luckily, there are other decision-making models to help you efficiently discover and evaluate your options and their consequences across a variety of situations.

If you’ve consistently shown that you have this person’s best interests at heart, then you’ve laid the groundwork for that person to be receptive to your constructive criticism. On the other hand, if you don’t have much of a relationship at all, or worse, have a negative one, your feedback is not likely to be accepted. It is too easy at that point for the receiver to disregard it. Radical candor is giving feedback in a way that both challenges directly and cares personally (upper right quadrant of the matrix). Your feedback is completely candid and gets to the root of an issue, its radical form. It goes hand in hand with deliberate practice because this type of feedback is exactly the type that should be given in a deliberate practice session: a specific account of what the person could be doing better at a particular skill they are trying to improve.


pages: 309 words: 114,984

The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age by Robert Wachter

"Robert Solow", activist fund / activist shareholder / activist investor, Affordable Care Act / Obamacare, AI winter, Airbnb, Atul Gawande, Captain Sullenberger Hudson, Checklist Manifesto, Chuck Templeton: OpenTable:, Clayton Christensen, collapse of Lehman Brothers, computer age, creative destruction, crowdsourcing, deskilling, disruptive innovation, en.wikipedia.org, Erik Brynjolfsson, everywhere but in the productivity statistics, Firefox, Frank Levy and Richard Murnane: The New Division of Labor, Google Glasses, Ignaz Semmelweis: hand washing, Internet of things, job satisfaction, Joseph Schumpeter, Kickstarter, knowledge worker, lifelogging, medical malpractice, medical residency, Menlo Park, minimum viable product, natural language processing, Network effects, Nicholas Carr, obamacare, pattern recognition, peer-to-peer, personalized medicine, pets.com, Productivity paradox, Ralph Nader, RAND corporation, Second Machine Age, self-driving car, Silicon Valley, Silicon Valley startup, six sigma, Skype, Snapchat, software as a service, Steve Jobs, Steven Levy, the payments system, The Wisdom of Crowds, Thomas Bayes, Toyota Production System, Uber for X, US Airways Flight 1549, Watson beat the top human players on Jeopardy!, Yogi Berra

Part One The Note Chapter 3 The iPatient Some patients … recover their health simply through their contentment with the goodness of the physician. —Hippocrates, Precepts You’ve probably played that parlor game in which you fantasize about what it would be like to have a drink with one of the great figures in history. Perhaps you’d choose Shakespeare, or Churchill, or Einstein. They all sound great to me. But as a doctor and a student of health policy, I would sooner choose Ignaz Semmelweis, the nineteenth-century Hungarian physician whose pioneering work on antisepsis led him to be committed to an asylum for heresy; Sir William Osler, who articulated many of the key principles of medical diagnosis and treatment; or Avedis Donabedian, whose insights transformed our understanding of healthcare quality. Or a man named Arnold “Bud” Relman. Relman, who died in 2014 at the age of 91, spent his early career at Boston University, where he conducted pioneering research into the causes and treatment of kidney disease.

One arm of this movement highlights the role of patients and their families in protecting themselves, such as having patients ask their doctors and nurses whether they have washed their hands. While many (including myself) are skeptical about how effective this is and whether it places an inappropriate burden on patients and their families, there are clearly times when patients or their loved ones are highly aware of their treatment plans and can participate meaningfully in catching errors. In the midst of doing the bar-code scans, Levitt decided to ask her young patient about this strange dose of Septra. Pablo was used to taking unusual medications, and on top of that, he remembered his mom’s parting words about the meds he’d be given for his colonoscopy prep. So Pablo told Levitt that the Septra dose seemed okay. Reassured, the nurse handed the half-filled cup of pills to her patient and he began to swallow them, some a handful at a time. Levitt remembers thinking to herself, “What a good kid, what a trouper.”

The nurse had already gathered some history before Sinsky entered the room to see her first patient, an elderly man with white hair and a pot belly; every Christmas, he plays a department store Santa. He was wearing a Harley-Davidson T-shirt that said “Motorcycles: Ride Free, Live Free.” On the wall of the small room was a series of colorful posters, one showing the four food groups and another instructing people to wash their hands. A third showed a child’s drawing of a bunch of flowers with the caption, “Don’t regret growing old. It is a privilege denied to many.” Sinsky sat knee-to-knee with her patient. Her laptop was open on her desk, but she was working hard to maintain eye contact. After gathering some of the history, she activated her computer’s dictation system. Before she started, though, she turned to the patient.


pages: 405 words: 130,840

The Happiness Hypothesis: Finding Modern Truth in Ancient Wisdom by Jonathan Haidt

coherent worldview, crack epidemic, delayed gratification, feminist movement, hedonic treadmill, Ignaz Semmelweis: hand washing, invisible hand, job satisfaction, Lao Tzu, longitudinal study, meta analysis, meta-analysis, Peter Singer: altruism, PIHKAL and TIHKAL, placebo effect, prisoner's dilemma, Ralph Waldo Emerson, selective serotonin reuptake inhibitor (SSRI), social intelligence, stem cell, telemarketer, the scientific method, twin studies, ultimatum game, Walter Mischel, zero-sum game

It m u s t have broken her heart, and one day she ignored the rules and went in. S h e was c a u g h t a n d sternly reprimanded. My father recovered with no paralysis, but this i m a g e has always stayed with m e : a small boy alone in a room, gazing at his m o t h e r through a p a n e of glass. My father had the bad luck to be born at the confluence point of three big ideas. The first was germ theory, proposed in the 1840s by Ignaz Semmelweis and incorporated into hospitals and homes with gradually increasing ferocity over the next century. When they began to collect statistics from orphanages and foundling homes in the 1920s, pediatricians came to fear germs above all else. As far back as records went, they showed that most children dropped off at foundling homes died within one year. In 1915, a New York physician, Henry Chapin, reported to the American Pediatric Society that out of the ten foundling homes he had examined, in all but one of them all the children had died before their second birthday.3 As pediatricians came to grips with the deadly effects of institutions on young children, they reacted in a logical way by launching a crusade against germs.

In some split-brain patients, or in others who have suffered damage to the corpus callosum, the right hemisphere seems to be actively fighting with the left hemisphere in a condition known as alien hand syndrome. In these cases, one hand, usually the left, acts of its own accord and seems to have its own agenda. T h e alien hand may pick up a ringing phone, but then refuse to pass the p h o n e to the other hand or bring it up to an ear. The hand rejects choices the person has just made, for example, by putting back on the rack a shirt that the other hand has just picked out. It grabs the wrist of the other hand and tries to stop it from executing the person's conscious plans. Sometimes, the alien hand actually reaches for the person's own neck and tries to strangle him.13 T h e s e dramatic splits of the mind are c a u s e d by rare splits of the brain.

Hindu homes in Bhubaneswar have the same concentric structure as the temples: Leave your shoes at the door, socialize in the outer r o o m s , but never go into the kitchen or the room or area where offerings are m a d e to deities. T h e s e two areas are maintained as zones of the highest purity. Even the human body has peaks and valleys, the head and the right hand being pure, the left hand and the feet being polluted. I had to take extraordinary care to keep my feet from touching anyone and to avoid handing s o m e t h i n g to another person with my left hand. As I moved around Bhubaneswar, I felt like a square in Spaceland as I tried to navigate a three-dimensional world with only the dimmest perception of its third dimension. T h e interviews I conducted helped me to see a little better. My goal was to find out whether purity and pollution were really just about keeping biological "necessities" separate from divinity, or whether these practices had a deeper relationship to virtue and morality.


pages: 453 words: 130,632

Nine Pints: A Journey Through the Money, Medicine, and Mysteries of Blood by Rose George

Affordable Care Act / Obamacare, air freight, airport security, British Empire, call centre, corporate social responsibility, Edward Snowden, global pandemic, Ignaz Semmelweis: hand washing, index card, Jeff Bezos, meta analysis, meta-analysis, microbiome, Nelson Mandela, obamacare, period drama, Peter Thiel, Rana Plaza, RAND corporation, Silicon Valley, Skype, stem cell

This consisted of “lightly wounded men, dental patients, and men suffering from sprains, flat feet and minor injuries.”55 Soldier donors weren’t paid but they were soon offered three weeks’ leave in England, a powerful incentive.56 Harvey Cushing reported that when volunteers were sought for transfusion experiments, and “Blighty leave” given as inducement, they came “like trout to a fly.”57 But the wartime spirit of comradeship did not survive the transition to peace, and the notion of an organized system of blood donation faltered. The medical profession applied its Semmelweis reflex, a refusal to accept change, named after Ignaz Semmelweis, who realized that doctors delivering babies after performing autopsies were lethally unhygienic but was scorned for decades. When it came to storing blood, “the feeling in England,” wrote Victor Horsley Riddell, “is that this is carrying change too far.”58 Surgeons and doctors stuck to what they knew: blood should be used fresh if it was used at all. Fresh blood meant having the donor come to the patient, slice open a vein—the term was “cutting down”—and then convey the blood either by connecting the two veins (direct transfusion) or by using a syringe or pump to transfer the blood (indirect transfusion).

And eventually they were told, you are menstruating. You are a woman now. I meet Ankita and Khushi in a schoolyard in Uttar Pradesh. I am traveling across India with a sanitation carnival called the Great WASH Yatra. Great, because its ambitions were big: five states, 1,243 miles. WASH, because that was what its ambitions consist of: to spread knowledge about water, sanitation, and hygiene (these are usually given the acronym WASH). And yatra, a Hindi word for a procession, pilgrimage, journey. In each state, the Yatra sets up shop: a central stage, and dozens of stalls housing games and entertainment, all promoting better hygiene, hand washing, the use of toilets. One morning, I wake early and emerge from the dorm room to see half a dozen policemen earnestly playing a game of poop chess (where a blindfolded player has to navigate between turds and find the soap).

Calves, lambs, mild and quiet creatures, were thought to transmit their sweet spirit to the frenzied and the troubled. We can laugh at this, but we will be laughed at in turn. Our knowledge of blood is wide and unfinished. * * * Find yourself a blue coat first. There are plenty in the cupboard that look grubby but smell clean. Then sit on the bench provided and put your hair in a bonnet, something like a shower cap, and wrap your shoes in plastic. Follow the instructions above the basin and wash your hands thoroughly. No, more thoroughly. That’s enough: they relaxed the restrictions a few years ago so you no longer have to wrap your beard or wear a snood. The pressure chamber now: this arrangement will be familiar to anyone who has been to a bank or traveled on a submarine. You step in and wait for one door to close before the other can be opened. The higher pressure of the air beyond keeps dust and bugs out.


pages: 453 words: 132,400

Flow by Mihaly Csikszentmihalyi

Albert Einstein, Bonfire of the Vanities, centralized clearinghouse, Charles Lindbergh, conceptual framework, correlation does not imply causation, double helix, fear of failure, Ignaz Semmelweis: hand washing, invisible hand, Isaac Newton, job satisfaction, longitudinal study, Mahatma Gandhi, meta analysis, meta-analysis, Necker cube, pattern recognition, place-making, Ralph Waldo Emerson, the scientific method, Thomas Kuhn: the structure of scientific revolutions, Vilfredo Pareto

In one of our studies the list of admired persons included an old lady who, despite her paralysis, was always cheerful and ready to listen to other people’s troubles; a teenage camp counselor who, when a swimmer was missing and everybody else panicked, kept his head and organized a successful rescue effort; a female executive who, despite ridicule and sexist pressures, prevailed in a difficult working environment; and Ignaz Semmelweis, the Hungarian physician who in the last century insisted that the lives of many mothers could be saved at childbirth if obstetricians would only wash their hands, even though the rest of the doctors ignored and mocked him. These and the many hundreds of others mentioned were respected for the same reasons: They stood firm for what they believed in, and didn’t let opposition daunt them. They had courage, or what in earlier time was known simply as “virtue”—a term derived from the Latin word vir, or man.

This fact results in two seemingly opposite outcomes. On the one hand, having a feeling of ownership of her decisions, the person is more strongly dedicated to her goals. Her actions are reliable and internally controlled. On the other hand, knowing them to be her own, she can more easily modify her goals whenever the reasons for preserving them no longer make sense. In that respect, an autotelic person’s behavior is both more consistent and more flexible. 2. Becoming immersed in the activity. After choosing a system of action, a person with an autotelic personality grows deeply involved with whatever he is doing. Whether flying a plane nonstop around the world or washing dishes after dinner, he invests attention in the task at hand. To do so successfully one must learn to balance the opportunities for action with the skills one possesses.

To alleviate this burden he invented a private activity that provides just enough challenges for him not to be completely bored during a dull lecture, but is so automated that it leaves enough attention free so that if something interesting is being said, it will register in his awareness. What he does is this: Whenever a speaker begins to get tedious, he starts to tap his right thumb once, then the third finger of the right hand, then the index, then the fourth finger, then the third finger again, then the little finger of the right hand. Then he moves to the left hand and taps the little finger, the middle finger, the fourth finger, the index, and the middle finger again, and ends with the thumb of the left hand. Then the right hand reverses the sequence of fingering, followed by the reverse of the left hand’s sequence. It turns out that by introducing full and half stops at regular intervals, there are 888 combinations one can move through without repeating the same pattern. By interspersing pauses among the taps at regular intervals, the pattern acquires an almost musical harmony, and in fact it is easily represented on a musical staff.


pages: 524 words: 155,947

More: The 10,000-Year Rise of the World Economy by Philip Coggan

"Robert Solow", accounting loophole / creative accounting, Ada Lovelace, agricultural Revolution, Airbnb, airline deregulation, Andrei Shleifer, anti-communist, assortative mating, autonomous vehicles, bank run, banking crisis, banks create money, basic income, Berlin Wall, Bob Noyce, Branko Milanovic, Bretton Woods, British Empire, business cycle, call centre, capital controls, carbon footprint, Carmen Reinhart, Celtic Tiger, central bank independence, Charles Lindbergh, clean water, collective bargaining, Columbian Exchange, Columbine, Corn Laws, credit crunch, Credit Default Swap, crony capitalism, currency peg, debt deflation, Deng Xiaoping, discovery of the americas, Donald Trump, Erik Brynjolfsson, European colonialism, eurozone crisis, falling living standards, financial innovation, financial intermediation, floating exchange rates, Fractional reserve banking, Frederick Winslow Taylor, full employment, germ theory of disease, German hyperinflation, gig economy, Gini coefficient, global supply chain, global value chain, Gordon Gekko, greed is good, Haber-Bosch Process, Hans Rosling, Hernando de Soto, hydraulic fracturing, Ignaz Semmelweis: hand washing, income inequality, income per capita, indoor plumbing, industrial robot, inflation targeting, Isaac Newton, James Watt: steam engine, job automation, John Snow's cholera map, joint-stock company, joint-stock limited liability company, Kenneth Arrow, Kula ring, labour market flexibility, land reform, land tenure, Lao Tzu, large denomination, liquidity trap, Long Term Capital Management, Louis Blériot, low cost airline, low skilled workers, lump of labour, M-Pesa, Malcom McLean invented shipping containers, manufacturing employment, Marc Andreessen, Mark Zuckerberg, Martin Wolf, McJob, means of production, Mikhail Gorbachev, mittelstand, moral hazard, Murano, Venice glass, Myron Scholes, Nelson Mandela, Network effects, Northern Rock, oil shale / tar sands, oil shock, Paul Samuelson, popular capitalism, popular electronics, price stability, principal–agent problem, profit maximization, purchasing power parity, quantitative easing, railway mania, Ralph Nader, regulatory arbitrage, road to serfdom, Robert Gordon, Robert Shiller, Robert Shiller, Ronald Coase, Ronald Reagan, savings glut, Scramble for Africa, Second Machine Age, secular stagnation, Silicon Valley, Simon Kuznets, South China Sea, South Sea Bubble, special drawing rights, spice trade, spinning jenny, Steven Pinker, TaskRabbit, Thales and the olive presses, Thales of Miletus, The Great Moderation, The inhabitant of London could order by telephone, sipping his morning tea in bed, the various products of the whole earth, The Rise and Fall of American Growth, The Wealth of Nations by Adam Smith, The Wisdom of Crowds, Thomas Malthus, Thorstein Veblen, trade route, transaction costs, transatlantic slave trade, transcontinental railway, Triangle Shirtwaist Factory, universal basic income, Unsafe at Any Speed, Upton Sinclair, V2 rocket, Veblen good, War on Poverty, Washington Consensus, Watson beat the top human players on Jeopardy!, women in the workforce, Yom Kippur War, zero-sum game

Bismarck introduced health insurance, accident insurance and pensions to Germany in the 1880s; France brought in health insurance and childcare help in the 1890s and 1900s; and Britain offered pensions and unemployment insurance in the first decade of the 20th century. In the second half of the 19th century, life expectancy also started to make significant gains. One reason was that scientists developed the germ theory of disease, and realised the terrible effects of insanitary conditions. It took time for these theories to be accepted. In 1847, Ignaz Semmelweis, a Hungarian obstetrician, correctly identified that puerperal fever was spread by doctors, and insisted that his colleagues wash their hands. But although the death rate of new mothers fell dramatically, his theory was not widely acknowledged. Semmelweis had a nervous breakdown and was beaten to death by guards in an insane asylum, never knowing that his ideas would become widely approved.100 In 1854, John Snow, a doctor who had written about cholera transmission, successfully traced an outbreak of the disease to a water pump in London: when the pump was taken out of service, cholera cases declined.101 Between 1859 and 1870, a team led by Joseph Bazalgette created a network of sewers under London that stretched for 550 miles (885km) and connected to a network that was 13,000 miles (21,000km) in all.

And there are provisions for a minimum wage for workers and for debt cancellation in certain circumstances; what modern lawyers would call a force majeure clause: If any one owe a debt for a loan, and a storm prostrates the grain, or the harvest fail, or the grain does not grow for lack of water, in that year he need not give his creditor any grain, he washes his debt-tablet in water and pays no rent for this year.32 In modern terms, this law (the 48th) gives the farmer a financial contract dubbed an option, giving him the right to walk away from the deal in certain circumstances. Thus the code has been hailed as containing the first financial derivative in history.33 In a later era, the Mesopotamians used specific “futures” contracts in which, for example, a seller agreed to deliver a certain amount of grain at a certain price by a set day in the future. The code also shows how the Mesopotamian economy had moved on over the space of 1,500 years. Sumerian and Akkadian empires had given way to the Babylonians. Monarchs had replaced priests as rulers. Land was held in private hands as well as by the temple, and could be bought and sold; the earliest evidence of land sales is from around 2700BCE.34 There were markets; in the Akkadian language the word for street, suqu, may be the basis for the modern term for a market, a souk.

Over time, of course, technology developed a wide range of consumer goods, and their associated manufacturing brands, from transport (cars, bicycles, motorbikes and scooters), through household goods (vacuum cleaners, washing machines, radios, TVs, ovens) to machines made for both work and home, such as typewriters and personal computers. Manufacturers face a multiplicity of challenges. Not only do they need to design a workable product but they must make it stylish enough to appeal to consumers (and of the right size and shape to fit into their homes). They must make consumers aware of the product through advertising and promotion. And they must make it available at a reasonable price. Small wonder that a small number of large firms tend to dominate many markets. The best hope for a smaller manufacturing company is to become a supplier to one of the global groups; to make the widgets or electronics that go into a washing machine or a car. The requirements of scale meant that there was a tendency towards consolidation from the earliest days of industrialisation.


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Countdown: Our Last, Best Hope for a Future on Earth? by Alan Weisman

air freight, Albert Einstein, anti-communist, Ayatollah Khomeini, Berlin Wall, Bretton Woods, British Empire, call centre, carbon footprint, clean water, colonial rule, David Attenborough, demographic transition, Deng Xiaoping, El Camino Real, epigenetics, Filipino sailors, Haber-Bosch Process, happiness index / gross national happiness, haute couture, housing crisis, ice-free Arctic, Ignaz Semmelweis: hand washing, illegal immigration, immigration reform, Intergovernmental Panel on Climate Change (IPCC), land reform, liberation theology, load shedding, Louis Pasteur, Mahatma Gandhi, megacity, Menlo Park, new economy, oil shale / tar sands, out of africa, Pearl River Delta, planetary scale, Ponzi scheme, race to the bottom, Ronald Reagan, Satyajit Das, Silicon Valley, South China Sea, stem cell, Stephen Hawking, Stewart Brand, unemployed young men, upwardly mobile, urban sprawl, Whole Earth Catalog, WikiLeaks

Biomedical Ethics for Engineers: Ethics and Decision Making in Biomedical and Biosystem Engineering. The Biomedical Engineering Series. Burlington, MA: Academic Press/Elsevier, 2007. ARTICLES Ambrose, Stanley H. “Late Pleistocene Human Population Bottlenecks, Volcanic Winter, and Differentiation of Modern Humans.” Journal of Human Evolution, vol. 34, no. 4 (1998): 623–51. doi: 10.1006/jhev.1998.0219. Best, M., and D. Neuhauser. “Heroes and Martyrs of Quality and Safety: Ignaz Semmelweis and the Birth of Infection Control.” Quality Safe Health Care, vol. 13 (2004): 233–34. doi:10.1136/qshc.2004.010918. Bodnar, Anastasia. “Stress Tolerant Maize for the Developing World—Challenges and Prospects.” Biology Fortified, Inc., website, The Biofortified Blog, March 20, 2010. Borlaug, Norman. “Billions Served: An Interview with Norman Borlaug.” Interviewed by Ronald Bailey. Reason Magazine, April 2000. _______.Nobel Peace Prize Acceptance Speech.

Pasteurization extended the shelf life of milk, which improved nutrition and reduced infections from pathogens such as salmonella and those causing scarlet fever, diphtheria, and tuberculosis. Pasteur was also instrumental in convincing humanity that disease did not occur through some mysterious spontaneous generation, but was spread by germs. In the nineteenth century, hand soap became common for the first time, both in homes and in hospitals. Before, patients died as often from infections picked up from a surgeon’s unsterilized hands and scalpel as from the ailment he was trying to fix. One of the first uses of surgical disinfectant was in a maternity ward in Vienna, where doctors washing their hands in a chlorine solution lowered both infant and maternal mortality by a factor of ten—an innovation with a direct impact on the number of living humans. In the twentieth century, medical advances kept coming, each saving—and extending—more human lives.

I wish every human now on the planet a long, healthy life. But either we take control ourselves, and humanely bring our numbers down by recruiting fewer new members of the human race to take our places, or nature is going to hand out a pile of pink slips. When you see survival of the fittest portrayed on the National Geographic Channel, it’s entertaining. When it happens to your own species, it’s not pretty. I lingered on the grass by Lake of the Isles until the young mothers with their strollers departed, leaving the early evening joggers. As twilight settled and Jupiter rose in a velvet sky, the path around the lake filled with lovers, young and old. Hand in hand, they represented the grand spectrum that has enriched the city of my birth from its early Scandinavian majority into the splendid swirl that defines our globalized species today: Latino, Caucasian, Asian, African, and Native Americans, joined in the ancient courtship rituals of my fellow humans, doing what comes naturally.


pages: 651 words: 180,162

Antifragile: Things That Gain From Disorder by Nassim Nicholas Taleb

Air France Flight 447, Andrei Shleifer, banking crisis, Benoit Mandelbrot, Berlin Wall, Black Swan, business cycle, Chuck Templeton: OpenTable:, commoditize, creative destruction, credit crunch, Daniel Kahneman / Amos Tversky, David Ricardo: comparative advantage, discrete time, double entry bookkeeping, Emanuel Derman, epigenetics, financial independence, Flash crash, Gary Taubes, George Santayana, Gini coefficient, Henri Poincaré, high net worth, hygiene hypothesis, Ignaz Semmelweis: hand washing, informal economy, invention of the wheel, invisible hand, Isaac Newton, James Hargreaves, Jane Jacobs, joint-stock company, joint-stock limited liability company, Joseph Schumpeter, Kenneth Arrow, knowledge economy, Lao Tzu, Long Term Capital Management, loss aversion, Louis Pasteur, mandelbrot fractal, Marc Andreessen, meta analysis, meta-analysis, microbiome, money market fund, moral hazard, mouse model, Myron Scholes, Norbert Wiener, pattern recognition, Paul Samuelson, placebo effect, Ponzi scheme, principal–agent problem, purchasing power parity, quantitative trading / quantitative finance, Ralph Nader, random walk, Ray Kurzweil, rent control, Republic of Letters, Ronald Reagan, Rory Sutherland, selection bias, Silicon Valley, six sigma, spinning jenny, statistical model, Steve Jobs, Steven Pinker, Stewart Brand, stochastic process, stochastic volatility, Thales and the olive presses, Thales of Miletus, The Great Moderation, the new new thing, The Wealth of Nations by Adam Smith, Thomas Bayes, Thomas Malthus, too big to fail, transaction costs, urban planning, Vilfredo Pareto, Yogi Berra, Zipf's Law

Thank you, modernity: it was “scientific progress,” the birth of the clinic and its substitution for home remedies, that caused death rates to shoot up, mostly from what was then called “hospital fever”—Leibniz had called these hospitals seminaria mortis, seedbeds of death. The evidence of increase in death rates is about as strong as they come, since all the victims were now gathered in one place: people were dying in these institutions who would have survived outside them. The famously mistreated Austro-Hungarian doctor Ignaz Semmelweis had observed that more women died giving birth in hospitals than giving birth on the street. He called the establishment doctors a bunch of criminals—which they were: the doctors who kept killing patients could not accept his facts or act on them since he “had no theory” for his observations. Semmelweis entered a state of depression, helpless to stop what he saw as murders, disgusted at the attitude of the establishment.

The reader can get a hint of the central problem we face with top-down tampering with political systems (or similar complex systems), the subject of Book II. The fragilista mistakes the economy for a washing machine that needs monthly maintenance, or misconstrues the properties of your body for those of a compact disc player. Adam Smith himself made the analogy of the economy as a watch or a clock that once set in motion continues on its own. But I am certain that he did not quite think of matters in these terms, that he looked at the economy in terms of organisms but lacked a framework to express it. For Smith understood the opacity of complex systems as well as the interdependencies, since he developed the notion of the “invisible hand.” Click here for a larger image of this table. But alas, unlike Adam Smith, Plato did not quite get it. Promoting the well-known metaphor of the ship of state, he likens a state to a naval vessel, which, of course, requires the monitoring of a captain.

Many things such as society, economic activities and markets, and cultural behavior are apparently man-made but grow on their own to reach some kind of self-organization. They may not be strictly biological, but they resemble the biological in that, in a way, they multiply and replicate—think of rumors, ideas, technologies, and businesses. They are closer to the cat than to the washing machine but tend to be mistaken for washing machines. Accordingly we can generalize our distinction beyond the biological-nonbiological. More effective is the distinction between noncomplex and complex systems. Artificial, man-made mechanical and engineering contraptions with simple responses are complicated, but not “complex,” as they don’t have interdependencies. You push a button, say, a light switch, and get an exact response, with no possible ambiguity in the consequences, even in Russia.


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Atlas Obscura: An Explorer's Guide to the World's Hidden Wonders by Joshua Foer, Dylan Thuras, Ella Morton

anti-communist, Berlin Wall, British Empire, Buckminster Fuller, centre right, Charles Lindbergh, colonial rule, Colonization of Mars, cosmic microwave background, cuban missile crisis, dark matter, double helix, East Village, Exxon Valdez, Fall of the Berlin Wall, Frank Gehry, germ theory of disease, Golden Gate Park, Google Earth, Haight Ashbury, horn antenna, Ignaz Semmelweis: hand washing, index card, Jacques de Vaucanson, Kowloon Walled City, Louis Pasteur, low cost airline, Mahatma Gandhi, mass immigration, mutually assured destruction, Panopticon Jeremy Bentham, phenotype, Pluto: dwarf planet, Ronald Reagan, Rubik’s Cube, Sapir-Whorf hypothesis, Search for Extraterrestrial Intelligence, trade route, transatlantic slave trade, transcontinental railway, Tunguska event, urban sprawl, Vesna Vulović, white picket fence, wikimedia commons, working poor

The crater field now features a meteor museum, souvenir shop, and hotel offering a buffet breakfast and sauna. Kaali Küla, Pihtla vald, Saaremaa. 58.303309 22.70604 A 360-foot-wide basin created by a blazing meteorite. HUNGARY Semmelweis Medical Museum BUDAPEST The Semmelweis Medical Museum contains some fascinating objects: a wax anatomical model with her intestines splayed open, an early X-ray machine, and a shrunken head, all housed in the very building in which Dr. Ignaz Semmelweis was born. However, the most interesting element of the museum is the story of Semmelweis himself. In the 1840s, Semmelweis, a Hungarian physician, was working in a Budapest maternity ward. At the time, a third of new mothers were dying from puerperal sepsis, a bacterial form of septicemia. Semmelweis was horrified by the deaths of these women, but the cause eluded him. He began keeping extensive notes on the hospital and found a surprising correlation: When there were fewer medical students around, there were fewer deaths.

In 1847, the death of a fellow doctor and friend, Jakob Kolletschka, finally provided the link he was looking for. Kolletschka perished after accidentally cutting his finger during a postmortem examination. His autopsy showed a similar pathology to the women with puerperal sepsis, leading Semmelweis to conclude that it was the doctors themselves who were causing the deaths of the mothers. Semmelweis implemented a strict hand-washing policy in his clinic, and the death rate quickly fell from 18 percent to 2.2 percent. But even Semmelweis himself couldn’t explain exactly why his method worked. It would be decades before Louis Pasteur confirmed the germ theory of disease. Without this underlying explanation, Semmelweis’s discovery was largely rejected as a “mania.” Later in life, in part due to the lack of success he had in spreading his theories, Semmelweis fell into a deep depression, writing bitter letters to prominent European obstetricians in which he accused them of being ignorant murderers.

A hall devoted to Egyptian bread-making includes ancient and modern ovens, a machine for washing wheat, a model of a bakery, and display cases exhibiting traditional pita breads and slices of Egypt’s delectably flaky layered pastry, feteer meshaltet. In the natural history section, walk among rows of pinned birds, insects, and butterflies before greeting the taxidermy horses, cows, leopards, and lion. (If the lion is lying on the floor, that’s normal—its legs aren’t too sturdy these days.) Round out your visit with a tour of the dioramas, which depict scenes from an Egyptian wedding, market, orchard, and a “potato- and bean-drying facility.” Much of the sprawling, decrepit museum is officially closed—“for renovation,” supposedly—but hand a tip to the staff and you may find they open a few forbidden doors for you.


Red Rabbit by Tom Clancy, Scott Brick

anti-communist, battle of ideas, diversified portfolio, Ignaz Semmelweis: hand washing, information retrieval, union organizing, urban renewal

When Zaitzev's identity as a Russian citizen had been confirmed, a call had been made to the Soviet Embassy, where it was speedily established that the man in question was a KGB officer. That generated interest in the rezidentura, just across the street from the hotel where he'd ostensibly died, and more telephone calls were made. Before five in the morning, Professor Zoltan Biro was awakened in his bed by the AVH. Biro was professor of pathology at the Ignaz Semmelweis Medical College. Named for one of the fathers of the germ theory that had transformed the science of medicine in the nineteenth century, it remained a good one, even attracting students from West Germany, none of whom would attend the postmortem examinations ordered by the country's Belügyminisztérium, which would also be attended by the physician-in-residence at the Soviet Embassy. The first done would be the adult male.

The colonel was as good as his word, passing through the control point three minutes later. By that time, Zaitzev had returned the cipher book to central storage and slipped the message form, plus the translation, into a brown envelope, which he handed to the colonel. "Has anyone seen this?" Rozhdestvenskiy asked. "Certainly not, comrade," Zaitzev replied. "Very well." Colonel Rozhdestvenskiy walked away without another word. For his part, Zaitzev left his work desk and headed off to the cafeteria for lunch. The food was the best reason to work at The Centre. What he could not leave behind as he stopped at the lavatory to wash his hands was the message sequence. Yuriy Andropov wanted to kill the Pope, and the rezident in Rome didn't like the idea. Zaitzev wasn't supposed to have any opinions. He was just part of the communications system.

"Hey, I have a meeting scheduled at the CPSU Central Committee building." "Anything I ought to know about?" "Like I said, you can read it in the Times. They fax you the Early Bird out of Washington, don't they?" "Yeah, it eventually trickles down here." "Then, day after tomorrow, you can read it," Prince advised, standing to take his leave. "Tell Ernie." "I'll do that," Foley said, extending his hand. Then he decided he'd walk Prince to the elevator. On the way back, he'd hit the men's room to wash his hands. His next stop after that was the Ambassador's office. "Hi, Ed. Meet with that Prince guy?" Foley nodded his head. "Just cut him loose." "Did he nibble at your hook?" "Nope. Just spat it right back at me." Fuller smiled crookedly. "What did I tell you? There used to be some patriotic reporters back when I was your age, but they've mostly grown out of it over the last few years."


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Enlightenment Now: The Case for Reason, Science, Humanism, and Progress by Steven Pinker

3D printing, access to a mobile phone, affirmative action, Affordable Care Act / Obamacare, agricultural Revolution, Albert Einstein, Alfred Russel Wallace, anti-communist, Anton Chekhov, Arthur Eddington, artificial general intelligence, availability heuristic, Ayatollah Khomeini, basic income, Berlin Wall, Bernie Sanders, Black Swan, Bonfire of the Vanities, business cycle, capital controls, Capital in the Twenty-First Century by Thomas Piketty, carbon footprint, clean water, clockwork universe, cognitive bias, cognitive dissonance, Columbine, conceptual framework, correlation does not imply causation, creative destruction, crowdsourcing, cuban missile crisis, Daniel Kahneman / Amos Tversky, dark matter, decarbonisation, deindustrialization, dematerialisation, demographic transition, Deng Xiaoping, distributed generation, diversified portfolio, Donald Trump, Doomsday Clock, double helix, effective altruism, Elon Musk, en.wikipedia.org, end world poverty, endogenous growth, energy transition, European colonialism, experimental subject, Exxon Valdez, facts on the ground, Fall of the Berlin Wall, first-past-the-post, Flynn Effect, food miles, Francis Fukuyama: the end of history, frictionless, frictionless market, germ theory of disease, Gini coefficient, Hans Rosling, hedonic treadmill, helicopter parent, Hobbesian trap, humanitarian revolution, Ignaz Semmelweis: hand washing, income inequality, income per capita, Indoor air pollution, Intergovernmental Panel on Climate Change (IPCC), invention of writing, Jaron Lanier, Joan Didion, job automation, Johannes Kepler, John Snow's cholera map, Kevin Kelly, Khan Academy, knowledge economy, l'esprit de l'escalier, Laplace demon, life extension, long peace, longitudinal study, Louis Pasteur, Martin Wolf, mass incarceration, meta analysis, meta-analysis, Mikhail Gorbachev, minimum wage unemployment, moral hazard, mutually assured destruction, Naomi Klein, Nate Silver, Nathan Meyer Rothschild: antibiotics, Nelson Mandela, New Journalism, Norman Mailer, nuclear winter, obamacare, open economy, Paul Graham, peak oil, Peter Singer: altruism, Peter Thiel, precision agriculture, prediction markets, purchasing power parity, Ralph Nader, randomized controlled trial, Ray Kurzweil, rent control, Republic of Letters, Richard Feynman, road to serfdom, Robert Gordon, Rodney Brooks, rolodex, Ronald Reagan, Rory Sutherland, Saturday Night Live, science of happiness, Scientific racism, Second Machine Age, secular stagnation, self-driving car, sharing economy, Silicon Valley, Silicon Valley ideology, Simon Kuznets, Skype, smart grid, sovereign wealth fund, stem cell, Stephen Hawking, Steven Pinker, Stewart Brand, Stuxnet, supervolcano, technological singularity, Ted Kaczynski, The Rise and Fall of American Growth, the scientific method, The Signal and the Noise by Nate Silver, The Spirit Level, The Wealth of Nations by Adam Smith, The Wisdom of Crowds, Thomas Kuhn: the structure of scientific revolutions, Thomas Malthus, total factor productivity, union organizing, universal basic income, University of East Anglia, Unsafe at Any Speed, Upton Sinclair, uranium enrichment, urban renewal, War on Poverty, We wanted flying cars, instead we got 140 characters, women in the workforce, working poor, World Values Survey, Y2K

Before the 20th century, cities were piled high in excrement, their rivers and lakes viscous with waste, and their residents drinking and washing their clothes in putrid brown liquid.3 Epidemics were blamed on miasmas—foul-smelling air—until John Snow (1813–1858), the first epidemiologist, determined that cholera-stricken Londoners got their water from an intake pipe that was downstream from an outflow of sewage. Doctors themselves used to be a major health hazard as they went from autopsy to examining room in black coats encrusted with dried blood and pus, probed their patients’ wounds with unwashed hands, and sewed them up with sutures they kept in their buttonholes, until Ignaz Semmelweis (1818–1865) and Joseph Lister (1827–1912) got them to sterilize their hands and equipment. Antisepsis, anesthesia, and blood transfusions allowed surgery to cure rather than torture and mutilate, and antibiotics, antitoxins, and countless other medical advances further beat back the assault of pestilence.

“Income—although important both in and of itself and as a component of wellbeing . . .—is not the ultimate cause of wellbeing.”16 The fruits of science are not just high-tech pharmaceuticals such as vaccines, antibiotics, antiretrovirals, and deworming pills. They also comprise ideas—ideas that may be cheap to implement and obvious in retrospect, but which save millions of lives. Examples include boiling, filtering, or adding bleach to water; washing hands; giving iodine supplements to pregnant women; breast-feeding and cuddling infants; defecating in latrines rather than in fields, streets, and waterways; protecting sleeping children with insecticide-impregnated bed nets; and treating diarrhea with a solution of salt and sugar in clean water. Conversely, progress can be reversed by bad ideas, such as the conspiracy theory spread by the Taliban and Boko Haram that vaccines sterilize Muslim girls, or the one spread by affluent American activists that vaccines cause autism.

True, but they do mean that you’re less likely to be a victim. For that reason they mean the world to the millions of people who are not victims but would have been if rates of violence had stayed the same. So you’re saying that we can all sit back and relax, that violence will just take care of itself. Illogical, Captain. If you see that a pile of laundry has gone down, it does not mean the clothes washed themselves; it means someone washed the clothes. If a type of violence has gone down, then some change in the social, cultural, or material milieu has caused it to go down. If the conditions persist, violence could remain low or decline even further; if they don’t, it won’t. That makes it important to find out what the causes are, so we can try to intensify them and apply them more widely to ensure that the decline of violence continues.


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Home Comforts: The Art and Science of Keeping House by Cheryl Mendelson

biofilm, Broken windows theory, clean water, deskilling, Ignaz Semmelweis: hand washing, Indoor air pollution, indoor plumbing, Jacquard loom, Own Your Own Home, sensible shoes, spice trade, Telecommunications Act of 1996, telemarketer

This is accomplished in four ways: frequent washing of hands; frequent and thorough surface cleaning followed, in appropriate circumstances, by a judicious use of disinfectants; the use of noncontaminated and noncontaminating tools and materials in cleaning; and keeping things dry. WASHING HANDS IS CRUCIAL Aseptic techniques were introduced in medicine in the nineteenth century, when Dr. Ignaz Semmelweis, a Hungarian obstetrician, noticed that the washing of hands in obstetrical units greatly reduced the incidence of puerperal fever (postpartum infection of the uterus). Even today, contaminated hands continue to be a major source of hospital infections, and the washing of hands continues to be the major defense against the spread of infection in hospitals. The same is true in your home. Washing Hands The Importance of Washing Your Hands. Our hands are probably the most important means by which nonairborne and nonwaterborne pathogens in our homes are spread to surfaces and other people. Frequent hand washing is one of the most important means we have of defending against pathogens in the home.

For the most part, the kitchen sink is not for washing your face or hands. So many homes lack a laundry tub these days that it is tempting to hand-wash laundry in the kitchen sink, but this is not a good idea either. If you have no laundry tub or sink, use a portable plastic tub and empty it into the toilet. My Italian grandmother was extremely rigid about this. You were permitted to do nothing in the kitchen sink but wash foods and dishes. No matter how many extra steps it cost you, you had to go up to the bathroom or down to the cellar to wash your hands. The dog’s dish had to be washed in the cellar, his water dish filled there. You could not empty a flower vase in the kitchen sink or even cut and arrange flowers there. My own procedure on washing my hands is to wash them outside the kitchen before I begin cooking.

Traditional dishwashing rules are so ingrained in me that I could far more easily walk off and leave all the dishes unwashed than bring myself to wash glasses after skillets or mix washed and unwashed items on one side of the sink. About Hand-Washing Dishes. No matter how high-tech and efficient your dishwasher may be, you need to know how to wash dishes by hand. When you’re cooking and have soiled bowls, pots, or utensils that you need to use again immediately, you can’t wait to run the machine; you must also know how to handwash all the things that cannot go into the machine. When the dishwasher is broken or too full, you have to hand-wash everything. And sometimes you want to hand-wash things because they seem too few to run the machine for and you do not want them to sit in the machine until it fills. If you do it properly, handwashing produces safe and bright dishes. Instructions appear below for washing by hand all the soiled dishes, glasses, flatware, serving dishes, pots, pans, and utensils created by an entire dinner.