Volume 2 * Number 1

When in Rome . . . Watch Out For Romans
by James Biddle, MD

In this issue of Healthy Notes you'll find a story about the fascinating life and tragic death of Dr. Ignaz Semmelweis, a medical pioneer who was shunned, driven mad, and finally killed because he insisted on following his conscience as a doctor and a scientist.

After you read the story, you may be tempted to think that such persecution could not happen in the world todayÖespecially not in the United States. The fact is, however, that even today the act of challenging the medical status quo leaves one vulnerable to attack, sometimes on the most flimsy of pretenses.

While I was doing my medical residency in Oregon, I became interested in hypnotherapy as a tool in healing. After reading some very well-documented studies published in leading medical journals, I enrolled at the Portland Academy of Hypnosis. This is a very well-educated group. They specialize in teaching health professionals how to use hypnosis. You have to be a dentist, M.D., or Ph.D. to join. I was so enthused about the potential of hypnosis that I actually presented a one-hour lecture, or "grand rounds," to the assembled doctors at my hospital. I naively expected an enthusiastic reception, because the data was simply outstanding.

My colleagues were, to put it mildly, unimpressed. In fact, the general consensus seemed to be that I was a couple sandwiches short of a full picnic, which was challenging for me since I had previously been pretty much a "company guy," towing the line and marching in step.

This was an incredible turning point in my career. At that moment, I realized that the vast majority of doctors don't care about hypnosis or any other potentially-useful treatments outside the current "standard of care," even in the face of great data. They are locked into a "paradigm box," only able to consider those options taught to them in the paradigm of their training, which focused on surgery and medications. I hear them use phrases such as "There's no evidence to support that treatment," when in fact there's overwhelming evidence, but they've either ignored it or refused to look at it. Therefore, I created a saying to help me understand the reactions I encountered, and still encounter, from conventional physicians: "All data will be ignored if it does not fit the ruling paradigm."

Since then, I've learned that advances in science, and especially medicine, unfortunately tend to occur more as revolutions than as evolutions. As outlined in the book "The Structure of Scientific Revolutions," new ideas are first ignored, then ridiculed, then persecuted, and then finally accepted as obvious, and as if they were the establishment's own all along.

After this experience cracked the walls of my own paradigm box, I became much more interested in what might actually help a patient, rather than in how most other doctors would treat that patient. This has, unintentionally, led me into a field sometimes known as "Alternative Medicine." I prefer the terminology of "Integrative Medicine," because I desire to integrate whatever really works.

A few years later, while working in an ER on the coast of Oregon, I also studied massage and became a licensed massage therapist. I had personally benefited from the transformative power of massage, and I wanted to utilize a variety of effective healing modalities. However, it wasn't until I moved to North Carolina that I realized just how risky it is for a physician to embrace techniques that are outside the mainstream "standard of care" of medical practice.

In North Carolina, in order to get your license to practice medicine, you must have a personal interview with a member of the state medical board after, of course, filling out a good bit of paperwork. I wasn't worried about this interview. I figured I'd hear, "You look like a fine young man and all your papers are in order. Welcome to North Carolina and please practice good medicine."

Unfortunately, it wasn't that simple. In reviewing my list of prior licenses, this good doctor discovered that darn massage therapy license. His first question to me was quite brusque, setting my hair on end: "What's this massage stuff all about?" I answered simply that I was interested in the power of healing and loving touch as a therapeutic option for people.

I don't remember the conversation exactly, but the gist of it was that he couldn't imagine why I would possibly be interested in massage therapy, other than to fondle women. In fact, he told me within the first five minutes of our interview that "I fully expect to see you up here within two years on sexual boundary violation charges." All of this because I was licensed as a massage therapist in Oregon. (By the way, I soon found out that he had never even once received a professional massage, and I thought, "boy, he sure could use one.")

At first I got scared. This guy, after all, held in his hands my ability to practice medicine in this state. But then I recalled that the state law actually required him to grant my license unless he had a valid reason to withhold it, and I had a spotless record. My fear turned to anger, so I let him know that not only did I expect to continue providing massage, but I was also considering working in an alternative medical clinic with an acupuncturist, studying homeopathy. Wow, then we really went round and round!

By the end of this tense interview, he told me that he would give me my license after all, but "with reservations." I assumed that meant that I got onto his "hit list" for future reference. His parting words to me were, "You're not in Oregon anymore. Now you're in North Carolina, and we don't do that alternative stuff here. So when you're in Rome, do as the Romans do."

"The Romans -- now weren't they those guys who threw the Christians to the lions?" escaped from my mouth before I hastened my exit.

I did get my license and I feel extremely fortunate that I've been able to practice medicine here as I desire. However, my right to do so has nothing to do with my sassy mouth around authority figures. I am gratefully one of the beneficiaries of a battle fought in part by some local medical pioneers. This battle resulted in a change in state law a few years ago, which effectively "pulled the teeth" out of the medical board's efforts to suppress physicians who dared to offer treatments outside the usual and customary "standard of care" in the community. This issue's article entitled "The Heavy Price of Medical Innovation" is a tribute to these pioneers.

Asheville is increasingly referred to as a "Mecca" for alternative and integrative medicine. A whole community of holistic healers and progressive physicians serve the area. Asheville has even been compared to Santa Fe and Sedona, other centers for alternative medicine. In fact, this remarkable growth of alternative medicine is one important facet of Asheville's overall strong economic performance.

It wasn't always like this. As in most revolutions, the early pioneers of alternative medicine in Asheville paid a heavy price for their innovation.

Dr. George Guess, a graduate of the Medical College of Virginia, practiced homeopathic medicine on a few of his patients back in the mid-1980s. In 1986, the N.C. Board of Medical Examiners revoked his license to practice and then stayed the revocation for three years. They offered to make the stay permanent if he would refrain from practicing homeopathic medicine. By 1992, exhausted by legal battles, Dr. Guess moved his practice to Virginia.

Another Asheville physician, Dr. John Laird, also ran afoul of the medical examiners, who said that his use of chelation therapy fell outside the accepted and prevailing standards of medical practice and charged him with "fraudulent practice."

"Facing an obvious quick death," he remembers, "I turned to the only remaining avenue: the state legislature. In 1992, I founded Carolinians for Health Care Access, a group to propose alternative medicine legislation. In 1994 we successfully passed (after a brutal fight) legislation that is currently in place. The board can revoke a license for alternative medical practices only if the therapy is proven to be ineffective, or if the side effects from the non-usual and non-customary therapy exceed the side effects from the conventional treatment approaches. In 1994, the board dropped their charges against me. I'm sure, given the amount of opposition and publicity we created, they had no desire to prolong the fight."

Even though he won his battle and is revered by the patients he helped, Laird was still an outcast among local doctors. Shortly after his victory, he sold his practice and moved to New Mexico.

Asheville acupuncturist Cissy Majebe had an even more frightening experience in 1990. Officers from the State Bureau of Investigation raided her Montford-area clinic, removing her patient and business records, as well as her diplomas. Majebe eventually prevailed and was named the first chair of the North Carolina Acupuncture Licensing Board.

The cost to pioneering physicians is appalling, but what of the cost to consumers of medical services? When pioneers and innovators are punished for their efforts, the quality of medicine must certainly suffer. The case of Dr. Ignaz Semmelweis, discussed below, is a profound example. Literally thousands of women died simply because physicians were unwilling to wash their hands properly.

Sadly, attitudes toward medical innovators and free-thinkers have not changed much in the current century. Despite encouraging developments in alternative and integrative medicine, there is still much room for improvement.

It has been known for over 20 years, for example, that certain combinations of antibiotics could cure peptic ulcers, which are caused by chronic infection in most cases (see http://www.helico.com). Nevertheless, doctors all over the country continue to treat this painful, dangerous condition simply with acid blockersÖeither because they are resistant to shifting their paradigm or because they have simply not learned of the new and better way of treating ulcers. Either way, the patient loses.

Rheumatoid arthritis is another wide-spread malady that can often be helped with antibiotics (see http://www.roadback.org). During WWII, Dr. Thomas McPherson Brown isolated an infectious organism that seemed to be the culprit in most cases of RA. However, for 50 years he was ostracized and attacked by his colleagues rather than acclaimed for his success in "curing" thousands of arthritis patients. Again, the patient loses. Dr. Kilmer McCully proposed in 1969 that abnormal levels of an amino acid called homocysteine can contribute to heart disease, but he was ridiculed for almost 30 years because he was not on the "cholesterol bandwagon" theory of heart disease. JAMA finally published his work in 1998. How many tens of thousands of Americans died prematurely because this simple test was withheld?

Reluctance to accept innovation has long plagued the medical profession. In 1928, Dr. George Papanicolaou and his wife-assistant Mary presented the world with "The Pap Smear," a gift that reduced the death rate from cervical cancer by 74% and eventually saved the lives of millions of women. Nevertheless it took almost 30 years for the procedure to become routine. How many women lost their lives in the interim?

You may be carrying around in your mouth another example of this medical malaise Ö something called "amalgams." This combination of silver, tin, and mercury was first introduced in the 1830s as a new material to fill teeth. The fact that the amalgam contained the toxic substance mercury prompted the American Society of Dental Surgeons to suspend several members of their organization for "malpractice for using mercury fillings."

Today, deadly poisonous ingredients notwithstanding, the American Dental Association (ADA) whole-heartedly endorses amalgams as a G.R.A.S. (generally recognized as safe) material for filling teeth. This, despite abundant research showing that mercury is highly toxic, highly volatile, and clearly dangerous.

The list, of course, goes on and on. The basic message is this: Data that does not fit the ruling medical paradigm will be ignored. This means that patients have to become better and better at choosing their health care. The horrible truth is that when it comes down to balancing your health against corporate financial interests or physician liability, "let the buyer beware."

On August 13, 1865, 47-year-old Dr. Ignaz Semmelweis died what can only be described as a horrible, lonely death.

Dr. Semmelweis, a gifted medical researcher and physician, expired in a Viennese insane asylum from internal injuries he received from guards at the asylum. At the time of his death, 15 days after the beating, he was reportedly weak from sleep deprivation, covered with boils, suffering from gangrene, delirious, and strapped into a straitjacket in a darkened room. He had been "treated" repeatedly with cold water dousing and doses of castor oil .

No priest was called to administer the last rites, despite the fact that the medical records at the asylum clearly indicated that he was Roman Catholic. Most of his colleagues in medicine declined to attend his funeral, as did his wife and children. No one at the asylum was held accountable for the staggering abuse to which Semmelweis had been subjected.

What was it that this man had done to brand him a lunatic and cost him his livelihood, his professional reputation, and even his life? What offense did this highly educated, compassionate, painstaking researcher and scientist commit?

It was quite simple reallyÖhe suggested that obstetricians should disinfect their hands before moving from a cadaver dissection to a pelvic exam on a live patient. That may sound reasonable by modern standards, but at the time, his fellow obstetricians were outraged.

Then, as now, proponents of the ruling medical paradigm were bitterly opposed to anything that did not fit within the boundaries of their limited experience. In Semmelweis's case, the opposition to change was fueled by national politics, professional jealousies, and, finally, his own outrage at the system.

His struggle began when, on his 28th birthday, he became an assistant to Dr. Johannes Klein, the head of the Viennese General Hospital's maternity clinic. Semmelweis, who held a medical degree from the University of Vienna as well as a master's degree in midwifery, was appalled at the mortality rate in the clinic. It was so bad, in fact, that expectant mothers actually begged to be discharged so that they could have their babies in another facility or even in the street. Some of them, if they had the strength and the mental resources, simply escaped. At one point in the clinic's shameful history, 11 of 12 maternity patients perished from what was then called "childbed fever." Dr. Semmelweis, a relative newcomer to the medical field, had entered a world that sorely need him.

There were many theories regarding what was behind the high incidence of childbed fever. Suspected causes included inadequate ventilation, poor circulation, protracted labor, injuries to the uterus during delivery, the tightness of petticoats, strong liquor, and even crowded rooms. Unsatisfied with any of the current explanations, Semmelweis began investigating the deadly disease on his own.

His research brought him to the conclusion that the disease was caused primarily by decaying particles of flesh carried on the hands of the physicians attending the doomed patients. In those days, it was standard procedure for a doctor to go directly from the dissection of a cadaver to an examination of a live patient. Some of the more progressive doctors washed their hands in water, some even used soap. However, Semmelweis discovered that mere soap and water would not kill the bacteria that were causing childbed fever. He developed a chloride of lime solution and insisted that the physicians in his section wash with it thoroughly before working on a live patient. The mortality rate in his section dropped to almost zero.

At this point, it seems as though the medical community would have hoisted Semmelweis on their shoulders and honored him for the many thousands of lives his discovery would save. Such was not the case.

Instead of being proclaimed a hero, this brilliant doctor found himself in the middle of a firestorm of resentment and political intrigue. Rather than embracing Semmelweis's solution, many doctors actively tried to discredit him. One prominent physician published a condemnation of chlorine washing, arguing that the amount of infective material around a fingernail would not possibly be enough to kill a person.

Another well-known doctor let it be known that he had used chlorine washingÖbut to no advantage. Later, one of his students revealed that his "washings" were little more than the dunking of the ends of one's fingers into fluid that had not been changed for many days and was itself full of harmful material. Still another noted physician funded a graduate student's examination of Semmelweis's findings. He was greatly disappointed when the student doctor's reports closely resembled those of Semmelweis. The student's work, although sound in method and presentation, was never widely circulated.

Even though his findings were grossly misinterpreted by the medical establishment and rejected by many prominent physicians, Semmelweis continued to achieve dramatic success in surgical procedures considered to be extremely dangerous by even the most skilled of his contemporaries.

This made no impression on the protectors of the status quo. In 1856, the editor of a Viennese medical journal added the following words to the end of an otherwise favorable report on chlorine washing by one of Semmelweis's assistants: "We believe that this chlorine washing theory has long outlived its usefulnessÖIt is time we are no longer to be deceived by this theory."

Eventually, embittered by his rejections and full of despair over the lives lost to childbed fever, Semmelweis began to deteriorate. He started drinking heavily and spending time in the company of prostitutes. He published angry open letters denouncing prominent obstetricians as irresponsible murderers.

An embarrassment to his colleagues and his family, Semmelweis was finally lured by a trusted friend to the insane asylum and held there against his will. When he discovered that he was being committed to the asylum he attempted to escape, got in a fight with the guards, and received the beating from which he would die two weeks later. Ironically, the disease that killed him-blood poisoning-was one of the maladies that had ended so many lives in the Viennese maternity ward where his struggles had begun.

Not long after his death, the medical community began to come around to his way of thinking. Today, he is honored as a medical pioneer. His childhood home has been turned into a museum of medical history, a hospital bears his name, and his views have been accepted as common knowledge among modern healers.

As disturbing as the Semmelweis story is, the appalling truth is that on a fundamental level little has changed for the better in the medical establishment. Certainly, surgical hygiene has improved greatly and the technology of medicine has developed at an astonishing rate. But what about the attitude of medicine? What about our objectivity and our ability to embrace new ideas? Are physicians today any more willing to admit error than they were in the days of Ignaz Semmelweis?

Conclusion

Currently in North Carolina, we are extremely fortunate to live in a state that has a Medical Practice Act law that is a relative shelter for offering patients their choice of reasonable therapies. However, every year there are attempts to change the law and restrict the options of both doctors and patients. In fact, I understand that the same medical board member that I encountered in my interview now sits on the recently formed committee to "over-see" alternative medicine. This is an example of why we encourage you to stay informed at both the local and national level, and perhaps even join one of the organizations below fighting to preserve and expand medical freedoms. As you may have heard, The Price of Freedom is Everlasting Vigilance.

RESOURCES:

"Childbed Fever, A Scientific Biography of Ignaz Semmelweis" by K. Codell Carter and Barbara R. Carter, Greenwood Press, Westport, CT. ISBN # 0-313-29146-2.

American Preventive Medical Association
Tel: 1-800-230-2762
http://www.apma.net
P.O. Box 458, Great Falls, Virginia 22066

Citizens for Health
TEL: 1-800-357-2211
http://www.citizens.org
P.O. Box 2260, Boulder, CO 80306

Friends of Chelation Society
Call our clinic for the Local Representative
http:/members.tripod.com/~focs