Medicine's Decline

THE RISE AND FALL of MODERN MEDICINE,
James Le Fanu, MD, Carroll and Graf Publishers, Inc., New York, 424 pp., ISBN: 0-7867-0732-1

But there has to be an explanation for this history as the author sees it and for those of us unable to accept a Fall. What inspired post-war medical achievement? And sustained it? What can it teach us in general about the nature of scientific solutions and the origins of scientific innovation?

All were diverse and often accidental and, after World War II, there was a pent up enthusiasm to be released. There was a rise in clinical science and a fusion of chemistry with capitalism to aid pharmacology, technology and the mysteries of biology. Technology and drug innovation "made possible spectacular breakthroughs in the treatment of disease without the requirement of any profound understanding of its causation or natural history."

This rise in clinical science also caused the best interests of the patient to become, in the name of progress, secondary to the scientific scrutiny of the illness; useful drugs increased from a handful to thousands; and technology-the heart pump, dialysis, endoscopy-liberated experimentation.

This well-written, completely referenced book lists and unravels 10 definitive moments in modern medicine: the discovery of penicillin, the discovery of cortisone, the identification of smoking as the cause of lung cancer, the cures of tuberculosis with streptomycin and Pas, open heart surgery, kidney transplantation, the prevention of strokes, cures of childhood cancer with chemotherapy, the first test-tube baby, and helicobacter as the cause of peptic ulcer.

These definitive moments, chosen from a longer list of innovations, were not the products of scientific reasoning, but accidents. Alexander Fleming picked up a petri dish waiting to be washed and noted that a contaminating mold inhibited a colony of staph. However, even though fluid (penicillin) from the mold inhibited other bacteria, its use was not pursued for 10 years.

The therapeutic potency of cortisone for rheumatoid arthritis and other conditions could not have been anticipated, "a gift from nature whose discovery was quite fortuitous." Among other intriguing accounts is one on the rise and fall of heart disease. Is there an organism responsible? The first heart was opened and was quickly followed by the development of the heart pump and many more surgical procedures until success assured the survival of patients.

Then statistics elucidated the cause of public health problems and the effectiveness of treatment, especially important in the control of tuberculosis. Clinical trials were indispensable in evaluating the new drugs developed in the wake of early discoveries.

There were drugs for treating psychiatric illnesses that had been woefully neglected. Chlorpromazine quieted schizophrenics, making them more manageable and thus aiding recovery although there was no understanding of the nature of the problem being treated, or why the treatment worked.

Other drugs lowered blood pressure to help prevent strokes. When drugs controlled immunity responses, kidney and organ transplants were possible.

All these accounts are absorbing and we are shocked when the Fall occurs with the introduction of Social Theories and the blame for disease on environment, on habits of living and on food consumption. There are too many environmental regulations and no understanding of disease processes.

There is also the New Eugenics and biology shows itself to be too complicated for genetic corrections not to fail. The discovery of disease genes has not resulted in successful gene therapy. There is a dearth of new drugs. Technology has over-investigated. The promises for fetal monitoring discoveries and the saving of babies have been disappointing. There has been too much intensive care to prolong the dying that aging inevitably brings.

A Fall after a spectacular success is difficult to accept, but history shows that every field of knowledge has a Golden Age followed by a decline in creativity and new ideas. Medicine has reached the unsolvable at both ends of the life span, reducing infant mortality and extending aging. It has left doctors disillusioned; medicine is now dull. Well persons are worrying too much and costs of medical care are increasing.

The falsehoods of the Social Theory and the New Eugenics must be discarded and the university departments of epidemiology closed down. The past must be recalled and an effort made to get back to preventing disease, relieving suffering and healing the sick.

Dr. Le Fanu gives us the story of medicine during the last 50 years, its ups and downs, and explains the present state of dissatisfaction in the medical profession. He suggests a return to basics.

I suspect there will be argument.

ebr8809@aol.com