Tuesday, October 8, 2013

Ideas that spread fast and slow

Ideas that spread fast and slow « Statistical Modeling, Causal Inference, and Social Science Statistical Modeling, Causal Inference, and Social Science:
Rapid acceptance of anesthesia but not antisepsis, why?
 Gawande asks, and shoots down a couple of natural explanations:
Did the spread of anesthesia and antisepsis differ for economic reasons? Actually, the incentives for both ran in the right direction. If painless surgery attracted paying patients, so would a noticeably lower death rate. Besides, live patients were more likely to make good on their surgery bill. . . .
Maybe ideas that violate prior beliefs are harder to embrace. To nineteenth-century surgeons, germ theory seemed as illogical as, say, Darwin’s theory that human beings evolved from primates. Then again, so did the idea that you could inhale a gas and enter a pain-free state of suspended animation. . . .
The technical complexity might have been part of the difficulty. Giving Lister’s methods “a try” required painstaking attention to detail. . . . But anesthesia was no easier. Obtaining ether and constructing the inhaler could be difficult. You had to make sure that the device delivered an adequate dosage, and the mechanism required constant tinkering. Yet most surgeons stuck with it . . .
So what were the key differences? First, one combatted a visible and immediate problem (pain); the other combatted an invisible problem (germs) whose effects wouldn’t be manifest until well after the operation. Second, although both made life better for patients, only one made life better for doctors. Anesthesia changed surgery from a brutal, time-pressured assault on a shrieking patient to a quiet, considered procedure. Listerism, by contrast, required the operator to work in a shower of carbolic acid. Even low dilutions burned the surgeons’ hands. You can imagine why Lister’s crusade might have been a tough sell.
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. . . .
And Andrew Gelman continues with his story about roaches.
I believe Richard Thaler is shouting: behavior economics somewhere.

BTW, Andrew called Atul Gawande "the thinking man’s Malcolm Gladwell". Is that a compliment?

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