Terry Prone: Revisionism isn’t always a bad thing — and it may help us learn from mistakes

History of medicine reveals a recurring truth: improvements come about because of two factors, innovation and revisionism

Martin Cormican was not the only former member of Nphet who was unhappy at the way meetings were conducted and the process by which dissenters were disregarded.

Paul Reid is against revisionism, at least as far as the upcoming inquiry into how we managed covid is concerned. 

He no doubt speaks for many within Government and the health system who have come to a consensus that we didn’t do too badly, all the same, with the pandemic and what’s the point of re-examining all that and perhaps kicking those who made mistakes along the way?

After all, revisionist kicking is not going to retrospectively supply protective clothing that works and it might make people unwilling to take risks in a future pandemic, when risk-taking is always necessary in the face of a chaotic threat.

Also, it might — with the wisdom of hindsight — dent the reputation of people who up to now were seen as having done a stellar job, using the data available to them at the time.

That’s a fair point. But the reality is that if we look at the history of medicine, we find one recurring truth: Improvements come about because of two factors — innovation and revisionism. Innovation creates historic heroes. Revisionism drills a hole in these heroes.

Up to a couple of centuries ago, for example, eminent surgeons were bleeding their patients in response to most illnesses, thereby robbing the patients of a considerable amount of their capacity to fight the infection or injury affecting their health.

When revisionists raised their counterintuitive heads, the bleeders pointed out that the bled felt only mighty after the removal of some of their oversupply of pesky blood, and the bled supported them enthusiastically. 

When they weren’t too busy dying, which many of them were.

George Washington, for example, woke up one day with a sore throat. Him being president of the US at the time, this was taken with proper seriousness. The medics — encouraged by the patient — removed 40% of his blood. He died. In outcome terms, not great.

Paul Reid isn't a fan of revisionism when it comes to a covid inquiry but we need to revisit where we went wrong and where we could do better.

What bloodletting, cupping and a bunch of other once-respected therapies prove is that, while practice doesn’t always make perfect, practitioners are rarely willing to acknowledge that — rather the reverse, in fact. Their very sense of self can become enmeshed in whatever barking therapy they’re used to delivering.

The classic example comes from Vienna, a couple of centuries back, when gynaecologists, despite the thousands of women under their care dying of puerperal/childbed fever, rejected the evidence-based alternative advanced by a doctor named Ignaz Semmelweis.

They rejected it because Semmelweis was intemperate, a lousy communicator, and a speaker of low German as opposed to the high German of the men he was trying to educate. 

They dumped him in an insane asylum where he died, while his former colleagues continued to examine women with unwashed hands that carried a wealth of bacteria garnered from postmortem examinations.

In consequence, hundreds of thousands of women continued to die agonising deaths that were preventable if only the guys in charge had been prepared to examine and revise their practices.

Nobody wants a 'blame game'

But they had heard Semmelweis describe them as murderers and didn’t relish the prospect of having that label stuck to them. They weren’t up for what’s currently being called a “blame game”. Nobody ever is.

Even the term “inquiry” can create the expectation of verdicts, of blame. Of what Paul Reid would see as a destructive revisionism.

In Saturday’s paper, Healthcare Correspondent Niamh Griffin quoted Cork GP Dr Mary Favier as believing there should be “a review, an evaluation, an audit, not an inquiry, of the country’s response to covid-19”.

Whatever you call it, even the most positive lookback over the pandemic may establish that mistakes were made. The Comptroller and Auditor General has already done so. 

Flawed PPE was bought. But it was bought in a panicked situation where national pressure was acute enough to (briefly) make a hero of a jumbo jet pilot going off to collect the stuff.

A review is unlikely to lay blame on individuals or call for them to be fired. 

It might look at the kind of training — like pilot simulator training — that keeps people grounded in reality in an unprecedented disaster such as covid.

Any after-event review must, of necessity, take into account data that has emerged post-factum.

A comment often attributed to economist John Maynard Keynes — 'When the facts change, I change my mind' — is relevant, here.

More facts are emerging about the virus and new analysis is causing inevitable revision. Like the re-examination of the initial — and pretty global — condemnation of Sweden’s largely laissez-faire approach to its covid-19 management.

At the time, the received wisdom held that Sweden’s Scandinavian neighbours had done measurably better at reducing the death toll by social distancing and lockdowns. Sweden’s state epidemiologist Anders Tegnell was widely excoriated for allowing schools to stay open and leaving mask-wearing up to personal choice.

More recent analysis of emerging mortality data suggests that the initial interpretation was deeply flawed, that Sweden did much better than claimed, and that Tegnell wasn’t all that wrong.

Having gone — presumably by informed choice — into obscurity in recent times, the epidemiologist may quite like the addition of data and analysis that has now, at least partly, removed the scarlet letter from the front of his jumper.  Sometimes, revisionism can be positive.

Making the review positive in its contribution to future epidemic healthcare in this country should take dissidents into account, and not just the high-profile experts who weren’t inside Nphet. 

It should listen to former insiders like Professor Martin Cormican, who has on several occasions and on multiple platforms, starting a few months ago, queried whether Nphet’s recommendations to Government were right and had only good outcomes. 

Cormican is not the only former member of Nphet unhappy at the way meetings were conducted and the process by which dissenters were disregarded.

Communications and group dynamics

If we are to develop a genuinely robust plan for the future, then any review should examine in-depth the communications and group dynamics that played out behind the closed doors of Nphet.

The timing of some communications going to Cabinet has been privately queried by ministers who perceived the timing as mandated by a desire to limit how Government could respond.

The group dynamic in play at the time should be examined, because Cormican has voiced out loud mutterings from within Nphet which have not been audible to the general public, but which have been known, nonetheless.

The implication is that anybody within the group who disagreed with an emerging Nphet consensus found themselves “othered”, their views and the evidence supporting those views shoved to one side.

If any of this happened, then it would be remiss of any review not to examine how it happened and what preventative measures should be laid down for the future.