Modern medicine is poisoned by professional arrogance. The antidote is professional humility.

The arrogance is exacting a high price. Several examples prove the point.

For forty years physicians regularly irradiated the thymus glands of children because of the mistaken notion that an “enlarged” thymus caused Sudden Infant Death Syndrome.

Anatomists had determined the “normal” thymus size from the cadavers of poor children, most having died of highly stressful chronic illnesses such as tuberculosis, infectious diarrhea, and malnutrition. We now know that chronic stress shrinks the thymus gland. The “normal” thymus glands of the poor were abnormally small. Here is where the fatal mistake occurred.  Since the autopsied thymus glands of the poor were regarded as normal in size, the SIDS-affected infants were erroneously believed to have thymic enlargement.

Rudolf Virchow, the father of cellular pathology, a man who stood at the top of the academic medical world for 50 years, was one of those who endorsed the mistaken therapy.  Virchow, the man who first explained the pathophysiology of pulmonary embolus, the man who named leukemia, and a founder of social medicine, got it wrong!

And because he and other respected leaders did, the practice went on for nearly four decades.

More than ten thousand people died due to thyroid cancers caused by the mistaken therapy and many others developed breast cancer.

An error of great magnitude occurred, ripe with important lessons for the medical community, yet doctors in training are not taught about this incident nor asked to reflect upon it.

Perhaps there is no better modern medical example of our capacity for serious error than the fact that we have given the wrong dietary advice since shortly after President Eisenhower’s heart attack in 1955.  We have repeatedly warned and continue to warn our patients to avoid saturated fat, leading the population toward a high intake of sugars and simple starches.  By doing so we have unwittingly promoted the intertwined epidemics of diabetes and obesity.

How could we go so far off track for so long?

Nobel prize-winning physicist Max Planck stated: “A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”

Or more succinctly: “Science advances one funeral at a time.”

Incorrect ideas persist, in part, because they are championed by leaders in the field and the climate of professional arrogance makes it difficult for new-comers to challenge the prevailing wisdom.  This needs to change.

We can learn from the model proposed by Tervalon and Murray-Garcia in how best to provide culturally sensitive care. They have challenged us to go beyond “cultural competency” and to embrace “cultural humility.” They advocate that medical providers engage… in a lifelong process … with patients, communities, colleagues, and with themselves. … It is a process that requires humility as individuals continually engage in self-reflection and self-critique as lifelong learners and reflective practitioners.

This model holds for the general practice of medicine as well. Humility is a personal virtue and a professional necessity. Personal humility is essential for good doctoring.  Professional humility promotes the questioning of medical dogma, leading to the scientific testing of hypotheses.

We need a Professional Humility Movement in medicine.  Professional arrogance is not just bad manners, it leads to long-lasting errors and much avoidable morbidity and mortality.

Would the terrible health outcomes from thymus irradiation have been avoided if a medical student had felt empowered to ask, “Dr. Virchow, are you sure that the thymus gland is abnormally enlarged in infants with SIDS?”

Jeffrey B. Ritterman
Lifelong Medical Clinic, San Pablo, California, USA

Publication

To Err is Human: Can American Medicine Learn from Past Mistakes?
Ritterman JB
Perm J. 2017

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