Friday, May 4, 2012

200 Years of the New England Journal of Medicine

If you have a spare 45 minutes, you should check out this online documentary put together by the New England Journal of Medicine, which charts some of the significant advances made in health care over the past 200 years and demonstrates how information reported in journals can translate into progress.

At the time of the publication of the Journal’s first issue in 1812, medical knowledge was limited.  There was no understanding of infectious disease and infant and maternal mortality was high.  Surgery was performed without anaesthetic and was thus a bloody and brutal affair, with half of all surgery patients dying from complications.  In 1846, a Boston-born dentist named William Morton began experimenting with ether as an anaesthetic tool and its benefits were demonstrated by Dr John Collins Warren, who painlessly removed a tumour from the neck of Edward Abbott,.  Today, anaesthesia is far less dangerous and is more effective than ever before, with less than one in 200 000 patients dying from anaesthesia-related complications.  While today’s medical professionals have a good understanding of hygiene and its role in patient safety, the patients of the mid-19th Century were not so fortunate.  Puerperal fever, or childbed fever, was a major cause of death for women.  In 1847, Ignaz Semmelweiss noted a decrease in the incidence of puerperal fever when physicians washed their hands in an antiseptic solution before performing gynaecological exams.  Ten years later, Louis Pasteur pioneered the theory of bacteriology and proved the existence of micro-organisms which could be responsible for causing infection.   

In the 19th Century, life expectancy was so low that cancer was quite rare, not having sufficient time to develop in the body of the patient.  As the 20th Century advanced, cancer diagnosis and treatment came to the fore of medical science.  In the 1930s, cancer was treated with crude radiation therapy and there was no treatment for blood-related cancers like leukaemia.  On the back of research about anaemia, Sidney Farber used folate as a potential treatment for acute lymphoblastic leukaemia (ALL).  This backfired, however, as the folate actually stimulated the growth of cancer cells.  Undeterred, Farber investigated “anti-folates” or folate antagonists as a means of countering cancerous cell production.  Farber’s patients went into remission, but unfortunately all relapsed within a few years.  In addition, this treatment killed healthy cells along with the corrupted cells, causing adverse side-effects.  By 1971, however, treatments had advanced so much that half of all ALL patients could be cured.  Adult leukaemia types, like chronic myelogenous leukemia (CML), presented differently from juvenile types.  Research into cancer genetics revealed the chromosomal abnormality of the Philadelphia chromosome as the cause of CML.  The discovery of this genetic component led to the creation of imatinib, a CML treatment which inhibits enzyme production instead of simply destroying all rapidly dividing cells.  The hope for the future is that cancer will become a chronic but treatable disease.

The 1980s saw the beginnings of the horrifying HIV/AIDS epidemic.  In the early days of the disease, a diagnosis of HIV was tantamount to a death sentence.  The disease spread through both the Western and developing worlds.  When the first treatment, called AZT, was developed in 1987, interest groups lobbied passionately for access to the drug.  New antiretroviral therapies (ARTs) were developed during the 1990s, and treatment for HIV now costs less than $100 per patient per year.  However, there are still issues with access to ART.

It was fascinating to see how far we’ve come, and how far we can still go!

Heather McGowan
Consumer Representatives Program

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