Medical Progress in the Last Two Centuries

Introduction

• In 1812, medical knowledge was very limited.
  • No understanding of infectious disease.
  • Poor health outcomes, especially for women and children.
  • Surgery was unsanitary and without anesthesia.
  • Cancer was largely unrecognized.
• Two centuries later, significant improvements in life expectancy and quality of life.
• The film explores stories of medical progress focusing on research, clinical practice, patient advocacy, and information translation.

Surgical Advances

Early Surgery and Anesthesia

• Before anesthesia, surgery was brutal and terrifying.
  • Patients were inebriated, operations were bloody and quick.
• 1846: Ether used successfully by Dr. John Collins Warren.
  • Revolutionized surgery, allowing more complex operations.
• Introduction of ether anesthesia made pain relief a surgical goal.
  • Reports spread quickly, standardizing its use.

Battle Against Infection

• Early surgeries had high mortality due to infections.
• 1847: Ignaz Semmelweis discovered handwashing could prevent puerperal fever.
  • His findings were not widely accepted due to lack of scientific explanation.
• 1860s: Joseph Lister applied Pasteur's germ theory to reduce infections with antiseptics.
  • Lister's methods faced resistance but eventually led to aseptic surgery.

Modern Surgical Practices

• Surgical teams use checklists to improve safety and outcomes.
  • Checklist elements include patient verification, equipment checks, and team briefings.
• Emphasis on minimally invasive techniques and team coordination.

Cancer Treatment and Genetic Research

Early Cancer Treatment

• In the 1930s, cancer treatment was limited to surgery and crude radiotherapy.
• 1946: Sidney Farber experimented with chemicals for leukemia treatment.
  • Initial trials with folic acid failed, leading to the successful use of antifolates.
• The Jimmy Fund was launched to support cancer research.

Advances in Chemotherapy

• 1950s-1970s: Development of protocols for chemotherapy combinations and cranial radiation.
  • Discovery of variations in leukemia types led to better-targeted treatments.

Targeted Cancer Therapy

• The Philadelphia chromosome in CML allowed for targeted therapy with imatinib (Gleevec).
  • Imatinib was a paradigm shift, being one of the first targeted therapies.
• Cancer genetics continues to evolve, providing more personalized treatments.

HIV/AIDS Research and Treatment

Early AIDS Epidemic

• Early 1980s: HIV/AIDS identified, initially with high stigma and fear.
• 1984: HIV identified as the cause of AIDS, leading to blood tests.
• ACT UP advocacy for HIV treatment and awareness.

Breakthroughs in HIV Treatment

• Late 1980s-1990s: Development of AZT and other antiretrovirals.
  • AZT significantly reduced mother-to-child transmission.
• 1996: Highly active antiretroviral therapy (HAART) introduced.
  • Drastically improved life expectancy and quality of life for those with HIV.

Global Efforts and Progress

• PEPFAR and the Global Fund helped scale treatment in developing countries.
  • Drastically reduced the cost of treatment.
• Ongoing challenges include access to care and managing long-term complications.

Conclusion

• Medical progress has been uneven but transformative over the last two centuries.
• Advances in surgery, cancer treatment, and HIV/AIDS therapy have significantly improved health outcomes.
• Ongoing challenges include managing the complexity of modern treatments and ensuring global access to care.