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IGNAZ
SEMMELWEISS and AUTISM:
when prevailing paradigms resist change
source
by Teresa Binstock
Researcher in Developmental and Behavioral
Neuroanatomy
My writings do not constitute medical
advice.
Instead, they represent a seeking to understand
autism-spectrum disorders
and their causes and associated traits.
The story of Ignaz Semmelweiss sheds light
upon why the NIH and NIMH are
impeding progress in research about causes,
diagnostics, and treatment in autism and
similar syndromes.
By clinging
to an oversimplified and outmoded model of autism (ie,
it's gotta be genetic), the stubborn persistence
of several research administrators in
the NIH and NIMH means that funding for
autism and autism-spectrum syndromes remains
funneled into the hands of a small group
of researchers who pledge (via
NIH-grant contracts) to conduct their
research in accord with the model wherein "it's
gotta be genetic" (1). This funding pattern
imposes a serious limitation on
research that ought be occurring, given
the growing amount of new data which indicate
that *more than* genetic-aspects need
be considered.
The relationship
between (a) the offically approved though outmoded
paradigm and (b) subsequent funding patterns
is worth re-stating: The persistence of
the NIH and the NIMH in focusing almost
entirely upon a genetic-theory of autism
means that a goodly amount of data continues
to be ignored, shunted from
view, and unfunded -- even as the primary
genetics-model researchers are blessed with
abundant funding despite decades of non-success
(1). For instance, the data from
Wakefield, Warren, Singh, Shattock, Oleske
et cetera are important, as are patterns
amidst parental anecdotes -- eg, gastrointestinal
atypicalities, vaccination effects,
extraodrinarily recurrent otitis et cetera.
However,
as recent years have shown, despite the many new data and
anecotes, the NIH and NIMH are resistant
to change. The new data remain virtually
ignored, the parents' anecdotes treated
as if mere hearsay. Not surprisingly, in the
face of this bureaucratic intransigence,
the goal of changing and improving the NIH and NIMH in
regard to autism funding will require
increased effort.
Toward
that goal, the data and fate of Ignaz Semmelweiss reveal much
about challenges to well-entrenched medical
paradigms, about how new data are
ignored, and proponents of new data and
alternative paradigms are treated. In short, when a
medical model becomes institutionalized
and its primary spokespersons
become set in their well funded ways,
such institutions and individuals strongly resist
change.
A fine rendition of the Semmelweiss story
is presented in Jeanne
Achterberg's book Woman as Healer:
"ON CONTROLLING GERMS
"By the end of the nineteenth century,
the work of Lister, Pasteur, Koch,
and other 'microbe hunters' led to the
germ theory of disease, and to knowledge of
sepsis and antisepsis. Hospital procedures
and sanitation dramatically improved.
"Even before
the germ theory, another man -- Ignaz Semmelweiss
(1818-1865) -- was successful in learning
to control the spread of pueperal (childbed) fever,
caused by Streptococcus pyogenes. His
is a long, sad story, representing
the worst that can happen when one challenges
the prevailing mode of thought.
"Semmelweiss
reasoned that dirty hands were the cause of pueperal
fever. He noted that wards staffed by
medical students had about a 10 percent
mortality rate due to fever, while those
staffed by midwives had... 3 percent... He also
knew that medical students went straight
from autopsy chambers to laboring mothers.
They [the med students] never washed their
hands, but wiped them, instead, on aprons
already coated with body fluids.
"Semmelweiss
ran several experiments requiring students to wash their
hands with soap and water and rinse them
in chlorinated lime solution before
entering the wards. With each study, the
death rate dropped to less than 1.5 percent,
only to return to the previous high levels
when the [hand washing] procedures were
curtailed.
"Semmelweiss's
work should have proven to be a boon to motherhood and
life. Not so. His colleagues greeted his
paper with jeers and scathing attacks on
his character. They simply refused to
believe that their own hands were the
vehicle for disease. Instead, they attributed
it to a spontaneous phenomenon arising
from the 'combustible' nature of the parturient
woman. Semmelweiss's academic rank was
lowered, his hospital priveleges restricted.
Despondent, he was committed
to an insane asylum, where he died of
blood poisoning, a disease not unlike the
puerperal fever he had almost conquered."
(2)
The relationship between (a) Semmelweiss's
data and recommendations and (b)
his medical school's professors, bureaucrats,
and their colleagues has
parallels in the modern-days relationship
between (i) new data from parental anecdotes and
from a few, daring autism researchers,
and (ii) the espoused beliefs of and funding
patterns enforced by key personnel within
the NIH, the NIMH, and their
affiliated subsidiaries we think of as
"medical school research facilities". Let us
consider two parallels between how Semmelweiss
was treated and how the NIH and NIMH
react to new data in autism-spectrum syndromes:
1: Initially
and for many years, new data are strongly ignored; then,
they are resisted; and finally, if a person
espouses those data and is persistent in
seeking to explore their ramifications,
then he or she becomes shunned and
excluded. That these reactions occur leads
to a second ramification significant to autism
research in the 1990s and beyond.
2: Despite
the new data and its acceptance by many individuals, the
data and *ramifications* of that data
tend to remain ignored by highly placed medical
bureaucrats. As a result, medical practices
that ought change because of
the new data's signficance do not change;
and people entrenched within the old
paradigm (now made outmoded by the new
data) do their best to enforce the old paradigm --
and do so despite the fact that the new
data suggest better methods of treatment,
diagnostics, or research.
During Semmelweiss's era, advances in agriculture
and in sanitary practices
(ie, events progressing *outside* of medical
schools and teaching hospitals) were
alleviating much human suffering, but
women amidst childbearing were not so
fortunate; they continued to die at needlessly
high rates. After
summarizing health-related progress in
the 19th Century, Achterberg writes:
"None of
the advances in health affected the abominably high infant and
maternal mortality rates, however. The
risks to life in giving birth and
being born were exacerbated to epidemic
proportions as increasing numbers of women
gave birth in hospitals." (2)
In other
words, there was a very real cost -- prolonged human
suffering, even numerous deaths -- because
despite the data collected and shared by Dr.
Semmelweiss, medical-research officials
of his day were defiantly resistant to change.
Similarly,
keeping Dr. Semmelweiss's fate in mind, we wonder in
regard to autism, how many years will
new data be ignored? In how many U.S. medical
school research facilities will promising
research be steered away from or squelched?
What will
be required to cause the NIH and NIMH to quit acting like the
officials who suppressed Semmelweiss and
instead to begin acting like sincere
scientists who appreciate new data, even
as paradigms must adapt or be
replaced.
My own hunch is that the NIH and NIMH will
not change from within; the senior
practitioners of the "it's gotta be genetic"
model have too much influence.
Just as Semmelweiss and his data were
suppressed, so too will the NIH/NIMH
autism-research insiders continue to act
against the the growing body of new data in
autism; the NIH's pro-genetic old-timers
will cling to their paradigm and its funding.
As a result, change within the NIH and
NIMH will have to be initiated from
outside those tax-supported corporations.
As a goal for 1999 and beyond, I offer
that parents and their
organizations and foundations increase
the pressure brought to bear upon the NIH and the NIMH in
regard to how autism-research funds are
allocated. The "it's gotta be
genetic" model is no longer the only paradigm
worthy of funding; and not to fund other
models and other data in autism is no
longer scientifically valid. The NIH and the
NIHM are re-enacting the Ignaz Semmelweiss
scenario wherein new data are ignored on
behalf of an old-guard and its outmoded
paradigm; autism children and their parents
deserve far more. The paradigm-shift in
autism must occur more rapidly, even within
the NIH.
Teresa Binstock
Researcher in Developmental and Behavioral
Neuroanatomy
(1) See autism-list posts by Ray Gallup
or Bob Jensen for further
discussion and important points.
(2) Jeanne Achterberg; p110-111; Woman
As Healer. Shambhala Publications,
Inc.; Boston, 1990.
Teresa
comments: this is an excellent, readable book offering many
insights about the history
of healing, herbs, and midwifery, focusing upon the role
of women, including during
the Inquisition, when women with knowledge of healing and
herbs ofter were killed
as "witches".
Any information obtained here is not to be construed as medical or
legal advice. The decision to
vaccinate and how you implement that decision is yours and yours alone. |
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