250 years of Medical Miracles
Last Saturday we celebrated our country’s Sestercentennial or Semiquincentennial (I’m not sure which is more correct), both are complicated ways to say we’ve been a nation for 250 years. It seems that lately we have often been concentrating on the negative aspects of our country, I admit I’ve been guilty of doing this as it relates to our government’s stance on some healthcare issues, but now is an ideal time to step back and look at where we are medically, 250 years after we became a nation.
The biggest breakthroughs came in six main areas, vaccination, our understanding of germs, anesthesia, antibiotics, imaging, and molecular medicine. Together, they increased human life expectancy by 40+ years.
Vaccinations – They began the era of preventive medicine. During the revolutionary war George Washington realized that he was losing more men to smallpox than he was to the British guns. This was especially true for the young men who had never been very far from home before the war and were especially vulnerable to smallpox. He ordered that the men would be vaccinated and, even though it made some men sick and even killed a small number, it proved very effective. Some credit his success in the war to his ability to keep his men healthy. In my experience in the military, I was lined up and given shots multiple times, especially when I went to the Vietnam theater toward the end of that war. It was just part of making sure this highly trained military machine . . . me, was ready to respond to the call to duty. Just recently there has been some controversy over members of the military not getting vaccinated. All I can do is reflect on how important it was 250 years ago to gain the freedoms we enjoy today. Insulin, discovered in 1921, turned type 1 diabetes from fatal to treatable. Penicillin and antibiotics came into use starting in 1928. Vaccines expanded in the first half of the twentieth century. Polio, diphtheria, tetanus, pertussis, and influenza vaccines caused childhood mortality to drop significantly. We saw vaccines during the COVID 19 pandemic that saved millions of lives. Vaccines have been protecting people and preventing disease in our country for 250 years.
Understanding of germs – Men like Semmelweis, Pasteur and Koch proved that microbes cause disease starting in the 1850s. These discoveries lead to the use of sterilization, pasteurization, and infection control. I recently read a book about President James Garfield. He was reluctant to run for the presidency but was drafted by his party and was elected in 1880. The evaluation of Garfield by those who knew him and by historians who studied him deduced that he would have been a great president. Unfortunately, he was shot by an assassin just 119 days after his inauguration and died 79 days later. Not from the gunshot wound but from the infection that was introduced by the doctors and surgeons who operated on him and cared for him. This happened because American doctors were slow to accept the understanding of germs and adopt the sterilization techniques discovered by England’s Joseph List. It highlights the value of early acceptance and access to new medicines and to new medical procedures.
Anesthesia - The discovery of ether and chloroform, which allowed pain-free surgery, were key in saving lives. Surgery became far more humane. When you married the use of sterile techniques and anesthesia, surgeries became much more successful, and the death rate dropped dramatically. Transfusion and blood typing, 1901–1930s, enabled safe transfusions which made trauma care and major surgery possible.
Imaging – X-rays, C scans and MRIs enabled noninvasive diagnosis, medicine to become visual. Dialysis, organ transplantation, and cardiac care were revolutionized in the later half of the twentieth century.
Molecular medicine – In the late 1900s genetics and biotechnology revolutionized how we treat patients. We understood the DNA structure and monoclonal antibodies. We mapped the human DNA and launched personalized medicine. We developed precision medicine and gene editing, used CAR T cell therapy to cure some leukemias and lymphomas. Used CRISPR gene editing to develop possible cures for sickle cell disease, blindness and more. In 2020, the COVID 19 pandemic proved that mRNA-based vaccines could be used safely and effectively which opened doors for developing vaccines for cancer, HIV, RSV, and other diseases. Last weeks blog talked about how now AI models are being used to detect cancer, predict heart disease, design drugs, and accelerate research timelines. We are now researching ways to have lab-grown organs, stem-cell therapies, and 3D bioprinting. We are truly at the cusp of huge discoveries that will dramatically improve the human condition
Over the last 250 years discoveries in medical procedures and medicines have reduced deaths from infections by 90%, surgery became safe, genetic diseases became treatable, cancer survival improved significantly, vaccines prevented hundreds of millions of deaths and, most importantly, life expectancy rose from ~40 years to ~78+ years today.
If I wouldn’t have had the benefits of these marvelous medical discoveries I most likely wouldn’t have witnessed my children graduate from high school, attend their weddings, or see my grandchildren. These scientific discoveries over the last 250 years have given us all more time. I’ve talked a lot lately about the early access to medicines that Americans enjoy. This has been possible because we created a fertile ground in the US for innovation. These scientific breakthroughs have resulted in early access to new medicines whose greatest benefit was giving us more time. As a country we need to quit erecting barriers to innovation and do everything we can to encourage scientific discovery. Time is of the essence.
Best, Thair