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First Published May23,2008

We hear a lot on-line about everything that is wrong is medicine. Improvement should always be our aim and this is healthy. I think it does us all a little good to take a step back and realize just what we have. There are some things medicine has done for us I don’t think you could put any price tag on. While most are intensely aware of shortcomings, here is a reminder of just what how powerful modern medicine has been.

1. Antiseptics– In the mid 18th century, around the same time, Oliver Wendell Holmes and a Hungarian physician, Ignaz Semmelweiss, both noticed that when obstetricians washed their hands, it drastically cut the number of mothers who died of fever afterward. Semmelwies reported this observation and was roundly chastised, discredited, and ridiculed. Holmes had actually published this same finding in a medical journal a few years earlier, even advocating disinfectants, where it was uniformly ignored.

Holmes turned prophet when the germ theory of disease emerged two decades later. Joseph Lister learned about the discovery of microbes as the cause of fermentation from Pasteur, theorized they could be the cause of wound infections and developed sterile operating technique with phenol. Infections rates plummeted, Lister’s fame soared, and the mouthwash named after him remains in use to this day.

2. Smallpox eradication– This disease killed an estimated 400,000 people in Europe every year in the 18th century, including 4 sitting monarchs. The mortality rate was 30% and it left survivors scarred for life wherever the sores developed. Sores on the eyes made it the #1 cause of blindness. Edward Jenner discovered the principle of vaccination in 1796, some efforts to organize campaigns to vaccinate were made as early as 1803 by the Spanish, however it took time to accept this wacky idea of injecting disease to get rid of disease.

Inoculation was banned in England in 1842. Over the next ten years the course reversed completely and vaccination was mandated in 1853. By 1900, Smallpox was virtually eradicated in the US and Britain, by 1978, it was eradicated from planet earth except in the freezer at the CDC for some suspect reason.

3. The polio vaccine– In the 1920’s Poliomyelitis was a scourge and a plague that everyone lived in fear of. The initial infection was as common and pretty identical to the common cold or influenza. Most people got, spread it and recovered. However, 10% of those infected had weakness, 1 in 10 of these developed permanent paralysis as the motor neurons in the spinal cord were destroyed.

Vaccination was first developed in the 18th century, and scientists fought to develop the vaccine for over fifty years. It took time to realize there were three different polioviruses, each pretty stable over time. In 1949, Dr. Jonas Salk made a breakthrough when he developed a technique to grow poliovirus in culture, rather than in live monkey brains. He then found a way to weaken the virus and the one of the most massive clinical trials in history was begun. People rushed their children to the doctor and proudly displayed buttons they were polio pioneers.

Today, polio has been eradicated in the Americas and tragically, only exists in very poor nations with poor vaccination rates. The WHO has long held a goal for complete eradication, which is theoretically possible and humans are the only host for the virus.

4. Anesthesia– Humphry Davy reported anesthetic properties of nitrous oxide in a paper in 1800. However, chemists decided it was much more fun as a recreational drug, until it was used in the first painless tooth extraction in 1846. Four years earlier, a surgeon by the name of Crawford Long had discovered diethyl ether had similar effects on the body as nitrous oxide and used it to anesthetize a patient before removing a neck tumor. Ether had this problem of flammability and tendency to explode leading to the development of several other inhaled anesthetics and now many IV anesthetics, which are much easier to administer reliably. This development, more than any other, is what allowed the advent of modern surgery.

5. Antibiotics- Though bread mold had been used to treat wounds by the Egyptians, and several other scientists had documented the penicillium molds ability to kill off bacteria in 1897-1914, the discovery of Penicillin is credited to Sir Alexander Fleming, who discovered the bacteria killer in 1928, just because he had the strange habit of playing around with fungus to see how it beat the bacteria off. He did not believe it would last long enough in the human body to kill bacteria and dropped the study in 1931. It remained for others to develop it for use as a drug and the US government went into large scale production during World War II. As sulfa, streptomycin and many others have been added to the arsenal, bacterial disease has never been the same since, pretty much uniformly sinking like a rock on the list of the top causes of mortality in the developed world.

6. Cracking the human genome– In 1950, A mysterious molecule called deoxyribonucleic acid had long been known to sit in the center of cells innocuously, not doing much. This changed in 1952 when Alfred Hershey and Martha Chase proved that DNA was the genetic material for the T2 bacteriophage virus. James Watson and Frances Crick then discovered the structure of deoxyribonucleic acid (DNA) and the way it could vary with 4 base pairs. This allowed Crick in 1957 to hypothesize the relationship of DNA, RNA , and protein in 1957. He would be vindicated as other scientists cracked the genetic code a few years later. Fast forward forty some odd years and the entire genome of mankind has been sequenced. Our understanding of inherited diseases has skyrocketed, with new information gained every day, multiplying exponentially both new ethical dilemmas and the possibility to treat the untreatable.

7. Medical imaging– In 1895, Wilhelm Conrad Roentgen was playing around with a myterious new “x-ray” he had discovered when he stopped in front of his ray detector and caught a glimpse of the shadow of his own skeleton. Two weeks later he took a picture of his wife’s hand and started us down the road to the entire field of Radiology. X-rays are vital to diagnose and treat bone problems and pneumonias, to name a few. Real time x-ray movies, or fluoroscopy is used routinely in surgery, CT scans gave us the first view of soft tissues, vastly improving the ability to visualize tumors, abscesses. This was followed by MRI, which my specialty is particularly fond of, giving us a chance for the first time to see detailed brain anatomy without radiating or cracking open the skulls of patients. Procedures such and functional MRI and PET are unlocking function and physiology secrets in living patients without laying a finger on them.

8. Acute lymphocytic leukemia– There are 4000 cases of ALL in the US annually, 3000 of these occur in children at a peak age of 2 to 5 years old, making it the most common childhood cancer. 30 years ago it had 100%mortality and was a death sentence. Since then, the development of Bone Marrow transplantation, umbilical cord blood stem cell transplantation and a National registry allowing clinical trials on a massive scale, have lowered that mortality to 20% in five years, for the most common type, 90% go into complete remission with about 60% cured.

9. HIV/AIDS antiretrovirals– Just when you thought we were done with all the major advances these days, along comes a new and deadly plague with knocking out the bodies defenses causing 100% mortality. Intensive study into the human immunodefieciency virus has led to antiretroviral medications that can knock HIV to undetectable levels. While we are still looking for a permanent cure, the current state of the art is bright. Unfortunately, Africa and Asia are in the throes of crisis and the developed/undeveloped gap has reared it’s ugly head, just as it did in the past with vaccines and antibiotics. Here’s hoping for another smallpox type resolution, rather than measles or polio.

10. Insulin- In 1889, Oscar Minkowski and Joseph von Mering decided to remove a dog’s pancreas to test the organ’s role in digestion. The animals keeper noticed afterward that swarms of flies were attracted to the dog’s urine. Thus they demonstrated the first link between the pancreas and diabetes, leading to the discovery of the insulin as the hormone all higher lifeforms use to metabolize sugar from the blood.

Type I diabetes was 100% fatal whenever it hit prior to this discovery, and became treatable for the first time. First the hormone was derived from animals, now gene splicing has enabled the production of genetically engineered human insulin, delivery systems are advancing all the time with the ultimate dream envisioned of the artificial pancreas, or perhaps pancreas insulin producing cell transplantation. Many, many years of life have now been added to both type I and II diabetics around the world.

So the next time you read about diminishing returns of medicine in improving our health, take a good look at just where medicine has taken us. I don’t think many people would want to go back. While learning to control costs and improve efficiency, and wise use of technology will be critical to sustaining healthcare in the future, it is hard to overestimate the benefits of modern medicine. What do you think? Did I leave anything out?

   Medicine for the brain is incredibly complex.  Yet, the joke goes around medical circles that Neurologists are admirers of disease, not treater’s of it.  This is far less true now than forty years ago, and is rapidly becoming less and less true everyday, but that small kernel of truth does say something about we who are drawn to the field.  I really do find the disease processes that affect brain function seriously fascinating. 


 We learn almost everything we know about the brain from what happens when things go wrong.  Genetic diseases become our laboratory, nature the experimenter, allowing us to learn things we would be monsters for trying to recreate in the lab with people.  In fact, Nazi physicians are generally hailed as monsters for doing precisely this, reducing the person to lab rat.

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The always fun topic of autism and vaccines has been in the news again.  Truth is, it never leaves, but this time the whole movement has found new life and hope in the brave, new world of mitochondrial disorders.  It all started when the first ever vaccines caused my child to develop autism case was won in court a few months ago by one of my fellow child neurologists.  Now, with one case in the law books, a second has arrived. I thought I might attempt a look at the issues this brings up.

I am now breaking a vow of silence and entering dangerous territory, the swirling vortex of controversy that is Autism and vaccination.  This is a difficult path for my conflict avoidant self to tread.  The amount of blog space devoted to this subject is long, the tone is invariably impassioned and the feelings involved are raw.  In a way, this is more interesting to me than the question of whether vaccines cause Autism itself.  Why is this such a lightning rod of an issue?

Because they are babies!!!


    The answers are actually rather complex, but the biggest factor is dealing with children, whom we subject to multiple needles full of mysteriously weakened viruses and various unknown and frightening substances at regular intervals in our weakest and most vulnerable population.  This undoubtedly requires a great deal of faith and trust in the medical field. I know that we doctors do not always behave in a manner completely worthy of this trust.  The parent child relationship is intense.  Our desires to want the best for them are very real.  There is a very real impulse to take the frustration that comes along when all is not well with the child and direct it at the physician.  I know, because I walk the tightrope associated with this in dealing with the parents of sick children every day.  My hope is that I might allay a fear or two without appearing to be insulting the impassioned opposition.  I have a hard time faulting parents for caring too much.

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We hear a lot on-line about everything that is wrong is medicine. Improvement should always be our aim and this is healthy. I think it does us all a little good to take a step back and realize just what we have. There are some things medicine has done for us I don’t think you could put any price tag on. While most are intensely aware of shortcomings, here is a reminder of just what how powerful modern medicine has been. Read the rest of this entry »

So I started last week with the resolve that I will not post any further Points of Interest until it naturally fills itself with all categories. I refuse to dig for the treasure I share, but will give freely of my abundance. This will assure that reports of my romp through cyberspace will remain a labor of love and not simply labor. The odd thing is, this post wrote itself, and a day early. Sticking to my guidelines, here is the no longer weekly, but however long it takes to have the goods to share version of my points of interest, coming in just six days. Read the rest of this entry »

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