What's Happening to Medicine: Autopsy Report (2)

2024 Author: Seth Attwood | [email protected]. Last modified: 2023-12-16 15:55

In a series of posts, I will briefly talk about what has been happening in medicine over the past few decades, and where it should go next. Topic of the second note: What are the advances in medicine over the past 50-100 years?

You can read about the author in the first note.

I am building my story from the answers to a number of key questions:

1. What are the needs and unresolved problems of medicine?

2. What are the advances in medicine over the past 50-100 years?

3. What are the real prospects for the "most promising" directions in "medicine of the 21st century"?

4. What are the obstacles to the development of medicine?

5. Where to develop medicine in the 21st century, taking into account the social, economic, scientific and technological context?

I try to adapt the text to the "skilled user" level - i.e. a person with common sense, but not burdened with many stereotypes of professionals.

I will make a reservation right away that there will be many controversial judgments and departures from the medical mainstream.

So, let's talk about the progress of medicine in the last 50-100 years

In the first article of this series, we touched on the topic of unsolved problems of today's medicine. It turned out that for the end consumers - patients - the methods of prevention of the most common chronic diseases are not established, access to medical care is limited, and the available help is not effective enough (often dangerous). From the point of view of the state and other structures funding medicine, too much money is spent on unnecessary or incorrectly prescribed drugs or procedures, and technological progress (including the development of new drugs) is too expensive. Deepthe problem is the conflict between the interests of key players in the health sector (namely, making a profit) and the goals of health care itself.

What was the situation 100 years ago? What problems did medicine face then? How did you manage to cope with these problems?

Unresolved problems from the point of view of patients and society can be judged by the structure of mortality. For simplicity, let's take a look at the data from the United States, a country considered to be the "benchmark" of progress in medicine.

During the 20th century, the overall mortality decreased significantly, by about 2 times, with the sharpest decrease occurring in the first half of the century (see figure).

What happened? It turns out that the structure of mortality has changed very noticeably: below are the top 5 causes (source 1, source 2, source 3).

Taking into account the absolute figures (available in the cited sources), it is easy to conclude that the sharp decline in mortality from 1900 to 1950. happened due to an almost 10-fold decrease in mortality from tuberculosis, an almost 7-fold decrease in mortality from influenza and pneumonia, and a multiple decrease in mortality from gastrointestinal infections.

Back in the late 1950s, publications appeared in the United States that significant successes in reducing mortality were achieved not due to "laboratory medicine", but due to social reforms and an increase in the well-being of the population, but already in the 1970s this position was considered "heretical."

Researchers who analyzed this issue in detail, came to an unambiguous conclusion:

1) the decrease in mortality in the USA (as well as in Great Britain) in the first half of the 20th century was due to infectious diseases;

2) the severity of airborne infections has decreased due to an overall improvement in nutrition;

3) the severity of infections transmitted through water and food has decreased due to sanitary and hygienic measures (water purification, food processing - for example, pasteurization of milk, etc.).

What's more, surprising is the fact that the surge in national health spending in the United States occurred AFTER a significant decline in mortality, around the mid-1950s (see graph from the 1977 survey). This once again confirms the minimal role of the development of medicine itself in reducing mortality in the United States.

In the same review, the authors show that of all vaccines and therapies introduced into practice in the 1930-60s (scarlet fever, typhoid, measles, tuberculosis, influenza, whooping cough, pneumonia, diphtheria, poliomyelitis), only the vaccine had a significant effect on mortality. from polio. However, the official point of view imposed on consumers on this issue ignores the facts and common sense and insists on the predominant role of vaccines and chemotherapy in the "victory over fatal infections."

So, back in the late 1950s, it was convincingly shown that the almost 2-fold decrease in mortality in the first half of the 20th century in countries such as the United States was caused not by the development of medicine, but by an increase in the welfare of society and the widespread introduction of sanitary and hygienic measures (this is also confirmed by modern Research Ref. 2). However, already in the 1970s, this point of view began to be considered "heretical", since she questioned the "outstanding achievements" of medicine and the effectiveness of huge financial investments in it.

But let's return to the prevailing point of view on the success of medicine.

Here is a survey conducted by the British Medical Journal (BMJ) in 2007. Readers were asked to select the most outstanding from a list of the greatest medical achievements from 1840 to the present day. The list of "candidates" was compiled by the journal's medical experts.

The final list of achievements with comments is presented below (cited from

1. Introduction of sanitation and hygiene (late 19th century)

2. The invention of antibiotics (1928)

3. The invention of general pain relief (mid-19th century)

4. Introduction of vaccination (early 19th century)

5. Discovery of the structure of DNA (1950s)

6. Microbial theory of disease (late 19th century, Pasteur)

7. Oral contraceptives (1960s)

8. Evidence-based medicine

9. Imaging methods (X-ray, computed tomography, magnetic resonance imaging)

10. Computers

11. Stem cells

12. Surgery in traumatology

13. Prosthetics, transplantation

14. Subcellular methods (gene therapy, metabolomics, metagenomics)

What conclusion can be drawn from the results of this survey?

Real achievements in medicine over the past century are mainly associated with the development of surgery and the introduction of the achievements of other industries into medicine

All the declared achievements of pharmacology (pharmaceutical business) are, in fact, more than modest. Pharmacology has failed to significantly reduce the burden of most of the most common chronic diseases.

These findings are supported by statistics on the effectiveness of drugs against some of the most important chronic diseases (from antidepressants, which are useless in 38% of cases, to antidepressants, which are useless in 75% of cases) (Brian B. Speed, Margo Heath-Chiozzi, Jeffrey Huff, "Clinial Trends in Molecular Medicine ", vol. 7, issue 5, 1 May 2001, pp.201-204, cited from: The Case for Personalized Medicine, 3rd Edition, p.7), I repeat again the figure from the first note.

And in 2003, the press "leaked" the recognition of the vice-president of the British company GSK (GlaxoSmithKline) Allen Roses, a specialist in pharmacogenomics (the dependence of the effectiveness of drugs on the genetic characteristics of the patient). Here is his direct speech: "The vast majority of drugs - more than 90 percent - work only for 30-50 percent of people. I will not say that most drugs do not work - no, they work, but only in 30-50 percent of patients. they do work on the market, but they do not help everyone.”Here is the share of patients who are helped by drugs registered for the treatment of certain diseases:

Important note: “helping” usually means not a cure, but a temporary relief of some of the symptoms. And let's not forget the side effects.

Now, having discussed the "achievements" of medicine in the 20th century, let's say a few words about the apparent failures. This is the inability of modern pharmacology to cope with the main chronic diseases and causes of death: cardiovascular diseases, cancer and diabetes mellitus. We do not take indisputable successes in instrumental diagnostics and surgical treatment - in oncology, cardiac surgery and other areas. But this is not the merit of pharmaceutical companies that form the ideology of today's medicine. As for the conservative (non-surgical) treatment of cancer, diabetes mellitus, coronary heart disease, arterial hypertension (following the links, you can get acquainted with the current state of the issue) - the main sources of disability and mortality - medicine was unable to solve the problems of consumers, namely: to create 1) effective, 2) safe and 3) inexpensive means of treatment and prevention.

Among the obvious failures of medicine in the 20th century is its contribution to the causes of death. The most detailed analysis was carried out for the United States as of 2001. Here is part of Table 1 from this review: Annual mortality from iatrogenic causes (i.e. causes associated with inappropriate / inappropriate treatment, care, or diagnostic procedure):

For comparison: the death rate from cardiovascular diseases in 2001 in the United States was approximately 700 thousand, and from cancer - about 553 thousand. That is, in the USA - "the country of the most advanced medicine" - iatrogenic factors have become the most important cause of death. It is unlikely that since 2001 the situation has changed dramatically.

Let's go back to chronic diseases. The standard goal of pharmacotherapy for chronic diseases is to "control" individual physiological parameters: blood pressure, blood glucose levels, "bad" cholesterol levels, etc.

Why is it impossible to move from mechanical influence on individual symptoms or complications to influence on the causes of these chronic diseases? I do not see a simple answer to this question.

Most chronic diseases have many factors that determine their development. But more often at the level of a person as a whole, it all boils down to the following: a person is sick because he does not live correctly (this is not quite what is commonly called the “wrong way of life”), experiences chronic stress and at the same time can neither cope with stress, nor fix your life. What does it mean "lives wrong"? How to live “right”? These and many other questions lie on a plane where modern medicine does not look and is not even going to look: after all, a person for her is just an organism, while the soul (psyche) is the lot of psychologists and charlatans, and questions of the meaning of life (without which it is impossible determine how to live correctly) and are completely removed from the framework of science.

Meanwhile, remember the WHO definition: health is "a state of complete physical, mental / mental and social well-being." While medicine reduces a person to a physical body, such medicine has no chances to solve health problems and cannot be.

Why do I return again and again to this discrepancy between the declared goals of medicine and its actual "working ideology" and the means that it uses? Why is it so important? Because over the past 50-60 years, medicine has become less and less cost effective. The cost of creating each new drug exceeds $ 2 billion. As a result, these costs are a burden on end users and society. If the benefit of the drug for the end user is minimal (in the sense of improving the quality of life, maintaining the ability to work, prolonging life), then maybe, finally, the MODEL should be CHANGED, on the basis of which decisions are made both on the development of new drugs and on the development of new medical technologies?

With this rhetorical question, we conclude this part of the autopsy protocol to get a hopeful look at the “most promising avenues” of medicine. We will devote the following note to a review of these areas.

Conclusion and conclusions:

one. A significant decrease in mortality that occurred in the economically developed countries of the world in the 20th century is associated not with the development of medicine, but with an increase in well-being (improved nutrition, living conditions, etc.) and the widespread introduction of sanitary and hygienic measures.

2. A sharp increase in health care costs in the second half of the 20th century only slightly affected the objective indicators of public health.

3. The role of vaccination and the invention of antibiotics in reducing mortality from mass infectious diseases is not supported by the facts.

4. Of all the achievements of medicine in the 20th century, only the progress in the field of surgery and the introduction of the achievements of other branches of science into medicine are indisputable.

5. Despite the enormous costs of developing new drugs, over the past 50 years pharmacology has failed to significantly alleviate the burden of chronic disease.

6. Medicines - the main tool of modern medicine - remain ineffective, unsafe and expensive. The vast majority of drugs - over 90 percent - work in only 30-50 percent of patients.

7. Iatrogenic factors (associated with inappropriate medical intervention) are one of the most important causes of death in economically developed countries.