Dr Alfred Dawes | The slow march of medicine
We are often bombarded with news about the advances in the field of medicine at an alarming rate. New drugs, new technologies and new treatment methods are replacing older ones almost daily. However, when you examine these 'breakthroughs', we realise that many are only improvements on existing technologies and not really paradigm shifts. In fact, the field of medicine is one where paradigm shifts are fiercely resisted by the establishment, leading to delays in implementing newer standards of care and resulting in needless loss of lives.
If you believe that we are racing ahead at light speed, think on these facts. Chemotherapy as a treatment for cancer was discovered during World War II, yet we still have no real cure for cancer. The amazing improvements in CAT scan imaging are merely improvements on a machine invented in 1972. This is akin to improvements in the new iPhone. Antibiotics were discovered in 1928, yet we still lose millions of lives each year as a result of infections. Vaccines were discovered in 1796 and we have only improved on the methods of making vaccines rather than create a new way of preventing infections by boosting the immune system. Laparoscopic surgery was first performed in 1910 and popularised in the 1970s and 1980s. When we fawn over the advent of robotic surgery, we should be reminded that these robots are merely improvements in the field of laparoscopy. Surgery has not moved much beyond improving on technology created 100 years ago.
Probably the most unbelievable example of how health-care professionals resist change to the detriment of their patients is the story of Ignaz Semmelweis. Semmelweis was a doctor working in a maternity ward in Austria in the mid-19th century. He came up with the notion that if doctors washed their hands after autopsies and before they delivered babies, fewer mothers would die from fever after childbirth. Despite reducing death rates from 18 per cent to less than two per cent, the idea was scorned by the establishment and it was only years after he died, along with countless mothers, that the practice of hand washing became standard in medicine.
Other pioneers who have stood up to the prevailing scientific opinion of their time have been met with ridicule and often hostility. For years, it was believed that it was stress and not eating properly that caused stomach ulcers. Even though patients were bleeding out, necessitating surgery to prevent death in some instances, the medical field refused to accept a radical theory about the cause of ulcers and stomach cancer, proposed by an Australian doctor, Barry Marshall. Dr Marshall and his co-researcher Dr Robin Warren believed that it was the infection of the stomach by a bacterium H. Pylori that caused ulcers. But it was well-established opinion in the scientific world that bacteria could not grow in the harsh acidic environment of the stomach. Frustrated by the stonewalling, Marshall drank some broth infected with the bacteria. He got violently ill with gastritis, the precursor to ulcers. His condition improved only when he took antibiotics that treated the infection, leading to curing his gastritis. The medical community, however, continued to baulk at the idea when confronted with this evidence. It took another 10 years before the idea of treating ulcers with antibiotics became an established practice.
Today, we still continue to resist paradigm shifts. One area is in the treatment of obesity. For years, the medical community has scolded overweight patients into dieting and exercising even when the success rate was observed to be poor. It is only now, with mounting evidence that the fat in our bodies produce hormones that resist weight loss and promote weight gain, that we have begun to acknowledge that diets and exercise programmes are not for everyone. Yet there is continuing resistance in accepting that weight-loss surgery is the best treatment for some patients, especially those who suffer from chronic non-communicable diseases such as hypertension and diabetes. Instead, overweight and obese persons continue to be fed with false teachings that they can lose the weight and improve their diseases by going on a diet.
One recent attempt at a paradigm shift is in the treatment of diabetes. The gastric bypass surgery has been shown to have about a 75 per cent success rate in curing diabetes. This is becoming more mainstream in developed countries, as physicians and patients are exposed to the results of the numerous studies on the procedure.
However, there is an even better procedure, known as the Ileal Interposition, that has a cure rate for diabetes of more than 95 per cent. This procedure is not approved in the United States and is only practisced by a few surgeons, in spite of it being the best chance yet at stopping the diabetes epidemic. The problem is the same as what was encountered by Semmelweis more than 170 years ago - doctors and scientists refuse to believe that the solution to the problem could be something they don't believe in. Even the very surgeons who are at odds with endocrinologists and physicians with respect to the surgical management of diabetes are reluctant to adopt this new procedure. Meanwhile, diabetes continues to create havoc across the globe.
Who knows what cures are lying dormant while those at the frontiers of science are crippling the advancements that can change the way we treat diseases and save lives? The tendency for humans to resist paradigm shifts has delayed our advancement as a species, and will continue to do so even as we hypocritically praise innovation. Luckily, there are the mavericks that defy the status quo and push heretical ideas that propel humanity forward by leaps and bounds. It is these men and women who have, through their resilience, helped to create a better world, even for their biggest detractors.