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Resistance Is Futile: Why That’s A Good Thing In Biomedicine

Opinion

Xconomy Seattle — 

Fans of Star Trek: The Next Generation are very familiar with the Borg, a society of cybernetic individuals linked together in a collective mindset. The Borg navigate the universe in cube-shaped spacecraft actively seeking members of other races to absorb into their collective. Whenever others oppose their efforts, the Borg let them know, in no uncertain terms, that “resistance is futile” and they will be assimilated. Without context, however, this phrase can be interpreted in several ways: are we talking about resistance to change, or resistance to orthodoxy?

I was thinking about this catchphrase when I was reading Christin O’Keefe Aptowicz’s historical biography, Dr. Mütter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine. The book details the career of Dr. Thomas Mütter, a pioneering surgeon working in Philadelphia in the decades just before the U.S. Civil War. It describes the state of doctoring in America during that time period, and recounts how Dr. Mütter and some of his colleagues tried to introduce several new advances in medicine. These included (1) the use of ether anesthesia in surgery, and (2) the concept that operations should be done under as clean a condition as possible to prevent disease in both the primary as well as subsequent patients.

What was surprising was how efforts to introduce these changes were met with tremendous opposition from many members of the medical establishment. This resistance, of course, thankfully proved to be futile in the long run. As additional data were accumulated with more clinical experience, it became clear that these changes to the existing orthodoxy would both prevent patient suffering and significantly decrease mortality. It is an early example of empirical research and outcomes-based experimentation on people. As industrial designer and futurist Buckminster Fuller later put it, “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”

Can you imagine undergoing surgery without the benefit of anesthetics? Can you picture your surgeon operating on you without washing his hands and while wearing a filthy surgical gown? The book is filled with horrifying descriptions of many of the medical procedures used in that era, and it reads like the fusion of a Stephen King novel with a touch of the Saw movies thrown in. During this time period, the best surgeons were renowned for their speed and the ambidextrous skills with which they handled the knife. Amputations, mending mangled limbs, repairing birth defects (such as cleft palates and club feet), and fixing the terrible scarring that resulted from fires were all procedures that were routinely done in the mid 1800s. A team of strong men was often part of the medical team, their job being to physically restrain the patient during the operation. These days, of course, the deliberate infliction of extremely painful medical procedures would be viewed as torture by most civilized people (with the possible exception of Dick Cheney).

Who Would Be Opposed to Anesthesia? And Why?

So why were many doctors strongly opposed to the introduction of inhalation anesthesia? There were essentially two reasons. The first was that the quality of the new ether-based anesthetics was, to put it charitably, not very good. Manufacturing of these agents had not been standardized, and there was significant batch-to-batch variability in purity and strength, which on occasion led to patients dying from too much anesthesia. Dosages were being worked out on an empirical basis. Edward Robinson Squibb, a Navy physician, took on the task of producing a pure and reliable source of ether, though he famously declined to patent either the process or the design of his apparatus. He went on to establish the pharmaceutical company bearing his name, which is now part of Bristol-Myers Squibb.

The second reason for opposing anesthesia was more of a philosophical and religious one. The conditions that physicians were called upon to correct, such as congenital deformities or injuries, were viewed by some as God’s will. The pain that patients had to endure in surgery was seen as part of God’s punishment for whatever transgressions had landed them on the operating table. Freeing patients from such agonies was viewed in some quarters as opposing God’s plan.

It was easier to understand why there was opposition to keeping the surgical suite as clean as possible, since this was before the discovery that infectious diseases were caused by microorganisms. The first antibiotics were still more than fifty years from being discovered, and Louis Pasteur, Joseph Lister, and others had not yet been developed the germ theory of disease. Ideas about what caused certain diseases to spread were still being actively debated, and the concept of epidemiology was just being birthed. The prevailing view at the time was that a noxious form of “bad air” caused diseases. A British physician, John Snow, is credited with stopping a … Next Page »

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Stewart Lyman is Owner and Manager of Lyman BioPharma Consulting LLC in Seattle. He provides strategic advice to clients on their research programs, collaboration management issues, as well as preclinical data reviews. Follow @

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