I think Semmelweis is interesting for other reasons. From what I understand, hand-washing was routine in Semmelweis' time; what he specifically championed was antiseptic washing (in his case with a solution of lime). And: he was an asshole about it. He had a particular theory of why his particular routine worked, and it was the wrong one: he believed particles from corpses were becoming airborne and landing in the wounds of patients. That theory was tested and falsified by numerous infections occurring in places no corpses had been present. Challenged with countervailing evidence, he doubled down, maintaining that childbed fever was caused by the cadaveric particles generated internally by necrotizing tissue crushed during the birthing process. Through it all, he was outrageously rude, hurled insults at his colleagues, stormed into operating theaters, and generally did everything he could to make sure his life-saving contribution was ignored.
The rudeness is a little interesting, I guess, but the big thing for me is the idea that just a little bit of intellectual humility --- stick to the empirical observation and stop yelling at people about corpses! You almost had it! --- would have made him a household name centuries later.
The article mentions unwashed hands is STILL a problem with physicians TODAY - with all the years of training, knowledge, books, microscopes that can see germs in action and most importantly, hundreds of years of evidence.
Changing people's minds is not easy - then or now. Shaming works way better than just talking. You can see how shaming has helped the cause of open source, black lives matter, pollution... But even with multiple champions, these causes are struggling, not a runaway success as you'd expect.
Compare this man to Richard Stallman - see any similarities? I'm sure Stallman would have been remanded to mental institution if he lived in the 1800s.
Even if this doctor was a giant asshole, I applaud his use of scientific-ish methods - methodologically cutting off unlikelies until arriving at the root cause - unwashed hands.
> Changing people's minds is not easy - then or now. Shaming works way better than just talking. You can see how shaming has helped the cause of open source, black lives matter, pollution... But even with multiple champions, these causes are struggling, not a runaway success as you'd expect.
I keep seeing this narrative, that shaming is the most effective strategy, and it continues to puzzle me. You're literally saying this in response to an example of shaming not working, and the examples you're using are pretty bad examples of shaming working.
Everything I see here is that putting the truth in front of people is what works. The video of George Floyd is powerful because it shows us the truth. I've seen more of my white friends realize their privilege in 8 minutes and 46 seconds of video than I've seen in decades of shaming people over dog whistles.
If shaming works, when why hasn't it worked yet? Where are the results?
>I keep seeing this narrative, that shaming is the most effective strategy
I never said it's the most effective strategy. I said, it's more effective than just talking.
>If shaming works, when why hasn't it worked yet? Where are the results?
As far as i'm concerned, this question is like someone doubting the existence of gravity. The effects of shaming is all around us.
Fashion is an industry that built its foundations on shaming. Kids are shamed into buying iphones, and designer shoes. Millions of kids are being shamed into early sex (ashamed of being virgins), and trying out drugs to be deemed COOL.
For programmers - PHP programmers are being shamed right here on HN.
When Google and other high profile companies do something really stupid like locking someone's account unjustly or some new policy, Twitter and Hacker news use shaming to get these guys to speedily reverse course.
>The video of George Floyd is powerful because it shows us the truth.
Isn't the video in question is an example of shaming - the police?
Why do you think police, FBI and the rest works hard to bar public access to ALL their activities?
Shaming someone hardly ever changes their mind; it can change their behavior, but usually only their public behavior.
>> The video of George Floyd is powerful because it shows us the truth.
> Isn't the video in question is an example of shaming - the police?
The people whose minds were changed by the video were people horrified by it, not people shamed[1].
> Why do you think police, FBI and the rest works hard to bar public access to ALL their activities?
Because all this shame hasn't changed their mind a single bit, it just makes them want to hide what they are doing.
----
1: Most police already knew shit like this happens, and most of them are already ashamed about it. However, they also know that their reports better include whatever makes the department the least legally liable, rather than the truth. Reporting a truth that causes the department to have to settle a lawsuit for more than they thought they could is the #1 career limiting move a cop can make.
Reporting bad behavior of coworks is a tough call to make in the best of situations. Mix in the following and it takes people of unusually strong moral-fiber to do it:
1. You will get fewer hours of OT (a de-facto pay-cut)
2. You will be passed over for promotion down the road because of it.
3. The coworker you reported on is very unlikely to be fired so you will be working along side them, quite possibly for many years.
Shaming is a very effective technique to maintain cohesion in a social group, but a lot of your examples are using the word wrongly. If I were to guess, you might be confusing 'shaming' with 'talking about problems' which are not the same thing at all. Shaming is an emotional and social phenomenon, linked to concepts of guilt and shortcoming.
Google & other companies for example are incapable of feeling shame - or indeed any other emotional response. They are incapable of making decisions due to a sense of shame. Therefore shaming is not especially effective against them.
> Fashion is an industry that built its foundations on shaming.
This one in is also off target. Fashion isn't built on shame at all. Fashion is built on giving people with wealth an ability to show it and to maintain a repertoire of signals to communicate with. The fashion industry is built on aspiration. Some people might feel ashamed that they aren't very important to the world, but that isn't where the fashion industry makes its major profits.
> Isn't the video in question is an example of shaming - the police?
It is evidence of activity that looks criminal. Police feeling ashamed isn't the thing that is going to drive the response there. I don't think anyone particularly cares if the police feel ashamed or not, they want that not to happen again and are going to be more than happy to make legal/political changes to do so. Sharing that video wasn't done informatively, it was done as a call to action to do something.
> As far as i'm concerned, this question is like someone doubting the existence of gravity.
Please leave comments like this out in the future. It adds nothing to the conversation, and escalates people's emotions pointlessly.
Every single example you've given is a very complex situation where shaming isn't the most relevant thing:
> Fashion is an industry that built its foundations on shaming.
Maybe in part, but there's a lot more going on there--a lot of it is just getting stuff in front of people. The original idea of having a skinny model was actually not about body shaming people or even about the model being attractive (that wasn't what was considered attractive at that time). It was about having someone the clothes hang off of so that the focus on the clothes and not the person (this became complicated as standards of attractiveness changed).
> Kids are shamed into buying iphones, and designer shoes.
Shamed by wbom? I don't see much ads these days, but the last ad I saw for an iPhone was literally just them showing a disembodied hand using the iPhone to do something. They have a damn good product and they know it, so to sell it they just show that it's good. No shaming needed.
Designer shoes: shame isn't the emotion I'd associate with that. Pride, actually, makes more sense.
> Millions of kids are being shamed into early sex (ashamed of being virgins),
If we're comparing things to gravity, sex drive is pretty arguably a force of nature. We've had millions of years of the genes for people who don't want to have sex literally removed from the gene pool.
> and trying out drugs to be deemed COOL.
Maybe they're trying them out because they think they're cool? Because they're curious? Because doing drugs obviously is fun (at least in the short term)?
I've been in some pretty druggie cultures (i.e. Burning Man, lots of similar smaller stuff), and literally never felt shamed because I didn't do drugs.
> For programmers - PHP programmers are being shamed right here on HN.
Where?
> When Google and other high profile companies do something really stupid like locking someone's account unjustly or some new policy, Twitter and Hacker news use shaming to get these guys to speedily reverse course.
This may be the best example on your list. But realize that that public shaming a company whose business is based on users, isn't targeted at the company, it's targeted at users. So the applicability here is pretty limited.
> Isn't the video in question is an example of shaming - the police?
No, it's very much not.
We're not trying to make the police feel ashamed. We're trying to put the police who did that in jail, and we're doing that by making sure that everyone knows they are murderers, because they can see it. And in a larger sense, we're not trying to shame police so they behave better: it's clear the police aren't going to change their behavior. It's to show people that the idea that police protect and serve is wrong, so that we can persuade people to reduce the power we give to police and have more accountability, without the permission of police.
Do you really think the police feel shame about any of this? If so, they certainly haven't acted on their shame. Their reaction has not been shame, it's been defiance and violence. Shame has no relevance here.
>You can see how shaming has helped the cause of open source, black lives matter, pollution...
I think there's a stronger argument to be made that shaming has hurt each of these causes more than it has ever helped. If you want to make people antagonistic towards you, belittling or demonizing them for not holding ${belief} is a great strategy. Public shaming is a threat-by-example to the broader community that certain behaviors and beliefs are forbidden. It doesn't encourage individuals to seek the truth, whatever it is, but to conform to safe beliefs (and if you're playing the status game, evangelizing those beliefs is a great fast-track to power).
Semmelweis may well have succeeded if he hadn't shamed people with an air of absolute certainty (an attitude which seems to be increasingly in-vogue for any kind of popular issue today) but had acknowledged the complexities of the problem and focused on ascertaining the truth.
There's a theory popular with jaded biologists that neckties alone may have killed more people than some minor genocides.
And the failure to perfect the practice of hand-washing is somewhat easy to understand: it's tedious, especially when done dozens of times per day. Some people suffer skin irritation. The cause of any infection can almost never be traced, making it hard to learn and/or punish the guilty.
Banning neckties is a rather binary policy decision, and compliance would be extremely easy to monitor. One would think people with advanced academic degrees would see the upside, and don't need to signal status with superfluous items of clothing in addition to that doctorate.
Ties are pretty mobile and can easily brush against a patient or instrument, especially if the doctor is leaning forward. Unlike other clothing, they are also rarely washed and they seem less essential than, say, pants.
A few studies have isolated MRSA and other nosocomial nasties from ties. However, it's unclear how much of an actual risk this is, and ties are thought to convey some sense of professionalism that makes the patients take medical advice more seriously and...tradition (ugh). This bit from The Lancet has some back-and-forth about it.
There was an article that explored this question many years ago, and IIRC, the answer was because the surgeons were in a hurry and didn’t have much time. This problem isn’t as common today with the ubiquity of hand sanitizer dispensers.
Also, try washing and desinfecting your hands 20 times a day. Your skin will start causing problems after a few days, usually dryness, itching, rashes, blisters. Cream helps a bit, but not always. Medical personnel invariably do have skin problems on hands and forearms.
> Shaming works way better than just talking. You can see how shaming has helped the cause of open source, black lives matter, pollution
It "works" but has hidden bad side effects. Shaming is a terrible way to enact change and should only be a last resort as it sows seeds of resentment and discord that push people to political extremes. It's like saying violent crusades are the most effective form of Christian missionary work. Technically true in terms of measured "conversions", but... also the side effects are really bad.
Plus, if you shame people and you turn out to be wrong, well... what should your punishment be?
> Changing people's minds is not easy - then or now. Shaming works way better than just talking.
Tell that to the "masks are oxygen-depriving freedom infringement devices" set. I mean... I agree that on the margins most people aren't nuts and even if they don't understand masks will put one on just to avoid a scene. But... yeah, we haven't come very far, have we?
Is there any reason we should ever stop wearing masks? From a public health perspective I think they are here to stay - possibly for the rest of my life.
There are a lot of more or less inconvenient things that people can do to improve societal safety. Never drive your car over 40 mph. Don't let subway cars get so crowded. And so forth.
Arguably masks fall on the less inconvenient side of things but they're not even the norm in Asia during normal times in countries which have had their share of epidemics. So, no, I don't expect they'll be the norm most places and that will make some people unhappy.
That's the way it works in most of east asia. People who are sick, or might be sick, or have the sniffles will put a mask on when they go out.
But no, no one wants to wear these full time forever. The collective danger[1] of a pandemic makes them worth the inconvenience. No one would make that trade for routine seasonal flu.
[1] Which, it has to be pointed out, even on this site, and even after months of pandemic spread, is not remotely the same thing as the personal risk to the mask-wearer.
> That's the way it works in most of east asia. People who are sick, or might be sick, or have the sniffles will put a mask on when they go out.
Celebrities also wear them if they don't want to be recognized, and people wear them on planes because it's thought to help with dehydration. The important thing is that it's normalized, so you don't stand out by doing it.
I think shaming is never acceptable, under any circumstance. It's trying to make someone feel emotional pain in order to force them to do something. It's basically applying torture, except instead of physical pain it's emotional pain.
> It's trying to make someone feel emotional pain in order to force them to do something.
But the "something" in this case is "not kill people". I'm sorry, I can't understand that absolutism. If I can save a million people by making some innocent babies cry from an immunization shot, I should be able to make their parents angry by shaming them into wearing a mask or washing their hands, right?
> But the "something" in this case is "not kill people".
Yes it's a worthwhile cause to speak up for!
> I'm sorry, I can't understand that absolutism.
I don't believe in 'the ends justify the means' except in some limited cases such as an imminent existential threat.
> If I can save a million people by making some innocent babies cry from an immunization shot, I should be able to make their parents angry by shaming them into wearing a mask or washing their hands, right?
I think you should use your logic to campaign for legislation or regulation, not try to force people by applying pain.
>So call the police or begin a private prosecution if a law is being violated.
You could certainly call the police on someone violating the mask mandate, but wouldn't calling the police also result in "mental health pain" for the perpetrator? Calling the police immediately would be extreme, and more likely someone is going to ask staff to intervene and ask the perpetrator to put on a damn mask, but that too will cause shame for the perpetrator.
All you're doing is is outsourcing who is causing the shame, but you're still the originating source of it.
Yes, and what do you imagine happens eventually if you don't pay it? Or happens right away if you argue about it, or if they decide to feel threatened by anything you say or do?
Police involvement is often a spectacle, and attracts a lot of negative attention. Many would consider having the police called on them embarrassing/shameful/stressful/mental health pain.
> I think you should use your logic to campaign for legislation or regulation, not try to force people by applying pain.
Campaigning for legislation or regulation is trying to force people through the use of the government's monopoly on physical violence. How is that less harmful than expressing negative judgment and hoping that someone feels sufficiently bad about being judged that they change their actions?
Your argument seems to be that making someone feel bad is worse than physically harming them.
I am confused. So it was not the corpses? Can you spell out what the problem then was? (I presume general bacterial infections then), but then why was the other ward not affected (so much)?
The puerperal fever that was killing the women laboring in the delivery room was caused by doctors doing autopsies beforehand. The doctors would bring bacteria back to the delivery room on their unwashed hands which then infected the women with group A streptococcus (GAS).
He was wrong about cadaverous poisoning. There was no such thing as corpse particles. This was before the acceptance of germ theory. He was right about hand washing, particularly with disinfectants like chlorine.
It’s just germs in general. Autopsies on infected cadavers were leaving germs on the doctors’ hands that would then spread to other patients, so in this particular case the elevated rate is tied to the cadavers, but it’s not cadaverous particles specifically.
This underscores something that is going on with the COVID-19 pandemic. There are a lot of complaints about face-mask ordinances that claim there is no "hard science" to show that masks are effective, followed by some sort of statement that public policy should be "based on hard science".
For a lot of reasons, hard science isn't all it's cracked up to be, certainly not by the lay public, who seem to treat it as a "final, definitive word" on subjects. First of all, it gives a lot more credit to science than even scientists give. But most importantly, you don't need to know the mechanism of a problem if you have statistical evidence that your actions are having an impact. You might not even know it's the direct result of the actual action you're taking, it might be a knock-on effect from some other action people are taking in response to the mandated action.
But that doesn't matter. What matters is that lives are saved. You can figure out the mechanism later. In the meantime, do the superstitious sky-god dance. Especially when it's really not that big of an imposition.
We know for a fact that most places that have strict mask ordinances are seeing large reductions in infection rate. Some aren't, but that's actually not an argument for not wearing masks. Indeed, it's the exact opposite. While the "hard science" is supposedly unclear, you absolutely should still wear the mask, so that the confounding variables are easier to discover.
My favorite example of this is Pasteur's revolutionary work in immunology itself:
A careful reading of Pasteur’s presentations to the Academy of Sciences reveals that Pasteur was entirely mistaken as to how immunity occurs, in that he reasoned, as a good microbiologist would, that appropriately attenuated microbes would deplete the host of vital trace nutrients absolutely required for their viability and growth, and not an active response on the part of the host.
There isn't any empirical evidence that hand washing, "deep cleaning protocols", or surface transmission matters for covid though. Countries which only did masks do just fine; it seems like people are getting infected by airborne transmission.
If anything, the trend is you should do the opposite of whatever WHO recommends.
If a specific person's respiratory system is really so bad that a mask would have a significant, deleterious effect, then a mask ordinance is of no consequence because that person really should not even be going out in public at all during the pandemic.
It is not just for them to decide that. They are in a risk group and therefore get infected more easily and spread the infection more easily. It is in their and all our best interest for them to stay home.
Right, society eventually get to decide, which society is it? The winner get to decide. Both side are part of the society. Both side fight for their interest. The against mask side will fight for its interest, just like the pro mask people fight for their interest.
>You rights end where your neighbor's nose begins
It goes both ways when you decide to force people who don't want to wear mask to wear mask.
So now you're talking about "want". Before you were talking about "can't". So which is it? Because if it's just "want", that's not people interested in living in a society.
>Because if it's just "want", that's not people interested in living in a society
Agree, people who don't want to wear mask certainly not interested in living in a society where they are forced to wear it against their will, thats why they fight for their interest just like the pro mask people fight for their interest to live in a society that they want.
> For one thing, doctors were upset because Semmelweis' hypothesis made it look like they were the ones giving childbed fever to the women.
This, I think, is a point that needs amplifying:
Doctor hubris causing harm and even death is not an isolated incident to this case. This is alluded to with the line about how difficult it is to convince health care providers to take hand-washing seriously today. One can look to some horrifying practices in medical history to see a track record of "I'm a doctor, so I know better than you" that caused needless deaths and sometimes despicably cruel outcomes. Rosemary Kennedy's case is an example of that happening all throughout her life, with first this:
During her birth, the doctor was not immediately available and the nurse ordered Rose Kennedy to keep her legs closed, forcing the baby's head to stay in the birth canal for two hours. (caused Rosemary's intellectual disabilities)
And then lobotomy [1].
On a personal note, my close family member is dealing with cancer. His last chemotherapy just about killed him - he lost 40 lbs in a week and went from being in full heath to severely underweight. When he told the doctor that he just could not do another therapy session - he feels that it will kill him - the doctor said exactly the above - "I'm a doctor, so I know better than you." He left that doctor - his tumor was already gone, he continued his last radiotherapy sessions. He was just like the people mentioned in this article [2] -
The surprising part was that people who were feeling the best at the start of the therapy ended up feeling the worst. They are the ones most harmed and who had the most to lose... without significant benefit for their cancer.
Sorry to hear about your family member's bad experience, but glad to hear they're on the mend. I'd highly recommend Atul Gawande's book Being Mortal which has a lot to say about doctor hubris in treating the terminally ill. He describes how the patient should guide the treatment based on their own preferences, informed by the doctor's expertise.
>Even today, convincing health care providers to take hand-washing seriously is a challenge. Hundreds of thousands of hospital patients get infections each year, infections that can be deadly and hard to treat. The Centers for Disease Control and Prevention says hand hygiene is one of the most important ways to prevent these infections.
When I wash my hands several times a day they become raw. Moisturizer helps a bit.
I wash my hands at least twenty times a day, probably, and they don't become raw. I don't use moisturizer either. It could be you have to build up a tolerance. Some people who don't brush their teeth often will similarly have discomfort and bleeding when they do brush (like right before a dentist's appointment).
Relative humidity has a huge impact on how dry your hands get. Winter in the mid-West my hands would crack even with moisturizer. Winter in SF? Never had an issue.
Really really. I tend to get dry skin, and I switched to Dawn some years back for doing dishes because it was better on my skin, while still doing the cleaning job.
"The Semmelweis reflex or "Semmelweis effect" is a metaphor for the reflex-like tendency to reject new evidence or new knowledge because it contradicts established norms, beliefs, or paradigms."https://en.wikipedia.org/wiki/Semmelweis_reflex
----
Bonus: "Look at yourself objectively" (by Aaron Swartz )
From 'The Plight of the Obscure Innovator in Science' (Moti Nissani, 1995) [0] :
"Semmelweis was laughed at in part because he was unable to explain the observed effect of soiled hands on childbed fever. So, to be believed, widespread resistance to obscure innovators must be documented and explained....
"Bernard Barber commented [1962] that 'one of the interesting aspects of the social process of discovery--the resistance on the part of scientists themselves to scientific discovery...has been largely neglected as a subject for systematic investigation.' A third of a century later, the subject has not yet received the methodical attention it so richly deserves. Only a time-consuming comprehensive historical survey will help to unravel the extent, nature, causes, consequences, and cures of this resistance."
Semmelweis died in an insane asylum in 1865. Joseph Lister = who'd discovered the use of carbolic acid that same year - published Antiseptic Principle of the Practice of Surgery in 1867. He'd read about Louis Pasteur's experiments confirming germ theory.
As much as we like to focus on the past, let’s not forget that we still have a long way to go. On average, nosocomial infections (hospital-acquired) kill 100,000 Americans per year in US hospitals. There are many issues that have yet to be resolved. The problem with adequately cleaning and disinfecting medical scopes, for example, was a recent topic in technology circles (Olympus TJF-Q180V).
Side note: The Knick was a great TV show about a hospital in the early 1900's before standard treatments for common conditions existed. If you liked this article, check out this show.
> Semmelweis was not very tactful. He publicly berated people who disagreed with him and made some influential enemies. Eventually the doctors gave up the chlorine hand-washing
Something Matthew Benjamin wrote stuck with me: "It is way more important to preserve trust, goodwill and respect than to get what you want, no matter how good what you want seems."
It seems like this can't be true - some things are surely more important than trust, goodwill and respect. What could be more important than saving lives? But this is an example of that being more true than I'd naively think.
"It is way more important to preserve trust, goodwill and respect than to get what you want, no matter how good what you want seems."
That is true if someone is leader of a group. You can't let the thread break because then you can't anything. But someone is pushing an idea, it's a different balance, I think. Maybe people understanding the idea is more important than them liking you.
Handwashing is overrated IMO. Yes, it's important for doctors and nurses(who touch dozens of sick humans a day), people who are in contact with animals, and small kids who don't have any concept of hygiene.
But for the average adult, they just do not have that many harmful bacteria or viruses randomly on their hands.
This caused some major issues with the Coronavirus. Eg. if you googled anything related to it in march, the search results displayed a "wash your hands message" even though the virus is spread by droplets AKA sharing air indoors with an infected person.
I can only imagine how many unnecessary infections and deaths this caused when people thought they were safe if they just washed their hands often. To this day, I'd say about half of the population has no clue how respitory diseases spread.
> Eg. if you googled anything related to it in march, the search results displayed a "wash your hands message" even though the virus is spread by droplets AKA sharing air indoors with an infected person.
There's a fecal-oral route for covid-19, which is why the protocols for people who share a home with someone infected with covid-19 all mention using a separate (if possible) toilet, or making sure the room is cleaned thoroughly after each use.
> If possible, have the person who is sick use a separate bedroom and bathroom. If possible, have the person who is sick stay in their own “sick room” or area and away from others. Try to stay at least 6 feet away from the sick person.
Handwashing remains a crucial part of the set of protection measures against covid-19 and other respiratory disease.
> Improvements in hand hygiene resulted in reductions in gastrointestinal illness of 31% (95% confidence intervals [CI]=19%, 42%) and reductions in respiratory illness of 21% (95% CI=5%, 34%). The most beneficial intervention was hand-hygiene education with use of nonantibacterial soap. Use of antibacterial soap showed little added benefit compared with use of nonantibacterial soap.
> There was moderate to low‐quality evidence of a reduction in both influenza and respiratory tract infection with hand hygiene interventions in schools, greatest in a lower–middle‐income setting. There was high‐quality evidence of a small reduction in respiratory infection in childcare settings. There was high‐quality evidence for a large reduction in respiratory infection with a hand hygiene intervention in squatter settlements in a low‐income setting. There was moderate‐ to high‐quality evidence of no effect on secondary transmission of influenza in households that had already experienced an index case. While hand hygiene interventions have potential to reduce transmission of influenza and acute respiratory tract infections, their effectiveness varies depending on setting, context and compliance.
Ever gotten a stomach bug? The common cold? The flu?
Hand washing helps with all of that.
And Covid is a respiratory virus, but that doesn't mean hand washing doesn't help. Some coughs on their hands, you shake their hand, then rub your eyes. Awesome, you just help transmit the virus from their respiratory tract to yours.
The rudeness is a little interesting, I guess, but the big thing for me is the idea that just a little bit of intellectual humility --- stick to the empirical observation and stop yelling at people about corpses! You almost had it! --- would have made him a household name centuries later.