NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Tuesday, March 31, 2015

In his 2013 New Yorker article “Slow Ideas,” the Harvard surgeon Atul Gawande offered a compelling way to understand why some good ideas spread slowly (if at all) while others spread like wildfire.

Gawande’s story begins in 1846, when Dr. Henry Jacob Bigelow published the first account of the use of an inhaled anesthetic to produce “insensibility” during surgery. Within months, surgeons all around the world took up the idea and began using their own ether-based concoctions. When you consider that there were no phones or airplanes to carry the news, it’s amazing how fast the concept of anesthesia spread.

Gawande’s second case study begins two decades later, when the surgeon Joseph Lister reported inThe Lancet that patients had much higher survival rates when he used carbolic acid to clean his hands and instruments prior to putting patients under the knife. However, Lister’s simple and effective antiseptic techniques did not go viral. It took a generation for these smart ideas to take hold.

What accounts for the difference in speed? In the case of anesthesia, the benefits of not having patients screaming and thrashing around during surgery were immediate—and they easily trumped the objections and fears that arose from clergymen and others. The same was not true of Lister’s antiseptic method. Because infection was largely an invisible problem and the symptoms appeared after patients left their surgeon’s care, the benefits of antisepsis were not as obvious. Meanwhile, there was a clear cost to doctors: the carbolic acid burned their hands.

I have found it useful to apply this thinking to the field of immunization, a field that is once again making big headlines, this time as a result of the California measles outbreak and the Ebola epidemic in West Africa. Vaccines are at once the source of both super-fast ideas and super-slow ones. Tiny injections of misinformation about vaccines often race around the globe in minutes while, in the words of Mark Twain, “the truth is still putting on its shoes.”

As with Lister’s antiseptic method, the benefits of getting the MMR or Hib vaccine are invisible while you’re sitting in the doctor’s office. For some people, invisible benefits that might materialize in the future are just not enough to get them over the clear and present fears common to all parents that something we’re exposing our children to could result in harm. As Melinda noted recently, most Americans “have forgotten what measles deaths look like.” Because of that luxury, a thin needle and glass vial can look scary.