Medical Regulation vs. Innovation
This piece is about medical regulation. Well, it’s actually about a doctor who put his own infant daughter on display in a carnival sideshow. That’s okay though, because of how many lives he saved…
Hmm, maybe I should backup a little. Ten millennia ought to do it.
Only in recent times has medicine become the refined, tightly-regulated, paperwork-deluged mechanism that it is now. For 10,000 years prior, medicine was gritty and desperate, with new techniques born in battlefield mud, straw huts, and following sabertoothed tiger attacks. Medicine did whatever was necessary, unapologetically, in whatever way it could.
And this paleolithic mentality came closer to our modern world than we like to think. Physicians like Dr. Martin Couney used anything at their disposal to save their patients, and in 1903, medicine rarely waltzed through a sterile lab. Usually, it crawled through alleys with the snake oil salesmen.
At the 1896 Berlin Exposition, Dr. Couney witnessed a breakthrough technology: glass and metal incubators designed to help save premature babies from their horrifyingly high mortality rate.1 The incubators were for sale, but how could Dr. Couney pay for enough of them to make a real difference? Furthermore, how could he afford rotating staff to care for the infants round the clock, and the medications and food they would require? At that point in time, preemies were often brushed aside as a lost cause. No investor would risk thousands of dollars on such a desperate gamble.
So Couney turned to the gawkers with their nickels and dimes. Afterall, as PT Barnum was probably saying at another carnival at that exact moment, “There’s one born every minute, and two to take him.” In the world before regulation, nearly anything was possible, if a physician was creative enough, and Dr. Couney was.
In 1903, Couney opened his first premature baby sideshow at Luna Park on Coney Island. For 25 cents, onlookers could enter and walk down the rows of glass incubators, looking at the tiny infants struggling to survive inside.2 Most of his babies came from local maternity wards that had discarded them as unaffordable. The exhibit (clinic?) was so popular, that he was able to open more at other Coney Island parks. In a poetic twist of fate, his own daughter was born prematurely, and was saved by his sideshow.
In the early 1900’s, carnival-goers leered at “The Human Owl” (a man who could rotate his neck 180o),3 laughed at “The Fattest Man in the World,” and incidentally provided medical care for premature infants. By the time Couney died in 1940, carnival goers had unwittingly saved over 6500 premature babies through his exhibits.3
Or perhaps it wasn’t so unwitting. We look back on the old carnivals as humiliating reminders of a calloused time when people put on display like taxidermied animals simply because they looked different.
However…
Within all but the most calloused of us, there exists an instinct to defend the defenseless, to protect the smallest and most vulnerable. And none are smaller or more vulnerable than premature babies. As mothers walked by the glass cases, looking down at the babies so like their own, but even smaller and weaker, did they not feel compassion, the desire to cradle and cuddle? As fathers walked by, looking down at the children like the ones they worked each day to feed, but even tinier and hungrier, did they not feel the need to protect? Each of these passersby knew that the quarter they had spent was indeed feeding, protecting, and warming those babies.
The infant incubators were a new innovation, and that is what innovation brings to the world: hope. Because without belief in a better tomorrow, there would be no reason to innovate.
The news is as gloomy now as it was in 1903. Politians lie and cheat. Wars and tragedies of all sorts abound, but innovation quietly disagrees. In miniscule ways—often no bigger than a preemie—innovators say “The future can be bright, because we can make it so. I have invented a small thing, and perhaps it cannot save the world, but it can keep this baby warm. And that is a step in the right direction.”
Regulation is necessary. Afterall, it’s the only thing that finally did away with the aforementioned snake oil salesman who bottled turpentine and sold it as cough syrup. But the other side of that unregulated coin are the carnival sideshows that not only saved thousands of lives, but ushered new neonatal technology to the forefront and changed the medical attitude towards preemies in general.
Since that time, however, regulations have blossomed, innervating every millimeter of the clinical world. Some are unquestionably necessary. Some are unquestionably not, and it is important to note that every time an unnecessary regulation is enforced, it usually kills a struggling innovation.
And make no mistake, every time an innovation dies—the patients it would have saved have no choice but to die with it.
If you’re reading this then you most likely work in medicine, so I will leave it to you: dealing with regulation every day is your lot, and it’s kind of a carnival, and it’s supposed to be helping you…
But has medical regulation gone too far?
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