A System Stuck in the Past

What was health like before 1900? Health and medicine were dominated by superstition, religion, and tradition. Most of what we thought about disease and how we treated illness was completely wrong. For nearly a millennium, the most prominent therapy for illness, regardless of cause, was bloodletting—“letting” blood out of patients with either leeches or a lancet.The Lancet, one of the world's leading medical journals, was named in 1823 after the blade commonly used for bleeding patients.

 

Scientific knowledge emerged slowly over painful centuries. In many instances, improvements in health and medicine were resisted—even mocked—before they were eventually accepted. Take anesthesia, for example. Prior to the discovery of nitrous oxide, a.k.a. laughing gas, surgeons relied on the ability to perform quick surgeries and be callous to patients’ cries. Nitrous oxide made those skills obsolete. Some surgeons mocked American physicians who used nitrous oxide, calling it the “Yankee dodge.”

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Why were we so resistant to better health?

The experience of Ignaz Semmelweis helps answer that question.

 

A Hungarian obstetrician in Vienna, Semmelweis defied medical tradition by arguing that each disease had only one cause, and that physicians’ unwashed hands caused childbed fever—a disease killing thousands of women. Semmelweis infuriated the medical establishment by hinting that physicians were killing patients, which in fact they were. A few other physicians attacked Semmelweis and admitted him into an insane asylum, where he was beaten to death in his 40’s. Old habits die hard. Those doctors were invested in the current system and were not open to change. Many of us are in a similar position because the system works for us. We are invested in the way things are.

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The tipping point for transforming "old" medicine came in the form of an unlikely person. Abraham Flexner was trained in education and commissioned by the Carnegie Foundation to assess the state of medical education in the U.S. By 1910, the medical education world in the United States had reached a tipping point. There seemed to be an increasing sense that a relatively simple, but new idea—test medical treatments with the scientific method—could lead to phenomenal improvements in health. The Flexner Report of 1910 essentially advocated for a permanent link between science and medical education. Here was the birth of the physician scientist.

 

As a result of Flexner's report and other forces, most of the medical schools in the U.S. closed their doors, merged with other schools, or significantly changed their curriculum and standards.

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At Revolutionize Health, we believe that a similar transformation of thought is needed today. While linking science to health education has had innumerable positive effects, we can do better! Care is episodic and inadequate. Prevention and wellness are overlooked. Education is out-dated and fragmented. We too often do not pay for value. Programs and policies don’t adequately consider interactions and local context. Things that we as a society really care about, like population health, wellness, equity, capacity, and efficiency, are sacrificed for short-term goals, projects, and clinical interventions. We need a new way of thinking.

 

The transformation at the beginning of this century came at a cost.  Deeply ingrained assumptions, social norms, invested interests, and institutional culture did not change easily.

Likewise, we don't expect easy change. That’s why we are spreading our net wide.  Our efforts aim at catalyzing, nurturing, and developing communities that apply complex systems thinking in health.