Monday, November 28, 2016

Who Knows Anything? - Journalism, Caesarean Section, and the Production of Knowledge

The New York Times ran a story about an amazing c-section survival in 1337. But historians of medieval medicine don't think it happened. 

By Monica H. Green

On Wednesday, 23 November 2016—the day before the Thanksgiving holiday in the U.S.—the New York Times ran what it likely assumed to be a “fun fact” story, a minor historical discovery on a slow news day. Under the category, “What in the World” and headlined “A Breakthrough in C-Section History: Beatrice of Bourbon’s Survival in 1337,” the Times piece recounted how Czech researchers had found “an apparent case” of a Caesarean section performed on the recently married, 19-year-old medieval queen of Bohemia.
Pullquote:  In our heightened debates about “Fake News,” we should give more thought to how “knowledge” (“unfake news”) is produced and disseminated.

The piece would likely have quickly become ephemera had it not been picked up by Twitter. There, the case of Beatrice reached the attention of historians specializing in medieval women’s history and medieval medical history. It immediately provoked skepticism.

In our heightened debates about “Fake News,” we should give more thought to how “knowledge” (“unfake news”) is produced and disseminated. In this case, the curtain that needs to be pulled back is the process of peer review.

To the historian of medicine, the study bears all the pitfalls of amateurish oversight. It takes no account of the past thirty years of scholarly literature in either the history of medieval obstetrics (or women’s history more broadly), nor the history of medieval surgery or anesthesia. Peer review by historians of medieval medicine would have quickly identified these problems. It seems, however, that the piece was only refereed by physicians.

What is peer review?

Peer review involves works being sent out, before publication, to other scholars who work on similar questions to the item under review. They assess the piece in terms of its coverage of the existing literature in a field, the originality of its question, and the rigor of its methods. Based on those criteria, publication (or not) is recommended.

But who are “peers”? In the case of medical history, that is a major issue. Are peers physicians who have been trained in modern medicine, who have treated living patients, excised real tumors, autopsied fresh cadavers? Or are they historians who have been trained in the languages, cultures, archives, and traditions of the past? Researchers who have both MDs and PhDs exist, but are rare. The authors of the Czech C-section study self-identify as a physician, a member of the philosophy faculty, and a historian, all at the Charles University in Prague: an impressive interdisciplinary team. The reviewing process should have involved scholars with a similar range of competence.

Pullquote: just as “local knowledge” is needed to interpret the nuances of language and culturally coded behaviors, so local academic knowledge is needed to explain how published work is generated in different professional fields.
The argument of the study hangs on the slimmest thread of evidence, the meaning of the Latin word incolumitate in two versions of a letter sent out under the queen’s name after the birth. Incolumis, according to the Latin dictionary commonly known by its authors’ names, Lewis and Short, means simply “unimpaired, uninjured, in good condition, still alive, safe, sound, entire, whole.” Its medieval usage is comparable. Yet from that single word, and from other accounts written a century or more after the said birth (leaving plenty of time for a private event to have mushroomed into legend), the authors deduce that the queen must have undergone a C-section. Since she clearly survived, the “operation” must have been successful.

There are legitimate grounds to debate the linguistic weight of the word incolumitate, and legitimate grounds to debate the political context in which this still uncrowned queen had to assert her right to the consort’s throne. There are also medical grounds to question the interpretation. Could not incolumitas here mean, for example, that Beatrice, still a teenager, had survived the birth without the crippling damage that obstetric fistula is known to visit upon girls being forced to bear children too young? Unfortunately, neither this scenario, nor many other possible obstetrical outcomes, all of which are well-known from medieval records, are assessed here.

National pride and international spin

The study appeared earlier this year in the national Czech journal of gynecology, meant, apparently, to provide an interesting reflection on national history to the country’s obstetrical specialists.[1] For its original audience, its speculations about the nation’s medieval history were no doubt fascinating. Once its message was amplified internationally by the New York Times, however, it suddenly became “a breakthrough,” a major scientific discovery. Antonin Parizek (“a noted obstetrician and expert on medical history,” according to the Times, and the study’s lead author), seems to be the only person interviewed for the news story. The unsubstantiated interpretation of incolumitate now becomes a fact of history: “Beatrice most likely passed out during delivery,” Parizek is quoted as saying, “and was believed dead … The surgeons opened her only to save and baptize the child. The pain from the operation then likely led to her awakening.”

In short, this is fiction. But, presented as “fact” by the New York Times, it becomes accepted as truth by a world-wide audience. The word “apparent” is the only qualifier given, and other statements—such as the reference to “other archival sources” without clarification that they postdate the birth by anywhere from one to five centuries—mislead the reader.

As noted above, the New York Times piece appears in a section of the newspaper called “What in the World.” This section is meant to circulate news stories coming from other national news outlets, and this one may have been picked up from Czech media. That is certainly a worthy, and indeed, necessary goal in our globalized world. But just as “local knowledge” is needed to interpret the nuances of language and culturally coded behaviors, so local academic knowledge is needed to explain how published work is generated in different professional fields.

The New York Times has given us a prime example of how fake news is generated. In this case, the news is not “fake.” The Czech study really was published. But the implication that it reflected any kind of consensus on what historians believe about women’s medical history was absolutely false.

“What in the world,” indeed.

Monica H. Green is a historian of medicine and global health. A professor of History at Arizona State University, she has published extensively on the history of medieval women’s healthcare, including her award-winning book, Making Women’s Medicine Masculine: The Rise of Male Authority in Pre-Modern Gynaecology (Oxford University Press, 2008). Many of her works, including her comprehensive bibliography on women and medicine in the Middle Ages, can be found on her page.

[1] Thanks to Roberto Labanti for this reference. Thanks as well to Maaike van der Lugt, Katharine Park, and Fernando Dias de Avila Pires for helpful comments.

No comments: