Honoring the past; challenging the future
This year, Medical Clinics of North America, a medical review journal, celebrates its 100th anniversary by looking back at some of the most significant medical innovations to grace its pages over the past 100 years. Medical Clinics has covered innovations from the opening of the first family planning and birth control clinic in the United States in 1916, to the development of cardiopulmonary resuscitation (CPR) in 1960, and the world’s first 3-D printed organ tissue in 2015.
Of the many world-changing advances described in the pages of MCNA, which ones occupy the very top tier? Which innovations over the past century have had the most significant impact on individual and global health?
My opinion of the top five medical innovations includes:
The development of antibiotics has saved billions of lives over the course of the past century. The most significant step could well be the discovery of penicillin in 1928. However, it wasn’t until 1939 when the word “antibiotic” was used to describe a compound that harms bacteria without being toxic to human cells. Four years later, the antibiotic streptomycin was discovered, which was subsequently used to treat tuberculosis and other diseases. Since then, hundreds of new drugs have been developed in a continuing battle with very adaptive bacteria, viruses and parasites.
Widespread vaccination, development of antibiotics and improved sanitation are the main causes of the marked jump in life expectancy in the 20th century. Key discoveries include development of the first influenza vaccine in 1945; the polio vaccine in 1955, which ultimately was responsible for eradicating infantile paralysis; the measles vaccine in 1964; and the chicken pox vaccine in 1974. In 1986, the first vaccine produced by DNA technology for hepatitis B was approved by the U.S. Food and Drug Administration (FDA). Vaccines for bacterial diseases such as pneumococcal pneumonia and Haemophilus meningitis have added a new and valued dimension to this domain.
3. Organ Transplantation and Substitution
Biological and technological replacement for some of the body’s major organs/processes has extended and enhanced the lives of millions. Technological substitutes can support major functions for brief or episodic periods, such as dialysis, developed in 1943, and cardiopulmonary bypass, demonstrated on animals in 1935 and first used clinically in humans in 1953.
Biological transplantation to completely replace the functions of a damaged organ for an extended period of time was first demonstrated in humans in 1954 when a kidney transplant was performed between identical twins. The first human heart transplant was performed in 1967, and in the ensuing half century, we have seen lung, liver, cornea, pancreas, bone marrow and face transplants, among others. The intersection of these two approaches – long-term artificial replacement – first became reality with artificial joints, and is now expanding into computer-supported organs such as artificial cochlear and eye implants.
The discovery of the structure of DNA in 1953 and the breaking of the genetic code in 1961 set the stage, the completion of the human genome sequence in 2000 produced the outline, and other innovations have led to the now-exploding world of medical applications of genomics. Genomic testing to assess disease risk, cancer subtyping and drug responsiveness are in wide clinical use.
The development of gene editing innovations such as CRISPR-Cas9 in recent years has made genetic modification at scale possible, showing promise in treating conditions such as muscular dystrophy and leukemia. At the same time, its huge potential power has led to a vigorous social and ethical debate over where it should and should not be used. We have finally reached the era where genomics is fulfilling its tremendous potential for driving precision medicine and addressing major disease problems.
5. Birth Control
The development of safe and widely available birth control methods is a huge advance, impacting population health the world over. Of course, birth control techniques have been around for centuries, but the advent of the diaphragm in the 1930s and particularly the first available oral contraceptive in 1960 made birth control reliable and convenient for millions.
Later innovations including the IUD (1968), safer low-dose pills (1980s), and long-lasting implantable contraceptives (1990) have increased the safety, reliability and flexibility of birth control. As with genomic medicine, the history of birth control innovation also includes the ongoing social, ethical and religious debate about its use, a debate which continues to this day.
The Next 10 Years
Given this impressive track record, what will the next century bring? With the growth of technology, it is almost inconceivable to think 100 years ahead in health innovation, but we can at least speculate 10 years ahead.
The next decade or so will see key advances and opportunities, including:
- Battling infection. The world needs to discover a more fundamental method of treating infections. Right now, the “arms race” taking place between bacteria and antibiotics is escalating, and we are losing the latest battles. We must find new methods that get around the resistance mechanisms of bacteria, just as the bacteria “discovered” mechanisms, through natural selection, to get around the antibiotics.
- Omics. Many more applications of genomics, proteomics and metabolomics will be developed, supported by the growing focus on personalized medicine. We can hope to see solutions addressing such areas as: identifying and managing overweight individuals who are insulin resistant; identifying the relation between nutrition and growth in healthy children; or determining the cellular response of malignant tumors to conditions such as hypoxia.
- Analytics and clinical decision support. Information technology will help us understand where problems lie and what to do about them, for a single patient or a population. Analytics can identify which patients, in which situations, can benefit from modifications in their personal health and medical treatment plan. Clinical decision support can make the clinician and patient aware of these findings andidentify the best diagnostic and treatment steps to prevent errors, optimize care and maximize health. Both technologies are advancing in capabilities and availability. We must still improve the overall sensitivity, specificity and usability of both; innovations in these two related technologies, especially combined, will have a profound impact on healthcare effectiveness.
- 3D printing. This is a field barely into its adolescence, yet we have already seen it move from basic plastic toy building to printing biological tissues, vascular systems, prosthetics and whole internal structures. Expect to see materials, techniques and applications expand rapidly.
Future Challenges: Innovation in Quality of Life
While the future of medicine and healthcare holds many opportunities and promises, it also presents some critical, thought-provoking challenges. Medicine today is arriving at a point where the concern is less about preserving life and more about enabling a healthier and happier life. The dilemma we are faced with is that increasingly, with thanks in part to the advances above, people are not only outliving their happiness, but spending their remaining years in a frail state physically, mentally and emotionally.
During our training, physicians are often taught that preserving life is everything. But along with focusing our research on life-extending innovation, I hope that we can set our priorities and our resource allocation even higher on conditions such as stroke and Alzheimer’s disease that end minds, relationships, happiness, mobility and resources.
Wouldn’t it be worthwhile if everybody who lives to 85 arrives as a bright, happy and healthy 85, still recognizing and engaging with their family? What innovations – whether social, technological, biochemical or otherwise – can preserve the identity of our loved ones for as long as modern medicine has now preserved their lives? This will be a significant issue – perhaps the most significant issue – in the years ahead, not only for individuals but for families and society as a whole.
It is almost mind-boggling to consider how medicine has evolved over the past 100 years. That pace will continue to accelerate as science and technology evolve. One can only imagine where medicine will be in the next 10, 20 and inconceivably, 100 years. Will the world be ready for it?