1. A friend shared frustration and incredulity that Cardiologists investigating her father’s heart issue during a hospital stay were unmasked. During a SARS2 surge. Cardiologists. Don’t they know SARS2 causes vascular damage?
It occurred to me, this is about culture.
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2. Culture is irrational. We follow culture even when it contradicts science. Medical professionals are no different. An interesting medical objection to Semmelweis’ infection control work almost 200 years ago was “a gentleman’s hands are clean.” What could that mean?
3. The resistance to Semmelweis was cultural. How so? Medical culture is complex. But fundamentally it’s about helping through diagnosis & medication/surgery. That work is active – it’s about doing, it’s about actively pursuing a goal.
I keep wondering what pandemic lesson can be drawn from Vaughan’s 1996 ethnographic account of the loss of the Space Shuttle Challenger?
Vaughan reconstructed the native viewpoint: How did NASA engineers & managers make sense of complex technology not performing as expected?
The Challenger burnt up due to heat erosion on the rocket booster O rings. A known fault. Most explanations suggest managers were too concerned with the schedule and organisational reputation. They pushed for launch to save face, save costs, and save time redesigning the booster.
But if managers cared only for reputation, costs, schedule, why launch the Challenger and risk the entire programme?
They did not see themselves doing wrong. They followed a comprehensive risk management process, measurement, analysis, documents.
Challenger was “acceptable risk."
The study is a preprint. Eric Topol: "I have not previously seen any substantive differences from their preprints compared with the final publications."
The median time between infections was: 79 days (1st & 2nd) and 65 days (2nd & 3rd).