William Harvey

In the early 17th century, before the scientific method began its ascendancy in the Western world, the Englishman William Harvey described how the blood circulates through the human body, solving a mystery that had stumped scientists for centuries.

Some other scientists — Galen, the ancient Greek; Ibn al-Nafis, who worked in Egypt in the 13th century; and Michael Servetus, a 16th-century Spaniard — had got a chunk of the story right.

William Harvey

William Harvey

Only Harvey, who assiduously tested his theories on living animals, figured out that blood circulates throughout the entire body.

He published his thesis in 1628, as On the Motion of the Heart and Blood in Animals. His discovery is considered one of the most important achievements in medical history.

Harvey introduced the "experimental and observational approach" to scientific inquiry, the British medical historian P.M. Dunn writes in an article for the Archives of Disease in Childhood.

In addition to his revolutionary work on blood, Harvey also advanced our understanding of human reproduction. His practice extended to obstetrics, and he was interested in and knowledgeable about birth.

Harvey's 1651 book On the Generation of Animals, published with the stunning essay "On Parturition," debunked the idea that embryos were fully formed at conception, and advanced the theory of epigenesis, which held correctly that a chick, for example, grew all its various parts from a single cell.

Harvey also addressed labor, advising birth attendants to let nature take its course rather than to intervene unnecessarily. Harvey's tract was the first original work on obstetrics written by an Englishman. Aside from these famous works, the rest of his prodigious writing has been lost.

What remains is "truly remarkable when judged against the ignorance of the times and the prevalent reliance on ancient authority," Dunn writes of Harvey.

Specialists in women and babies

The American College of Obstetricians and Gynecologists was founded in Chicago in 1951, the latest in a line of associations that has sought to serve the organizational needs of specialists in medicine for women.

By the time the organization was founded, the controversy over whether the two specialties should be practiced separately or together had been largely resolved, which reflected an improvement of the status of obstetrics. (One 19th century proponent of keeping the two disciplines together had characterized obstetrics as "the portal to the temple of gynecology.")

Obstetricians are not the only doctors who deliver babies — family physicians attend about 20 percent of births nationally, and midwives, mostly nurse-midwives, handled about 8 percent of births in 2004. Still, obstetricians deliver the majority of American babies.

ACOG membership is voluntary. The group, now headquartered in Washington, D.C., has 52,000 members, more than 90 percent of board-certified OB-GYNs. Important ACOG activities include the annual meeting, continuing education and the publication of the monthly journal Obstetrics and Gynecology, the so-called Green Journal.

Some of  ACOG's members are specialists in maternal-fetal medicine, gynecologic oncology, reproductive endocrinology, and other areas.

He wrote the book

In 1899, John Whitridge Williams, whose name lives on in the definitive textbook on pregnancy and childbirth, succeeded Howard Kelly as the head of obstetrics at Johns Hopkins Medicine.

Kelly had split off baby-catching from the more interesting (to him) department of gynecology, which he continued to head up.

John Whitridge Williams
John Whitridge Williams

Williams, a Baltimore native, came from a medical family -- his mother's forebears had been doctors for 160 years. He trained at the University of Maryland, and then in Vienna, Berlin, and other European cities, which exposed him to a different way of looking at medicine.

Williams' Obstetrics, first published in 1903, and still in print today, came out of Williams' desire to render everything about pregnancy and birth in scientific terms. The first edition contained more than 1,000 references to other medical publications.

Williams wrote five additional editions of the book before he died in 1931, of complications from abdominal surgery.

The departments of obstetrics and gynecology were finally reunited at Johns Hopkins School of Medicine in 1960.

The 23rd edition of Williams' Obstetrics was published in 2009.

Medicine too complex to be error-free

I notice that the American College of Obstetricians and Gynecologists is gearing up for its annual clinical meeting May 15 through May 19 in San Francisco.

The 2009 annual meeting was in Chicago, and I attended as many sessions as I could -- I don't want my ideas about what is going on in obstetrics to stop with my own birth experiences. (Sadly, I won't be able to attend the San Francisco meeting.)

I learned a lot last May, but one thing stayed with me in particular, Dr. Robert Wachter's keynote address.

Dr. Wachter,  chief of the medical service at the University of California at San Franciso, among other titles, is one of the founders of the hospitalist movement, and an expert in patient safety.

He spoke about efforts to improve safety since 1999, when the Institute of Medicine released its landmark report,To Err Is Human, which revealed that as many as 98,000 people were dying from medical mistakes every year.

Dr. Wachter's message is important for the birth story because obstetricians are the doctors most often sued for malpractice. A 2003 ACOG survey showed that 76 percent of OB-GYNs have been sued at least once.

Many of them would say that if anything ever goes wrong with a birth, they are sued whether the mishap was their fault or not. Dr. Wachter agreed that "the blame game" is "not productive."

He said, "Medicine is too complex to be error free." Some other complex industries have better safety records, though, he said, often because they have developed "systems thinking," standardizing procedures and accepting that some mistakes are a natural part of the process.

 

Medicine is only as good as its evidence.

People talk about "evidence-based medicine" in obstetrics, and in the holistic birthing community as well, as if it's a sleek, shiny package tied up with a bow and ready for Christmas morning.

But evidence-based medicine is a shambling, messy thing, always on the move, only as reliable as the researchers who conduct it -- and as the research that has gone before and serves as its foundation.

The Lancet's retraction earlier this month of a 1998 study that appeared to establish a link between the development of autism in young children and the vaccine for measles, mumps and rubella is a good demonstration of the fallibility of evidence-based medicine.

One reason the original Lancet study collapsed was that other researchers could not duplicate lead author Andrew Wakefield MD et al.'s results. But even while 10 of the 13 original co-authors withdrew their support for the study, the public absorbed the idea that a cause-effect relationship exists between vaccination and autism.  That idea has not been eradicated by the Lancet's retraction.

And while such a retraction is unusual, it is unfortunately not unheard of.

Last July, anesthesiology researcher Scott S. Reuben MD of Baystate Medical Center in Springfield, Mass., was revealed to have falsified results in at least 21 studies that appeared in several peer-reviewed journals. Anesthesia and Analgesia alone retracted 10 of Dr. Reuben's articles.

Dr. Reuben specialized in multimodal analgesia, a drug-delivery system designed to control the pain of surgery.

In January, Dr. Reuben pleaded guilty to fraud for such audacious creations as a 2005 trial of Pfizer's drug Celebrex as an agent in a multimodal analgesia model. Dr. Reuben accepted $74,000 from Pfizer to conduct the study, simply did not do the work, and then published fabricated results in Anesthesia and Analgesia.

Unfortunately, other researchers based their own work on those phony results.

The collapse of Reuben's data has left multimodal analgesia “in shambles....The big chunk of what people have based their protocol on is gone,” said Jacques Chelly,  an anesthesiologist at the University of Pittsburgh Medical Center, in Anesthesiology News last March.