Advances in the Medical field.
Is Medicine an Art or a Science? For us physicians, Medicine is the science which allow us to diagnose, treat as well as prevent diseases. Centuries from the medieval times to the present, has bought different aspects of a science which refine itself to a point that Medicine is becoming a combination of Art and Science. The content of the medical knowledge, the tools used for medical investigations and even the details of medical treatments become refined. Let us re-visit some of the breakthroughs that have permitted physicians and healers to save life over the centuries.
Not much is known about our Neolithic ancestors, but we discovered that they were able to perform dentistry using flint tipped drills and bowstrings. Timothy Darvill and Geoff Wainwright, both British archeologists, believe Stonehenge in Southern England was the equivalent of Lourdes, a place which attracted healers and medicine men, a place where the sick looked for healing. Many during the years may have settled their permanent bases to provide care to the sick.
According to the Rigveda, an ancient Hindu text, a warrior queen named Vishpala, believed to be a rejected princess, received the first prosthetic leg, an iron leg, around the 12th century (1500-1200 BC). The leg was donated by the Ashwin’s, horse headed twin gods who fly around in a gold chariot, handing presents and healing the sick. The Ashwin’s reminded the modern Santa Claus.
Alcmaeon of Croton is described as one of the most eminent philosophers and scientist of all time. He was referred as a thinker of a considerable originality. He made the difference between veins and arteries, in 500 BC. He is called by many, the father of Neuroscience. More, he was considered as a pioneer and an advocate of anatomical dissection of animal and human bodies.
An Italian monk, Salvino D’Armate of Florence (1258-1312) was credited for the invention of the first wearable pair of glasses; They were convex lens able to correct hyperopia but could be used as well to correct presbyopia, in 1285. Some doubted the authenticity but a memorial plaque boring the inscription “Here lies Salvino degl’ Armati, son of Amato of Florence, inventor of “eyeglasses”, is the source of the credit.
Francois Magendie (1773-1855), a French physiologist is considered a pioneer of experimental physiology, pharmacology and pathology. He described the foramen of Magendie. He initiated studies on the effects of drugs on the body like Morphine and Strychnine. He isolated Emetine with Joseph Pelletier (1788-1842). He confirmed the observation made by the Scottish Sir Charles Bell in 1811 on the fact that the anterior roots of the spinal nerves were motor in function while the posterior roots communicate sensory impulses. He gave one of the earliest descriptions of the cerebrospinal fluid in 1825. He is believed to be the first modern medical scientist. Lessons of Anatomy have helped us give him more respect when the Hole of Magendie was dissected in laboratory.
Edward Jenner, an English physician and scientist, was the pioneer in creating the first world vaccine: the smallpox vaccine, in 1796. For centuries, Smallpox has devastated mankind and our island of Haiti also has suffered from an epidemy which took many lives. In modern times, we would not have to worry much about this disease but with the recent world trade center attack on September 11, 2001, the threat of biological warfare has bought back the fear.
Themistocles Gluck, a German physician, was an unrecognized genius. He invented the first endoprosthesis in 1890 at Berlin, Germany. The prosthesis was made from ivory. More than 130 years after, we are still using such component to secure a hip replacement allowing less wear down of the prosthesis. He performed the first documented total wrist arthroplasty.
Wilhelm Rontgen, (1845-1923) was a German mechanical engineer and a physicist who produced and detected electromagnetic radiation in a wave-length range known as X-rays or Rontgen rays, in 1895, achievement that earn him the Nobel prize in 1901.
Willem Einthoven, (1860-1927), was born on the island of Java, in the former Dutch East Indies, now Indonesia. Physician and physiologist, he invented the first practical electrocardiogram in 1903 and later received the Nobel prize for his work in 1924.
Alexander Fleming, (1881-1955) was a Scottish physician, microbiologist and pharmacologist who is best known for his discovery over the lysosome enzyme in 1923 and the first antibiotic substance: Penicillin, to fight infection. Fleming wrote numerous papers on bacteriology, immunology and chemotherapy. He was elected emeritus professor of bacteriology at the University of London in 1948. He became a Fellow of the Royal Society in 1943 and knighted in 1944. He received the Nobel prize in Medicine in 1945.
Rosalind Franklyn, (1920-1958) , was an English chemist and X-rays crystallographer who made contribution to the understanding of the molecular structure of DNA, RNA, Viruses, coal and graphite around 1952. This pioneer molecular biologist has allowed us to understand the mystery of the double helix. She won the Nobel Prize in 1963 and the next year, biologist James Watson and Francis Crick were able to build on the first DNA model. Rosalind Franklyn died four years after, victim of an ovarian cancer.
The American Surgeon John Heysham Gibbon, (1903-1973), performed the earliest successful open-heart by-pass operation using a heart-lung machine in 1953. This was a lifetime project, making him a leader and pioneer in the field of cardiac surgery. He remained as Chief of Surgery at Jefferson Medical College and wrote a standard textbook on chest surgery.
In 1957, the first intravenous infusion of bone marrow was performed on cancer patients. The bone marrow produces blood cells, immature cells called stem cells. Now day, it is common practice to call hematopoietic stem cell transplantation, a transplantation of omnipotent hematopoietic stem cells usually deriving from the bone marrow, peripheral blood or the umbilical cord blood. It may be autologous, allogenic or syngeneic, but it is used to cure a wide variety of life-threatening disease ranging from cancer to Immunodeficiency syndromes to anemias like Sickle cell disease.
Swedish surgeon Rune Elmqvist, also engineer and inventor (1906-1996), developed and implanted a Pacemaker, for the first time, in 1958 under the direction of a cardiothoracic surgeon Ake Sinning at the Karolinska University Hospital in Solna, Sweden.
The first birth control pill was approved in 1960. They were hormonal pills taken daily to prevent pregnancy in women. The medication was safe and affordable, effective with many health benefits in stopping the sperm from reaching the ovula (Fertilization). The hormones in the pills were able to prepare the endometrium in producing a thick mucus at the cervix, rendering difficult the road for the spermatozoids to swim toward an egg.
An American Physician, William Fouts House, otologist and medical researcher, (1923-2012), invented the first cochlear implant for profoundly deaf patients. Those implants were a neuro-prosthetic device, surgically implanted which provided a sense of sound to a person with severe to profound sensorineural hearing loss. Those implants bypassed the normal acoustic hearing process in replacing it with electric hearing.
Sir Godfrey Hounsfield was an English electrical engineer (1919-2004), who developed the first commercial Computed Tomography (CT) in 1967 with Allan Cormack after studying electronics and radar as a member of the Royal Force during the World War II. Both received the Nobel Prize for Physiology of Medicine in 1979.
Many names of American and Foreign physicians like Lawrence Bennett and Irwin Weisman bring practicality to the world of Magnetic Resonance Imaging (MRI) but, the preliminary work on ”magnetic resonance phenomena” will surface as a discovery, in 1946, by Felix Bloch (1904-1983), a Swiss physicist mainly working in the USA, on new ways and methods for nuclear magnetic precision measurements and Edward Mills Purcell (1912-19870), an American Physicist working on nuclear resonance in liquids and solids. They both won later, the Nobel Prize in 1952. Two other scientists also extended their work in different aspects of Magnetic Resonance Imaging: An American Paul Lauterbur (1929-2007) and Sir Peter Mansfield, an English physician (1933-2017), who shared also the Nobel Prize in Physiology and Medicine in 2003. They were able to assure the reproduction of MRI Images.
The world’s first child was conceived through in vitro fertilization. Born in 1978, her name was Louise Brown. In this process, an egg is combined with sperm, outside the body but in vitro after the woman ovulatory system was previously stimulated. An ovum was taken off to be fertilized by the sperm in the laboratory.
Puma 560 robotic surgical arm performed the first documented use of robot-assisted surgery. It was for a delicate neurosurgical biopsy. Then an industrial robotic arm developed by Victor Scheinman at the University of Stanford. Puma was purchased by Westinghouse (1980) and later by a swiss Company Staubli (1988). Nokia was also associated with the Puma company in the fabrication of the early models. The advantages in the new systems to overcome obstacles encountered in laparoscopic surgery are beneficial in increasing dexterity and restoring proper hand-eye coordination as well as improving visualization. Nowadays, a Nephrectomy or a Hysterectomy can be performed through a 5 to 10 inches long incision around the umbilicus or above the pubis. These systems make surgeries that were technically difficult or unfeasible previously, now possible.
Yoshizumi Ishino (1959- ), a Japanese molecular biologist and researcher discovered the sequence of clustered DNA, paving the way for gene editing, in 1987. Genome editing is a type of genetic engineering in which DNA is inserted, modified, deleted or replaced in the genome of a living organism.
Julio Palmaz (1945- ), an Argentinian Radiologist, invented the intravascular stent to prevent clogged arteries, at the University of Texas Health Center in San Antonio TX in 1988. Within four years of approval by the FDA, these stents, balloon expandable were used in more than 80% of percutaneous coronary interventions. This was an unparalleled success. Soon litigation between Palmaz and Johnson and Johnson were initiated until a district court in Delaware settled the issues.
Dolly the sheep (1996-2003), was the first mammal cloned from an adult cell. She was a female domestic sheep cloned from an adult somatic cell, using the process of nuclear transfer. She became by far the most famous clone although cloning has existed in nature since the dawn of life especially in asexual bacteria. Clone are all around us and are fundamentally no different to other organisms. A clone has the same DNA sequence as its parent and so genetically identical. Several clones have been produced before Dolly in frogs, mice and cows but the cells of embryos were used. This make Dolly remarkable for being the first clone from an adult cell, a major scientific achievement.
In 2000 a map of the nucleotide sequences for each chromosome in the human DNA was completed as part of work on the human genome project. Remember what a nucleic acid sequence is: a succession of letter indicating the order of the nucleotides forming alleles within a DNA or RNA molecule.
Laurent Lantieri, an eminent French plastic surgeon, performed the first full face transplant in 2005 on a man whose face was disfigured by elephant man disease. Face transplant has been a reality for now two years and successful transplant of the whole lachrymal system which produce tear as well as the mouth was achieved. Since, American surgeons have learned the techniques, and in November 2005, a woman received the first partial transplant (lip. nose and chin) in Amiens, France while another one full face transplant was performed at the Cleveland clinic.
San Diego Bioprinting Company Organovo-3D prints the first ever blood vessel. In the three-dimensional bioprinting, 3D printing and 3D printing -like techniques combine cells, growth factors and biochemical parts to maximally imitate natural tissue characteristics.
Finally, we can conclude that, the first decade of the 21st century brought discoveries, mistakes and medical advances that has influenced the world of Medicine, from Genomes to Hormones:
The Human Genome discoveries as discussed in the last AMHE Newsletter will help in explaining what our 23000 genes will do. We have already demonstrated the way, time and money have influenced our medical world, but many believe that Preventive Medicine will dictate how to approach a patient through their genes.
We may not have a national anti-smoking laws but already 27 states and the District of Columbia have adopted smoking bans in bars, restaurants and casinos cutting out exposure to second hand smoke. Such action will only reduce heart attack and death rate in people suffering of heart diseases. On the other side, doctors and hospitals are motivating patients to quit smoking.
Heart disease is decreased by 40% with cessation of smoking. New drugs that did not existed 15 years ago like the new statins, the TPA, “Tissue Plasmogen Activator”, Stent surgery and By-pass surgery have improved the outcome vascular disease. The American Heart Association set a decade goal that started bringing results. New treatment and Prevention combined have improved the mortality rate in heart disease.
We have already discussed the advances in the Stem cell researches in our last AMHE newsletter, but it is surprising to know that Europeans have genetically manipulated the bone marrow cells taken from 2 seven years old twin boys and then transplanted the altered cells into the sick boy, arresting the progress of a fatal brain disease called “Adreno-leuko-dystrophy” or ALD. Presently, we can make embryonic like stem cells directly from skin cells. New drugs based on stem cells are also being developed. The last ten years has shown spectacular progress.
A specific oncogene HER-2, estimated to be found in 25% of women breast cancer, will respond to HERCEPTIN even if powerful chemotherapy drugs have failed. This drug was presented by a team from Duke University. Another cancer drug called “Gleevec” target genetic mutations” bcr-abl” (b.c.r. able) that cause cancer cells to grow and multiply in patients with a variety of cancer including chronic myeloid leukemia (CML) or stomach cancer (GIST). Those agents open the door to new drugs able to control the growth and the blood supply of the tumors.
The introduction of a highly active anti-retroviral therapy with HAART has downgraded HIV/AIDS from a serious disease to now a chronic disease with survival stretching into decades. We remember well 25 years ago, any young patient with AIDS in the USA, will not live more than five years and will prepare himself to die but now, they are expected to live until their seventies once they continue taking their medication. Our next challenge will be to cure AIDS.
We have in the last twenty years, prescribed hormonal supplements like Estrogen or a combination of Estrogen and Progestin to protect patients from heart conditions especially after menopause. Hormone replacement therapy (HRT) were given to protect bones, brain, skin, libido or even symptoms like hot flashes, sleep disturbances, depression until the National Heat lung and Blood Institute stopped supporting the program because of an increase in risk of heart attack, stroke, blood clots and breast cancer. Inversely, HRT did show an impact in reducing colorectal cancer, fractures and post-menopausal hot flashes.
We have already demonstrated the impact of MRI in the field of Medicine. Nowadays, sophisticated imaging techniques can map the way the brain works in tracing neurons, brain cells, by tracking oxygen level and blood flow while a patient lies awake inside the MRI Scanner.
The difference between the world in which we are living and 150 years ago is not based on internet or new planes or even nuclear weapons. It is based on the LIFESPAN. We doubled our lifetime expectancy, now 80. You would have been dead in the past with Smallpox, now eradicated because of the vaccine, or the Cholera would have infected you, but you have now filtered and chemically treated water. One can always ask himself why we are not dead yet and everybody will have an explanation to justify such existence. Remember well that life-saving treatment have become routine.
We still need to look for answers why so many premature deaths and what can we do to grant people in poorer countries the same life expectancy we enjoy. If in the past, people have died of Tuberculosis, Unexplained Fever, Infectious or parasitic diseases, we have learned how to prevent complications and treat such diseases. It is always good to look backward.
We have mastered in the 20th century microbes, bacteria, parasites, viruses and have learned how to avoid their infestations. Death can be mysterious, but we have always found an explanation and a solution to fight back. The science of medicine will bring light in our search of the unknown, a way to fight because we cannot afford to lose. This is a fight of a Lifetime.
Maxime Coles MD
References:
1-Popular Science, Special Edition. Our Future Body-“Medicine Advances so Far”. PP 6-7.
2- Medpage Today.” The Top Ten Medical Advances of the Decade”.
3- Wikipedia, the free encyclopedia. “3 D Bioprinting”.
4-Wikipedia, the free Encyclopedia. “Genome Research”.