In the 1880's, American surgeons lost a large fraction of their patients to post-operative infection, including assasinated president James A. Garfield. They simply refused to adopt the antiseptic methods pioneered by Joseph Lister, although those methods were thoroughly documented and proven. In the 2010's, programmers fail to effectively complete a large fraction of their software projects, including ones that are essential to the survival of the organizations that employ them. They, and the educators who train them, simply refuse to adopt effective methods of modern software development. What is the common thread? Ego.
A surgeon at the University of Glasgow, he read the work of Louis Pasteur, who showed that rotting and fermention were due to micro-organisms. After confirming Pasteur's results with his own experiments, Lister experimented with antiseptic techniques for treating wounds.
Lister found that carbolic acid solution swabbed on wounds remarkably reduced the incidence of gangrene. In August 1865, Lister applied a piece of lint dipped in carbolic acid solution onto the wound of an eleven year old boy at Glasgow Infirmary, who had sustained a compound fracture after a cart wheel had passed over his leg. After four days, he renewed the pad and discovered that no infection had developed, and after a total of six weeks he was amazed to discover that the boy's bones had fused back together, without the danger of suppuration.
Lister wrote papers, a book, and did his best to spread the word of his life-saving technique.
The Doctors' Response
You would think that doctors would have quickly and enthusiastically adopted the antiseptic method to help improve their awful survival rates. But you know what actually happened. As described in her excellent book, Candice Millard tells the story:
Although the results were dramatic -- the death rate among Lister's surgical patients immediately plummeted -- antisepsis had provoked reactions of deep skepticism, even fury. In England, Lister had been forced repeatedly to defend his theory against attacks from enraged doctors. "The whole theory of antisepsis is not only absurd," one surgeon seethed, "it is a positive injury." Another charged that Lister's "methods would be a return to the darkest days of ancient surgery."
Things got better in Europe. But not in the US.
By 1876, Lister's steady and astonishing success had silenced nearly all of this detractors at home and in Europe. The United States, however, remained inexplicably resistant. Most American doctors simply shrugged off Lister's findings, uninterested and unimpressed. Even Dr. Samuel Gross, the president of the Medical Congress and arguably the most famous surgeon in the country, regarded antisepsis as useless, even dangerous. "Little, if any faith, is placed by any enlightened or experienced surgeon on this side of the Atlantic in the so-called carbolic acid treatment of Professor Lister," Gross wrote imperiously.
James A. Garfield
Garfield was one of the most extraordinary men ever elected president. He was shot in the back four months after being inaugurated in 1881, which is the event that brings us to Lister.
The Medical Treatment of Garfield
This site provides a summary of what happened:
The first doctor on the scene administered brandy and spirits of ammonia, causing the president to promptly vomit. Then D. W. Bliss, a leading Washington doctor, appeared and inserted a metal probe into the wound, turning it slowly, searching for the bullet. The probe became stuck between the shattered fragments of Garfield's eleventh rib, and was removed only with a great deal of difficulty, causing great pain. Then Bliss inserted his finger into the wound, widening the hole in another unsuccessful probe. It was decided to move Garfield to the White House for further treatment.
Leading doctors of the age flocked to Washington to aid in his recovery, sixteen in all. Most probed the wound with their fingers or dirty instruments. Though the president complained of numbness in the legs and feet, which implied the bullet was lodged near the spinal cord, most thought it was resting in the abdomen. The president's condition weakened ... It was decided to move him by train to a cottage on the New Jersey seashore.
Shortly after the move, Garfield's temperature began to elevate; the doctors reopened the wound and enlarged it hoping to find the bullet. They were unsuccessful. By the time Garfield died on September 19, his doctors had turned a three-inch-deep, harmless wound into a twenty-inch-long contaminated gash stretching from his ribs to his groin and oozing more pus each day. He lingered for eighty days, wasting away from his robust 210 pounds to a mere 130 pounds. The end came on the night of September 19. Clawing at his chest he moaned, "This pain, this pain," while suffering a major heart attack. The president died a few minutes later.
A whole nation of doctors simply ignored the evidence of the effectiveness of Lister's methods. Lister himself came to America and lectured on them, and American doctors were well aware of the methods. Full of themselves and comfortable in their ways, they continued wantonly killing patients who could have lived -- including President Garfield.
Antiseptic techniques and Software
What can possibly account for this behavior? I know one answer, because I see the equivalent in software groups all too frequently. Put simply, it's ego.
Each group, and particularly its leader, is convinced that they're doing the best possible job that can be done, against steep obstacles. They feel starved for resources, pressed for time, but nonetheless performing at a very high level. They are educated, experienced, and feel they've made the best possible choices of tools, methods, designs and architectures.
Somehow, the leader or someone in the group hears about something new that's supposed to be really effective for tasks like theirs. Maybe they hear about it from some know-it-all who's somehow associated with investors, or someone else they are "supposed" to listen to.
In my experience, the reaction of the software group is nearly identical to that of the American doctors. Whatever the new thing (tool, method, technique, design, architecture), it can't possibly be as good as what they're already doing. Even when they hear stories about great results, they are deeply skeptical, and are convinced that their own methods are still better. Period. Why, to consider the possibility that someone else is doing things better than they are implies that they are not the best at what they do. Impossible!
What explains this profound lack of interest? While other factors are sometimes involved (I'll explore them another time), it's hard to discount the impact of human ego, pure and simple.