Accidents can lead to progress
Ignaz Semmelweis, who died in ignominy and is largely forgotten, is responsible for one of our greatest healthcare discoveries.
Semmelweis was the first person to understand physicians could be transmitting germs to women in labor, causing them to die of “childbed fever.” When he insisted staff use chlorine on their hands, the rate of deaths dropped dramatically. He ultimately was fired and then purportedly lost his mind, but Semmelweis was basically the first healthcare provider to link the importance of handwashing to preventing germ transmission. It's a fight still waged daily in most nursing homes.
His discovery, like many in science history, was largely based on trial and error. He asked “Why?” In other instances, famously in the case of penicillin, major progress was made due to an accident, specifically a messy lab. I'm optimistic that if my office desk stays disorganized enough, genius will strike, although probably not by the time you are reading this column.
More seriously, in long-term care, there's a Parkinson's disease treatment that was discovered due to a fluke.
Amantadine was prescribed to prevent flu in the 1960s. A patient with Parkinson's disease symptoms noted the medication seemed to help her PD symptoms, and clinical trials ensued from that observation in the early 1970s. As most long-term professionals know, Parkinson's disease symptoms include problems with motor control, including shaking, slowness, stiffness and balance issues.
Amantadine was eventually found to act on the presynaptic membrane, enhancing the release of dopamine and inhibiting its reuptake. When a resident has Parkinson's, his or her brain is gradually producing less dopamine, which means less ability to control one's body and movement. Amantadine also blocks NMDA receptors, which can reduce the severity of levodopa-induced dyskinesias from Parkinson's. These dyskinesias refer to involuntary movements, such as tremors.
Whether it's amoxicillin or Amantadine, sometimes the drugs that have been around for a long time are the ones we take too much for granted. Beyond medication, great progress is often made with existing treatments as they are allowed to expand among a patient base. This week, Medtronic announced that Deep Brain Stimulation is becoming more of an option for those with Parkinson's, due to the FDA expanding its approval. While the agency approved DBS in 2002, it was only for those with advanced symptoms. Now, it can be used for Parkinson's patients who have had the disease for four years and have motor complications. The approval was based on a New England Journal of Medicine study that said those with this type of therapy had a mean improvement of 26% in their disease-related quality of life at two years.
Ironically, Amantadine isn't a preferred drug for flu anymore, and it is still around because one patient 50 years ago told her physician what she saw. Let that be a lesson to us — we live in an era where we want to find the latest and greatest, whether it's in medicine, technology or even relationships. But great discoveries can be made by asking what could be better among an existing structure, whether a good process can be expanded, or through understanding how side benefits can arise from a basic treatment.
At a certain level, this is what Quality Assurance and Performance Improvement can be about: not just drilling down to “root cause” analysis, but to understand what's working already — and why — and what tangential benefits are being created.
Elizabeth Newman is Senior Editor at McKnight's. Follow her @TigerELN.