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
Posts
No comments:
Post a Comment