When doctors treat themselves and disrupting the status quo

"A physician who treats himself has a fool for a patient". Sir William Osler (1849-1919)

While Sir William Osler's cautionary advice about physicians treating themselves remains relevant, some exceptions stand as pivotal moments in medical history, underscoring the potential of self-experimentation in advancing healthcare.

Although the advice of doctors not treating themselves or family members is generally considered sacrosanct, there have been several notable exceptions. Here are six examples of physicians who, through their self-experiments, significantly advanced our understanding of medical science and paved the way for novel treatments.

William Stark

In 1769, William Stark conducted self-experiments on his own diet and the role of vitamin C in treating scurvy.He began a 31-day diet of only bread and water. Soon his gums began to bleed, and his symptoms mimicked those of British sailors suffering from scurvy. Stark was severely malnourished, and in less than a year, he died of scurvy at only 29 years old.

Stark's meticulous records, confirming the impact of vitamin C deficiency on scurvy, served as a crucial validation of his hypothesis, emphasizing the importance of data in scientific research.

Werner Forssmann

Werner Forssmann was a German physician who made medical history in 1929, when he made an incision into the antecubital vein inside his elbow and then inserted a 25-inch urinary (italics mine) catheter into this vein. Using fluoroscopy, he advanced the catheter into the right atrium to confirm its position. Forssmann used this procedure in animals as well as himself. The results of his work led to a Nobel Prize and the initiation of the field of interventional cardiology.

Barry Marshall

As a medical student, I learned that excessive stomach acid and stress were the causes of gastric ulcers, and the treatment was antacids and, if ineffective, then surgical removal of the stomach was used to treat resistant gastric ulcers. Barry Marshall, an Australian physician, believed that gastric ulcers were caused by the bacterium Helicobacter pylori, which is often found in the lining of the stomach and in the ulcers of patients with gastritis and gastric ulcers.

Marshall was so convinced that H. pylori was the culprit of gastric ulcers that he took gastric juice with bacterial samples from a sick patient, made a slurry of the bacteria, and drank it. Shortly after drinking the concoction of the bacteria, Marshall became sick with bloating, decreased appetite, and vomiting. Marshall submitted to an endoscopy, which confirmed he had gastritis, and he began a regimen of antibiotic therapy, which provided an effective cure, which was confirmed by a follow-up gastroscopy. His experiment on himself confirmed the connection between H. pylori and ulcers. Today, the standard of care for gastric ulcers is the use of oral antibiotics, proton pump inhibitors, and antacids. In 2005, Marshall was awarded the Nobel Prize in physiology for his discovery.

Evan O'Neill Kane

Surgeon Evan O'Neill Kane had performed over 4000 appendectomies. He aimed to demonstrate that, in certain instances, local anesthetics could serve as an alternative to general anesthesia for the removal of an inflamed appendix. In 1921, he made himself a test case. When his appendix became infected, he was scheduled to have an appendectomy by another surgeon. Before his own appendectomy, Kane decided to do the surgery on himself. Kane injected his skin with a local anesthetic and removed his own infected appendix. Kane's bold decision led to a greater understanding of the use of local anesthetics and how to avoid general anesthesia in patients for whom it posed a danger.

Alexander Bogdanov

Alexander Bogdanov, a Russian physician, believed that blood transfusions could extend human life. In the 1920s, Bogdanov gave himself multiple blood transfusions. Unfortunately, one of his transfusions involved the use of a medical student's blood, who was sick with malaria. Soon after that tainted transfusion, Bogdanov died. His successors, impressed by his work, continued his research, and made advances that established Russia as a leader in developing a central national blood transfusion system.

Christian Chaussy

Christian Chaussy, M.D., a urologist in Munich, Germany, and the founder of the extracorporeal shock wave lithotripsy in 1980, revolutionized the treatment of nephrolithiasis using shock waves instead of open surgery. He demonstrated the safety of the procedure on himself and the necessity for general anesthesia by subjecting himself to the treatment before using it on patients. As a result, millions of patients worldwide have had their kidney stones treated by using shock waves to fragment renal calculi into sand-like particles, which pass spontaneously through the urinary tract.

What's the take-home message? There are a few brave doctors who will subject themselves to medical interventions and leave the status quo and their comfort zone to advance medicine with new treatments and new technologies. I am not recommending that doctors embark on self-treatment in order identify new therapeutics. I am however, suggesting that there are times we need to

Doctors who are going to change the status quo need to look for ideas that are outside the usual rules and guidelines. What worked last year won’t necessarily work this year; the only way to know is to challenge it. Moving the status quo means not only generating new ideas but escaping from obsolete ones as well.

Medicine has its sacred cows. Examples include patients needing a chest x-ray and electrocardiogram before elective surgery, women needing to take a two-week course of antibiotics for an uncomplicated urinary tract infection, and imaging being used more than the physical examination of the patient. Which of these sacred cows can be challenged?

There is a prevailing dogma across society that goes something like this: “If it ain’t broke, don’t fix it.” But let’s look at successful businesses. The best businesses aren’t the ones that fix what is broken but the ones that find new and improved ways of providing a better service to their customers. So instead of thinking up a new surgical technique to replace the Whipple procedure, why not focus on finding a blood test to identify pancreatic cancer before it becomes symptomatic or even how to prevent pancreatic cancer and completely eradicate the disease.

The status quo may represent obstacles but there are some physicians who don’t see obstacles. They visualize opportunities—opportunities to improve the science of medicine, the quality of life of our patients, and the healthcare of our community, our nation, and our world and this doesn’t require physicians to treat themselves.

If you have any opinions or suggestions for disrupting the status quo, please let me hear from you. doctorwhiz@gmail.com

Neil Baum, M.D., is a physician in New Orleans and the author of Business Basics for Creating and Managing a Healthcare Practice (Springer 2022)