Atul Gawande

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“Making Them Work Can Be Tedious, If Not Outright Painful”

July 23, 2013 in Excerpts, Science/Tech, Urban Studies | Permalink

From “Slow Ideas,” another excellent Atul Gawande New Yorker article, this one about why some innovations are almost instantly sticky and why others get stuck:

“This has been the pattern of many important but stalled ideas. They attack problems that are big but, to most people, invisible; and making them work can be tedious, if not outright painful. The global destruction wrought by a warming climate, the health damage from our over-sugared modern diet, the economic and social disaster of our trillion dollars in unpaid student debt—these things worsen imperceptibly every day. Meanwhile, the carbolic-acid remedies to them, all requiring individual sacrifice of one kind or another, struggle to get anywhere.

The global problem of death in childbirth is a pressing example. Every year, three hundred thousand mothers and more than six million children die around the time of birth, largely in poorer countries. Most of these deaths are due to events that occur during or shortly after delivery. A mother may hemorrhage. She or her baby may suffer an infection. Many babies can’t take their first breath without assistance, and newborns, especially those born small, have trouble regulating their body temperature after birth. Simple, lifesaving solutions have been known for decades. They just haven’t spread.

Many solutions aren’t ones you can try at home, and that’s part of the problem. Increasingly, however, women around the world are giving birth in hospitals. In India, a government program offers mothers up to fourteen hundred rupees—more than what most Indians live on for a month—when they deliver in a hospital, and now, in many areas, the majority of births are in facilities. Death rates in India have fallen, but they’re still ten times greater than in high-income countries like our own.

Not long ago, I visited a few community hospitals in north India, where just one-third of mothers received the medication recommended to prevent hemorrhage; less than ten per cent of the newborns were given adequate warming; and only four per cent of birth attendants washed their hands for vaginal examination and delivery. In an average childbirth, clinicians followed only about ten of twenty-nine basic recommended practices.

Here we are in the first part of the twenty-first century, and we’re still trying to figure out how to get ideas from the first part of the twentieth century to take root.”

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“It Has Long Been An Important Problem In Medical Science To Devise Some Method Of Mitigating The Pain Of Surgical Operations”

May 4, 2012 in Excerpts, Science/Tech, Urban Studies | Permalink

From Atul Gawande’s New England Journal of Medicine piece, “Two Hundred Years of Surgery,” the moment in the Western world when medical procedures began to migrate from the external to the internal:

“The crucial spark of transformation — the moment that changed not just the future of surgery but of medicine as a whole — was the publication on November 18, 1846, of Henry Jacob Bigelow’s groundbreaking report, ‘Insensibility during Surgical Operations Produced by Inhalation‘ The opening sentences crisply summarized the achievement: ‘It has long been an important problem in medical science to devise some method of mitigating the pain of surgical operations. An efficient agent for this purpose has at length been discovered.’ Bigelow described how William Morton, a Boston dentist, had administered to his own patients, and then to several more who had undergone surgery at the Massachusetts General Hospital, a gas he called ‘Letheon,’ which successfully rendered them insensible to pain. Morton had patented the composition of the gas and kept it a secret even from the surgeons. Bigelow revealed, however, that he could smell ether in it. The news burst across the world. The Letters to the Editor pages were occupied for months with charges and countercharges over Bigelow’s defense of Morton’s secrecy and credit for the discovery. Meanwhile, ether anesthesia rapidly revolutionized surgery — how it was practiced, what could be attempted with its use, and even what it sounded like.” (Thanks Browser.)

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“The Cause Of Our Troubles Is Actually The Complexity That Science Has Given”

April 17, 2012 in Science/Tech, Urban Studies, Videos | Permalink

Atul Gawande, great writer and thinker, holds forth at TED on the modern problem of making medical systems–and all complicated systems–work.

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“Well Into The Nineteen-Fifties, Psychologists Were Encouraging Parents To Give Children Less Attention And Affection”

April 1, 2011 in Excerpts, Science/Tech, Urban Studies | Permalink

"No matter how tightly they clung to the surrogate mothers, however, the monkeys remained psychologically abnormal."

A note about an important shift in child rearing that occurred during the 1950s from “Hellhole,” a 2009 New Yorker article about solitary confinement by the Brooklyn-born surgeon and excellent writer Atul Gawande:

“Well into the nineteen-fifties, psychologists were encouraging parents to give children less attention and affection, in order to encourage independence. Then Harry Harlow, a professor of psychology at the University of Wisconsin at Madison, produced a series of influential studies involving baby rhesus monkeys.

He happened upon the findings in the mid-fifties, when he decided to save money for his primate-research laboratory by breeding his own lab monkeys instead of importing them from India. Because he didn’t know how to raise infant monkeys, he cared for them the way hospitals of the era cared for human infants—in nurseries, with plenty of food, warm blankets, some toys, and in isolation from other infants to prevent the spread of infection. The monkeys grew up sturdy, disease-free, and larger than those from the wild. Yet they were also profoundly disturbed, given to staring blankly and rocking in place for long periods, circling their cages repetitively, and mutilating themselves.

At first, Harlow and his graduate students couldn’t figure out what the problem was. They considered factors such as diet, patterns of light exposure, even the antibiotics they used. Then, as Deborah Blum recounts in a fascinating biography of Harlow, Love at Goon Park, one of his researchers noticed how tightly the monkeys clung to their soft blankets. Harlow wondered whether what the monkeys were missing in their Isolettes was a mother. So, in an odd experiment, he gave them an artificial one.

In the studies, one artificial mother was a doll made of terry cloth; the other was made of wire. He placed a warming device inside the dolls to make them seem more comforting. The babies, Harlow discovered, largely ignored the wire mother. But they became deeply attached to the cloth mother. They caressed it. They slept curled up on it. They ran to it when frightened. They refused replacements: they wanted only ‘their’ mother. If sharp spikes were made to randomly thrust out of the mother’s body when the rhesus babies held it, they waited patiently for the spikes to recede and returned to clutching it. No matter how tightly they clung to the surrogate mothers, however, the monkeys remained psychologically abnormal.”

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