Episiotomy, Cesarean and Hitler

What do episiotomy and Cesarean section have to do with Hitler? Nothing, actually, but it did catch your attention. Perhaps it was simply to catch your attention that Dr. Michael Klein entitled his editorial in this month’s edition of the journal Birth What Do Episiotomy and Cesarean Have to Do with Copernicus, Galileo, and Newton? Episiotomy and Cesarean section have nothing to do with Copernicus, Galileo and Newton, either.

Yet I suspect that the title was more than a cheap bid for attention. Rather, it was an example of the ludicrous grandiosity of Dr. Klein and certain other critics of modern obstetrics: he actually believes that he should be included in the pantheon of scientific immortals, among Copernicus, Galileo and Newton. In other words, Dr. Klein suffers from the “conceit of the brilliant heretic.”

Consider the way he begins his essay:

Like those who thought the world was flat and the sun revolved around the earth, believers in routine episiotomy considered its use as based on “normal science,” as defined by Thomas Kuhn, and fully accepted within the obstetrical/gynecological community — a discipline that saw birth as inherently abnormal, and whose scientific questions were based on this conception of reality as the only framework for legitimate inquiry…

In the early 1980s, I pondered how to get funded for a randomized controlled trial of an accepted procedure that I thought was inappropriate when applied routinely. Later I struggled to get the episiotomy trial published when the dominant culture
wanted the results buried. In this context, I thought about how strongly held beliefs came about and the critical importance of timing. And then I discovered
“paradigm shift,” as coined by Kuhn.

So obstetricians who used episiotomies were flat-earthers, awaiting the arrival of a man of extraordinary brilliance like Michael C. Klein, MD, CCFP. But when the great man appeared in their midst, those ignorant obstetricians did not recognize his brilliance (possibly because it was blocked by the size of his enormous ego). Fortunately, he can soothe himself by comparing their response to those who refused to recognize the seminal insights of Copernicus, Galileo and Newton. He, too, was persecuted for his earth shattering insights.

Sound familiar? It’s the “conceit of the brilliant heretic” that refuge of crackpots everywhere. I have written about it before. As explained in The Holistic Heresy: Strategies of Ideological Challenge in the Medical Profession by Paul Wolpe, Klein believes:

[His view] is the inevitable (or desirable) next step in the history of medicine, and like other heroes of medical history who were initially rejected by the orthodoxy of the day … [he] is simply ahead of his time. Innovation is always initially resisted … [People like Klein] portray themselves as mavericks, leaders, with every expectation that soon all of medicine will, by necessity, follow in their footsteps.

It is a conceit of monumentally embarrassing proportions. Klein imagines that his work on episiotomy is of equal importance to the theory of the Earth revolves around the sun. Klein dares to equate the way obstetricians treated his hypothesis with the persecution of Copernicus and Galileo. Really, Dr. Klein? Did anyone threaten to kill you for your beliefs? Did they threaten to excommunicate you from your religion? What, after all, did they do to you? Evidently they failed to recognize your genius, in your mind a sin every bit as monstrous as the threats to Galileo’s life.

By the way, Dr. Klein, including Newton betrays a deficit in your knowledge of history. Newton was not persecuted. He was a founding Fellow of the British Royal Society, which as the name implies, was blessed with a royal patron, no less than the king himself. You can’t get recognition more official than that. But I guess the temptation to compare himself to Newton was too great for Dr. Klein to resist, regardless of historical inaccuracy.

I’m going to go out on a limb here and assert that Dr. Klein’s finding that routine episiotomy might increase the risk of severe perineal tears is NOT equivalent to the insight that the sun is at the center of the galaxy, even if it were true; and his findings have not been reproduced often enough to be sure that he is correct. Indeed, recent scientific evidence suggests that the decline in episiotomies has not been followed by the decline in perineal tears in the magnitude that his finding predicts.

I’m also going to give Dr. Klein a bit of friendly advice. If he intends to be taken seriously, and not laughed off the stage at future professional meetings, he ought to stop comparing himself to the immortals of science. He is not one of them. He should be profoundly embarrassed that he dared to mention his own name in association with theirs.

I’ve got news for Dr. Klein. His findings are not earth shattering. They have not changed much of anything in modern obstetrics, let alone ushered in a new paradigm. They are a few paltry observations on the possible consequences of a minor surgical procedure, nothing more and possibly a lot less.