On sharing medical techniques
As happens to most people who visit him, I learned a lot of things from Dr. Eran Bellin when I met him last week. One story he told stayed with me because of a mild obsession I have with the social pressures around sharing information.
The story he told was the one told to him by his father, Lowell Bellin as a medical student. It was about the secrecy surrounding the invention of the obstetric forcep, a tool that would have saved many lives had other physicians known about it earlier.
I am not sure if I have the exact story he was talking about, but a little Googling around led me to the Chamberlen family. For perhaps a whole century only the Chamberlen family knew and kept the secret.
Apparently Peter the Elder was the inventor of the forceps. The brothers went to great length to keep the secret. When they arrived at the home of the woman in labor, two persons had to carry a massive box with gilded carvings into the house. The pregnant patient was blindfolded as to not to reveal the secret, all the others had to leave the room. Then the operator went to work. The people outside heard screams, bells, and other strange noises until the cry of the baby indicated another successful delivery.
Eventually, different members of the family sold the secret to other people, and then someone leaked the secret to the public.
What is interesting to me is how late the dates are: the 16th and 17th century, well after patents had become common in Europe. Dr. Bellin’s mention of the story, and its implicaitons for patient care, inspired me to scan two articles I have that cover the invention of patents in 15th century Florence (Brunelleschis Bargain and Brunelleschis Patent). The idea was to give inventors a way to make more money from sharing their inventions rather than they would from hiding them.
Fillippos Brunelleschi, the architect of Florence’s remarkable cathedral, won the world’s first patent for a technical invention in 1421. Brunelleschi was a classic man of the Renaissance: tough-minded, multi-talented, and thoroughly self-confident. He claimed he had invented a new means of conveying goods up the Arno River (he was intentionally vague on details), which he refused to develop unless the state kept others from copying his design. Florence complied, and Brunelleschi walked away with the right to exclude all new means of transport on the Arno for three years.
The reason that Dr. Bellin mentioned the forceps story is the same that he had created Clinical Looking Glass software and joined the Emerging Health Information Technology company. He wanted doctors to learn from each other what works, and then to use what they learned to help patients. For that I congratulate him.
But the story of Chamberlen family saddens me, and I would go further to say that a doctor doing this today would be acting unethically. I hope, at least, that there are enough incentives that such a doctor would also be acting foolishly.
Update: Dr. Bellin kindly corrected a couple of mistakes I made in this post. First, he heard the story about the Chamberlens not as a medical student, but from his own father, also a physician committed to the duty of physicians to share knowledge. And second, Emerging Health Information Technology was created by its current CEO, Jack Wolf, who in the words of Dr. Bellin “had the vision to realize that the only way to afford cutting edge technology in the health care sector was by creating virtual cooperative communities of hospitals sharing infrastructure costs through a trusted outside entity”.