History Of Medical ScienceHistory Of Medical Science

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Why History MattersWhy History Matters

Constant Change for 150+ YearsConstant Change for 150+ Years• Limited Development of Societal Limited Development of Societal

ConsensusConsensus• Always Ahead (or Behind) The LawAlways Ahead (or Behind) The Law

Classic Divisions Still PrevailClassic Divisions Still Prevail• ShamanismShamanism• Greco-Roman RationalismGreco-Roman Rationalism

The Best and Worst of TimesThe Best and Worst of Times

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ShamanismShamanism

Oldest MedicineOldest Medicine Primitive TribesPrimitive Tribes Alternative MedicineAlternative Medicine Integrates Religion And MedicineIntegrates Religion And Medicine Persists Even Today In So Called Persists Even Today In So Called

Modern CulturesModern Cultures

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Explicitly Ministers To The Explicitly Ministers To The Psyche And The BodyPsyche And The Body

Driven By MythsDriven By Myths Trial And Error And Careful ObservationTrial And Error And Careful Observation Often Sophisticated Rituals And HerbalsOften Sophisticated Rituals And Herbals Some Cure, Most Do NotSome Cure, Most Do Not LeviticusLeviticus

• Public Health CodePublic Health Code• Rules Reduce Food PoisoningRules Reduce Food Poisoning

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Useful PharmacopeiaUseful Pharmacopeia

EthnobotanyEthnobotany• Study Of Plants Used By Ritual HealerStudy Of Plants Used By Ritual Healer• Many Drugs Have Been Discovered This Many Drugs Have Been Discovered This

WayWay• Witches Used Foxglove - DigitalisWitches Used Foxglove - Digitalis

Medicinal ChemistsMedicinal Chemists• Refine And Modify BotanicalsRefine And Modify Botanicals

Conflicts Over Ownership of Indigenous Conflicts Over Ownership of Indigenous RemediesRemedies

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Greco-Roman RationalismGreco-Roman Rationalism

Galen And SuccessorsGalen And Successors Driven By Rational TheoriesDriven By Rational Theories Religion Is Left To PriestsReligion Is Left To Priests Observations Forced To Fit Into The Observations Forced To Fit Into The

TheoryTheory• Plato Was Terrible About ThisPlato Was Terrible About This• Mistakes Are Not CorrectedMistakes Are Not Corrected

Predominant Until 16th CenturyPredominant Until 16th Century Still Lurks in Clinical DecisionmakingStill Lurks in Clinical Decisionmaking

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Modern Medicine/Scientific Modern Medicine/Scientific MedicineMedicine

Not The Philosopher's Scientific Not The Philosopher's Scientific MethodMethod

The Imperative To Disprove The Imperative To Disprove TheoriesTheories

The Full Disclosure Of InformationThe Full Disclosure Of Information Science Is Constantly Questioning Science Is Constantly Questioning

And RethinkingAnd Rethinking

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Systematic Observation is Systematic Observation is the Keythe Key

Diseases Have Variable CoursesDiseases Have Variable Courses Patient's Have Variable ConditionsPatient's Have Variable Conditions Serious Participant-Observer Serious Participant-Observer

ProblemProblem Controlled Studies Are Key Controlled Studies Are Key

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Problems With Controlled Problems With Controlled StudiesStudies

CCUCCU• Cannot Control Variables WellCannot Control Variables Well• Many Things Do Not WorkMany Things Do Not Work• Rating The Severity Of The Patient's Rating The Severity Of The Patient's

ConditionCondition Treatment Of ControlsTreatment Of Controls

• Someone Gets The Old/No TreatmentSomeone Gets The Old/No Treatment• Cannot Use Drugs Until Trials Are OverCannot Use Drugs Until Trials Are Over

AIDS ExampleAIDS Example

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Science Versus ScientistsScience Versus Scientists

Scientists Are Just PeopleScientists Are Just People• Probably More Honest Than MostProbably More Honest Than Most• Some Are CorruptSome Are Corrupt• Some Are NaïveSome Are Naïve

Science Is Process, Not PeopleScience Is Process, Not People• Weeds out the Bad StuffWeeds out the Bad Stuff• Can Take TimeCan Take Time

Lawyers Seek Out The WorstLawyers Seek Out The Worst

A Brief Chronology of A Brief Chronology of MedicineMedicine

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ParacelsusParacelsus

Philippus Aureolus Theophrastus Philippus Aureolus Theophrastus Bombastus Von HohenheimBombastus Von Hohenheim

Early 16th CenturyEarly 16th Century Transition From AlchemyTransition From Alchemy Experiments And Systematic Experiments And Systematic

ObservationsObservations AntimonyAntimony

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Anatomy And FunctionAnatomy And Function

Andreas VesaliusAndreas Vesalius• Mid 16th CenturyMid 16th Century• Accurate AnatomyAccurate Anatomy

William HarveyWilliam Harvey• Early 17th CenturyEarly 17th Century• Flow Of The Blood And Operation Of Flow Of The Blood And Operation Of

The HeartThe Heart

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Edward JennerEdward Jenner

SmallpoxSmallpox Major KillerMajor Killer Wiped Out The Indigenous PeoplesWiped Out The Indigenous Peoples 1798 – Published His Book On 1798 – Published His Book On

CowpoxCowpox

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John SnowJohn Snow

Cholera In LondonCholera In London Broad Street Pump Broad Street Pump Proved Cholera Is WaterborneProved Cholera Is Waterborne 18541854

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Ignaz Philipp SemmelweisIgnaz Philipp Semmelweis

Childbed FeverChildbed Fever Fellow Medical Student DiedFellow Medical Student Died Controlled StudiesControlled Studies 18491849

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Louis PasteurLouis Pasteur

Scientific MethodScientific Method Germ TheoryGerm Theory Vaccination For RabiesVaccination For Rabies PasteurizationPasteurization 1860s-1880s1860s-1880s

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Foundation of Modern Foundation of Modern SurgerySurgery

William MortonWilliam Morton• AnesthesiaAnesthesia• 18461846

Joseph ListerJoseph Lister• AntisepsisAntisepsis• 1867-1880s1867-1880s

Surgery Became Big BusinessSurgery Became Big Business Drove Development of HospitalsDrove Development of Hospitals

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Infectious DiseasesInfectious Diseases

Koch’s Postulates - 1880sKoch’s Postulates - 1880s• Agent Must Be Present In Every Case; Agent Must Be Present In Every Case; • Agent Must Be Isolated From The Host And Agent Must Be Isolated From The Host And

Grown In Vitro [In A Lab Dish]; Grown In Vitro [In A Lab Dish]; • Agent Must Cause Disease When Inoculated Agent Must Cause Disease When Inoculated

Into A Healthy Susceptible Host; And Into A Healthy Susceptible Host; And • Agent Must Be Recovered Again From The Agent Must Be Recovered Again From The

Experimentally Infected Host.Experimentally Infected Host. LimitationsLimitations

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Tuberculosis Control - Tuberculosis Control - 19001900

The Major KillerThe Major Killer Koch And PasteurKoch And Pasteur SanatoriaSanatoria Pasteurization Of MilkPasteurization Of Milk Disease Control Of Dairy HerdsDisease Control Of Dairy Herds

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Drug Chemistry – 1880sDrug Chemistry – 1880s

German/Swiss Dye IndustryGerman/Swiss Dye Industry BayerBayer Hoffman La RocheHoffman La Roche CibaCiba

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AntibioticsAntibiotics

Sulfa Drugs In The 1930sSulfa Drugs In The 1930s PenicillinPenicillin

• Alexander Flemming – 1928Alexander Flemming – 1928• Purified By Chain And Florey In 1939Purified By Chain And Florey In 1939• World War II - Coconut Grove Fire (1942)World War II - Coconut Grove Fire (1942)

Streptomycin – 1944Streptomycin – 1944• First Antituberculosis DrugFirst Antituberculosis Drug• Selman Abraham Waksman – 1944Selman Abraham Waksman – 1944• (Coined The Term Antibiotic(Coined The Term Antibiotic

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Post World War IIPost World War II

Conquering Microbial DiseasesConquering Microbial Diseases• VaccinesVaccines• AntibioticsAntibiotics

Chronic DiseasesChronic Diseases• Better DrugsBetter Drugs• Better StudiesBetter Studies• LeukemiaLeukemia

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TechnologyTechnology

MicroelectronicsMicroelectronics• MonitorsMonitors• PacemakersPacemakers• VentilatorsVentilators• Heart-Lung MachinesHeart-Lung Machines

DialysisDialysis Most Depend On DrugsMost Depend On Drugs

• InfectionsInfections• RejectionsRejections

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New ChallengesNew Challenges

Aging PopulationAging Population Failure of Public HealthFailure of Public Health Antimicrobial ResistanceAntimicrobial Resistance Justice IssuesJustice Issues

• How To Pay For Health CareHow To Pay For Health Care• How To Deliver Health CareHow To Deliver Health Care

Should Health Care be a Right?Should Health Care be a Right?