Way to Go

Eisenhower’s care shows how little doctors could do for heart attacks in 1955, three years before I entered medical school, where we were taught that medicine would be a lifetime of learning.

For me, an electrifying moment came in the early 1960s. Dr Bernard Lown of Harvard reported how a shock of direct current applied to the skin over the chest at a precise point in the heart beat could safely correct a number of dangerous heart rhythms. Alternating current could not be used because such shocks were often lethal. But application of the direct current technique helped make open-heart surgery ¿ and many other advances ¿ possible. In time, pacemakers came along. Now we have implanted devices that serve as both pacemakers and defibrillators. They can automatically detect a life-threatening abnormal rhythm and then shock the heart. Vice President Dick Cheney, who had a sophisticated pacemaker and defibrillator implanted in 2001, is perhaps the most prominent recipient of these advances.

DRUGS THAT CAME BACK:

Thalidomide has gone through an amazing resurrection. In the 1960s, the FDA kept thalidomide off the American market (though some doctors gave out free samples). Its use in other countries soon showed that the drug produced flipper-like arms and other ghastly birth defects among children born to mothers who took the drug as a sedative or for morning sickness. Now thalidomide is approved for a complication of leprosy, and doctors prescribe it off-label for some cancers.

Anti-rejection drugs have allowed organ transplant surgery to flourish, though no one has solved the organ donor shortage that deprives many people of a chance at longer lives.

Although doctors had measured blood pressure, few believed until the 1960s that lowering high blood pressure would prevent complications like strokes, heart attacks, loss of vision and kidney disease. In medical school, a standard therapy was the sedative phenobarbital. Now, people take more effective medications, like diuretics, to prevent these hazards.

A million test tube babies would not have been born without the in vitro fertilisation technique introduced in 1978. And immunisations introduced in recent years protect children against infections that include chicken pox, hepatitis A and B, measles, mumps and pneumococcal pneumonia.

FINDING BOTOX: As epidemiologist at the Centers for Disease Control and Prevention, I helped investigate some of the last outbreaks of polio in the United States. We used vaccine-laced sugar cubes that were easier to administer than injections in a public health emergency. I also helped investigate outbreaks of botulism, a food-borne disease produced by one of the deadliest toxins known. A few researchers mused about turning the toxin into a useful drug for serious neurological problems. That vision became Botox. But none of us dreamed that the most common use would be cosmetic, to temporarily erase the visible wrinkles of aging.

IMAGING TECHNOLOGY:

As the son of a radiologist whose office was in our home, I grew up seeing conventional X-rays displayed on my father’s light boxes. When I went to London in 1973 to report on the first brain CT scanner, I was astonished to see how it could detect tumours, strokes and other disorders that never could be seen on X-rays. Later versions of CT, MRI and PET scanners revolutionised medical practice. These scanners have simplified the decision-making process, allowed the development of simpler and safer procedures, and eased suffering for patients.

Imaging technology also has reduced the need for exploratory surgery to detect various abnormalities. Now, CT scans can detect an abdominal abscess, for example, and have reduced what once required three operations to one.

FIBRE OPTICS: Medical instruments made from fibre optics have enabled doctors to peer into many areas of the body that previously were inaccessible or that required major surgery. One example, colonoscopy, detects intestinal polyps before they become cancerous. Another involves the repair of torn ligaments and tissues in knees and other joints.

CATARACT: In ophthalmology, cataract patients once had to stay immobilised in a hospital for about 10 days. Sandbags were positioned to prevent any movement of their head to protect the newly implanted lens. Now a technique called phacoemulsification allows a lens to be implanted in a simpler cataract operation performed as an outpatient procedure.

AIDS: During my training, most professors said that all diseases were known. That hubris left doctors unprepared when AIDS came along in 1981 to cause one of history’s worst pandemics. The Human Immuno Virus (HIV) has infected an estimated 60 million people and killed 25 million.

In 2002 and 2003, came along a new disease, severe acute respiratory syndrome, or SARS, spread from China to Canada and elsewhere. Scientists, in a rare World Health Organisation collaborative effort, quickly identified the cause: a new coronavirus.

But we still do not know, for example, the precise biological mechanisms of basic life events like labour. Back to work, then.

—LAWRENCE K ALTMAN / NEW YORK TIMES