Making Medicine Better

Ezra Klein reviews Atul Gawande's book, Better:

The chapter on treating injuries of war makes this point nicely. In the Revolution War, 42 percent of the injured died. In the Vietnam and Persian Gulf wars, 24 percent died. But in the current wars, only 10 percent have died. And those gains have come “despite having no fundamentally new technologies or treatments since the Persian Gulf War.” The difference has been the application of things we already knew, not the development of treatments Gulf War-era doctors could never have imagined.
The chapter on childbirth that makes a similar point: “Doctors in other fields have always looked down their noses at their obstetrical colleagues,” Gawande writes. “They didn’t think they were very smart — obstetrics had long had trouble attracting the top medical students to their profession — and there seemed little science or sophistication to what they did. Yet almost nothing else in medicine has saved lives on the scale that obstetrics has ...do those of us in other fields of medicine use these measures anywhere near as reliably and as safely as obstetricians use theirs? We don’t come close.”
One other plug for Gawande: He’s enormously good at explaining why things that seem simple don’t happen the way they theoretically should. The fact that doctors don’t wash their hands enough, despite the fact that doing so could save thousands of lives and billions of dollars, seems insane. But it makes more sense if you understand that washing their hands “enough” would mean “a third of staff time spent just washing hands” — and that’s assuming a swift, minute-long cleanse. Similarly, the fact that cesarean sections don’t show better results than forceps makes the reliance on cesarean sections seem insane. But it makes more sense when you read Gawande’s explanation of how few people are actually able to use forceps effectively, versus how many doctors are capable of performing a cesarean.