In 1812, the year The New England journal of medicine and surgery first started to publish. Medical knowledge in the US and the world was limited. We had no understanding of the infectious disease. Health outcomes were particularly poor for women and children. The surgery was unsanitary and was performed without anesthesia. Cancer was largely unrecognized because, so few people lived long enough to develop it.
Two centuries later people in the US live longer and better than ever before imagined. This article explores three remarkable stories of medical progress. Progress has been uneven, but the advances have shown us that we can get better.
From Rough to Refined: The Rise of Surgery
The field of anesthesiology has continuously changed and there are new products and new research that come out all the time. In the last 25 years, we went from one in five thousand patients dying from their aesthetic itself to less than one in two hundred thousand, as rare as a plane crash.
Before the introduction of anesthesiology, surgery was just brutal and terrifying. The patient would already be inebriated with alcohol and other kinds of substances. It was incredibly bloody and gruesome. The introduction of ether anesthesiology in mid-1940s really revolutionized the practice of surgery.
The discovery of anesthesia and the discovery of how to prevent infection allowed us to do more ambitious operations for the first time.
Targeting Cancer: The Story of Leukemia
In 1930s a diagnosis of cancer was always grim. Radiotherapy was very cruel in 1930s and with cancers like leukemia that are disseminated in the blood, there was no cure. In 1946 a colleague of Sidney Farber had shown that folic acid could cure a certain kind of anemia. Dr. Farber thought this could be used to treat acute leukemia, since they are both types of blood related. This experiment backfired and the folates only stimulated the cancer cells. This time Farber got an anti-folate, a drug called aminopterin, and gave it to 16 of his patients suffering from ALL. Much to his surprise the drug massively destroyed the leukemia. Sometimes patients die from the side effects.
After this, they tried longer chemotherapy treatments in different combinations. They added cranial radiation and gave the methotrexate directly into the spinal column. Within 10 years they were curing half of all cases of ALL. The field of cancer and genetics would continue to evolve over the next 30 years revealing hundreds of variations in almost every kind of cancer.
50 years after Sidney Farber’s work, in 2001, we had a huge understanding of the genetic basis of cancer and even some of the true biochemical and metabolic differences between a cancer cell and a normal cell, and all those were becoming amenable to targeting. In 2022, advances and research in therapy continue, the hope is that all cancers will one day become if not curable then chronic and manageable diseases.
The Plague of Our Time: The HIV/AIDS Epidemic
In the late spring of 1981 was when the first article was published which mentioned five gay men extremely sick because of pneumonia like a disease. Even doctors from internal medicine and infectious diseases were quite afraid, the reaction to the first person who was admitted was as if he was carrying smallpox. It was not recognized in the new England journal of medicine of its potential seriousness of what It was. To make matters even worse, the disease carried a terrible social stigma because it was seen most commonly in gay men and IV drug users.
It was established in 1982 that the virus was transmitted sexually and by the blood of infected drug users. In 1984 French and American researchers discovered the cause of AIDS. It was a retrovirus they called human immunodeficiency virus or HIV that attacked our immune system and integrated itself into the genome of our cd4 cells. Within a year blood test for AIDS was developed. By this time AIDS was spreading exponentially in developing countries. The gay and HIV-infected communities mobilized to demand care and affordable access to the first HIV drug, AZT.
By 1994 the number of AIDS cases in the US had surpassed 400,000. The use of AZT to prevent mother-to-child transmission introduced HIV drugs to the developing world. It was the first truly effective step in combating AIDS in resource-poor settings, but there was still no durable treatment. Challenges remain in the developing world. Only half of the 14 million people affected with HIV who should receive antiretroviral therapy are getting it.
We look back at all of human history and realize that disease was the principal problem of life and existence. You also realize that only in its most recent period we have gotten these strong scientific and technical apparatus available to modify it in some way. We all are very thankful that we live in this age where there are tons of possibilities and hope for every person.
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