Semelweis and the Police

Bear with me on these next few paragraphs, I promise they are relevant.

Ignaz Semelweiss was a Hungarian physician that worked in obstetrics in the mid 19th century. For the purposes of this blog – and I won’t go into too much detail – he was a pioneer of evidence based medicine. He was the first to buck the accepted theory of ‘miasmatic’ transference of disease; this basically referred to disease being transferred through the air, instead of by contaminated contact.

Miasmatic transference was the accepted ‘norm’ within the scientific community at the time of his study, but he did not accept it as red, and conducted his study using his own observations of the difference in death rates between a maternity ward staffed with midwives, when compared with a ward staffed by doctors. The ward staffed by doctors had a much higher death rate, and the current theory of airborne infection was used to explain this. Semelweis discovered that the current airborne theory of infection was false, and that it was the fact that doctors were not washing their hands between the mortuary and other patients that was the deciding factor.

Semelweis found that when mandatory hand washing was introduced, the mortality rate dropped from 18% to 2%, and then down to 1% when they started washing the instruments too. He implemented this in the hospital where he was working, but because the current thought (we shall call it the narrative – because it was the accepted story and language of that era) was in totally the opposite direction, he was eventually removed from post by the senior managers. They were convinced that the change in mortality was actually down to an upgraded air conditioning system…

Semelweis was moved to another hospital, and shortly after moved into a mental hospital. He died there as a patient. Twenty years later, his work heralded a revolution in medical thinking, with the miasmatic beliefs dying away to be replaced with contact based disease transmission theories. In those twenty years, thousands of people died, because the current thinking and narrative would not accept this new evidence. It was too out of kilter with the theories espoused by senior medical practitioners across the country.

At this point, I will move away from mortality rates, and back into my usual discussion around cop culture. In the UK we are at the point where evidence based practice is a relatively ‘new’ term. Some of the study will buck significant narratives that have been in place for many, many years. Here is an important question:

What are the current ‘miasmatic’ theories in policing? What assumptions rule our behaviour that are totally incorrect, yet we set up entire industries around them as if they were sacrosanct?

And another just as important question:

What would we do with our Semelweis?

If someone were to find evidence that one of our accepted practices was in fact counter-productive, what would become of them? I can think of one that gave evidence at the PASC and then left the job immediately after (James Patrick); I can also think of one initiative that continues to buck repeated evidence and is still discussed as a great ‘reform’ initiative – Scared Straight. The truth is that Semelweis-like characters are likely to increase as EBP grows, and the way that profession and colleagues interact with them is also very likely to hit the front page of the newspapers.

I write this blog – again – with reference to Stop and Search. It is continuing to hit the headlines as there are rises in knife crime in London, and I have read many commentaries on dealing with the problem. Some are extremely well written and I can react positively to the sentiment, but the thinking that is required to tackle them relies heavily on experience, narrative, and culture.

I had a great conversation with a Chief Superintendent last week about the development of ‘gut feel,’ as a vital component of policing. As someone who used to love my drug jobs, I relied on it heavily, and after over a decade of experience I’m pretty good at predicting who is ‘carrying’ and who isn’t. This kind of ‘feeling’ is a direct product of experience, and somewhere in my brain, my subconscious is making connections based on previous interactions that lead to conclusions that I act upon. I’m sure that the ‘feelings’ around knife crime are similar, and there can be no doubt that removing a knife from the streets can only be seen as a good thing that may have saved a life that night.

But, we have seen a steady build up of evidence that the occurrence of knife crime is not strongly linked to the rate of stop and search. What does this mean? It means that no matter how many searches the police carry out, the effect of them upon knife crime is not significant. If you want to see the data, have a look at the work of the Police Foundation, in particular Gavin Hales here. What conclusions can we draw from this? It’s always dangerous to draw total conclusions, but it is possible to ask some serious questions:

  1. If the rate of stop and search doesn’t affect the knife crime rate in a significant way, are the cops using it in the right people and in the right places? (pretty sure this is asked daily)
  2. In the knife crime that takes place, would it have been possible/probable to catch the offender en route to the place of offence via stop and search?
  3. Is it possible that the knives that are being found currently are carried for defense and not offence?
  4. If the latter is true, how do we change tactics to address knives being used in an overtly offensive way (i.e. with specific intent).

The problem with all these questions, is that the answers take a huge amount of analysis, and are therefore lengthy and expensive. I have no idea if they are being considered, but they aren’t being discussed on public forums or on the media, nor are the wider questions of community cohesion and a culture of violence. Knife Crime is a wicked problem. It is unsolvable. The only solutions possible are ‘clumsy’ and will involve lots of different initiatives that connect and are delivered jointly. Stop and Search is not ‘the‘ answer to knife crime, it is part of a complicated tapestry – and the evidence suggests, not a very effective part at that.

At this time, the main opposing voices in this debate are external, and are mainly academics that study policing, and on the other side, police officers. The debate looks like this:

Academics: we study this with rigour, the tactics are proven to be variably poor.

Police: We know Stop and Search works because our experience tells us so and we totally believe it.

Sound familiar? It should. It’s a Semelweis problem. Experience and narrative against proven evidence. Don’t get me wrong, Stop and Search is part of the answer, but it probably needs to change in the way that it is used (significantly), and then accompanied by a plethora of other totally different interventions. Who will be the real Semelweis on this topic? Probably not me, it’s taken me weeks to pluck the courage up to even write this, such is the strength of the accepted narrative.

Opening our profession to critique is a necessary step in the process of learning. Our current assumptions that underpin our decisions can be totally incorrect, and many years in the making. These assumptions may cause people to die (as they did in medicine in the mid 19th Century with hand washing). Critical thought therefore isn’t a luxury, it’s a necessity. People’s lives depend on it.

Let’s listen to our Semelweis. They are out there. They are the different ones that won’t accept the current culture and stick out. They are the ones who constantly question, say no, and challenge rank based assumptions. Diversity in the workplace isn’t about numbers, it’s about welcoming the Semelweis characters and learning from them.

Changing deeply held assumptions takes difference of thought, but mainly, it just takes the ability to actually, actively, listen.


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