Foundations of the History of Contemporary Medicine: Full Abstracts
The Evolution Theory: Does it matter to medicine?On the evening of July 01 1858 the papers entitled "On the Tendency of Species to Form Varieties" and "On the Perpetuation of Varieties and Species by Natural Means of Selection" were read by Alfred Wallace and Charles Darwin respectively at a meeting of the Linnean Society in London. This Big Bang of modern biology was followed by the publication on November 24 1859 of "On the origin of the species by means of natural selection" by Charles Darwin. Since then, the Theory of Evolution has been at the center of every meaningful biological development, debated and vilified, supported and dogmatized. But what is the Theory of Evolution and what does it means for those directly involved in the care of men, members of the Homo sapiens species. Should it affect how we view and understand diseases? Are we as a species subject to it as we accept is the rest of the biological world and if so how can we make meaningful use of this? This lecture within the framing of the practice of medicine will bring forward a contemporary view of the Theory of Evolution and how its application can profoundly impact the practice of medicine.
William Harvey and Critical Thinking'Calculations of the amount of blood leaving the heart and visual demonstrations of its force, confirm my supposition; I am therefore obliged to conclude that in animals the blood is driven round in a circuit with an unceasing circular movement, and that this is an activity or function of the heart which it carries out by virtue of its pulsation.'
* From Wright, Thomas "William Harvey: A Life in Circulation"
William Harvey's theory of circulation is ranked among the greatest scientific achievements of man and consider to be in the company of Darwin's Theory of Evolution and Newton's theory of gravity.
William Harvey was born in 1578 during a period known as "The scientific revolution" where there was a dramatic change in how to study the natural world. His life epitomize the development of a new way of thinking which propelled our civilization toward heights not seen before and from where even higher peaks are seen. The scientific method and critical thinking are inextricable intertwined constituting the foundation upon which our civilization can gaze with confidence to the future. It remains today, in the words of Dr. Stanley Schultz, "the greatest 'single-handed' discovery in physiology and medicine, if not science in general."
But, Who was William Harvey? What kind of education allowed him to have the tools and skill necessary to obtain such an achievement? Drawing from accounts obtained from primary sources, this is a glass through which we can see the seeds of today's science , and perhaps develop an appreciation for a past that lives in the present.
Pasteur, Koch, Yellow Fever, Malaria, and the Building of the Panama CanalSoon after Darwin published "On the Origin of the Species" in 1859, the controversies over spontaneous generation of life were reignited. Using simple experiments Louis Pasteur settled the controversy demonstrating that life is not generated from dead matter and established the new science of microbiology. Twenty years younger, another scientist Robert Koch working with anthrax in Germany laid the methodological foundations for the Koch's postulates, a systematic approach to establish the causal relationship between a particular microorganism and a specific disease. Pasteur was interested in questions of immunity and Koch in public health measures. Their work converged during the construction of the Panama Canal where not for the foundations they have laid out, it would have been impossible to eradicate malaria and yellow fever in one of the most monumental efforts in sanitation and public health seen by man. This lecture will take us from "pasteurization" to rabies vaccine to anthrax spores culminating with the work of Dr. William Gorgas during the building of the Panama Canal.
From Mold to an Antibiotic: The penicillin miracleThere are probably no other therapeutic agents better known to man than antibiotics and of it penicillin. Its impact in the history of mankind is well established. The story of penicillin is not less than a miracle. It is a tribute to the scientific method, the fruits of team collaboration and of the bountiful benefits of the application of science to improve manís lot. Discovered under the hardship of a feared invasion of England by Germany the discovery of penicillin opened the door to a new approach to the development of therapeutic agents and forever changed the landscape of infectious diseases and of drug manufacturing. Wrapped in popular mythology the true story of how this miracle happened is more alluring and fascinating. This lecture should bring to life men like Alexander Fleming, Howard Florey and Ernst Chain as well as other that although lesser known are nonetheless as important, including, Norman Heatley. Heatley who developed the back extraction technique for efficiently purifying penicillin in bulk was awarded in 1990 an honorary Doctorate of Medicine from Oxford University, the first given to a non-medic in Oxford's 800-year history.
The Molecules of Life: DNA, physics, and the birth of molecular biologyThe intersection of chemistry and physics has been a fruitful one. The discovery of the molecules of life by Watson and Crick and the birth of molecular biology with the 3MP(the three man paper) has led to a plethora of applications in medicine ranging from radiology, to radiotherapy and the better understanding of diseases particularly cancer where today paired with the sequencing of the human genome, these advances have produced a true "new world". How this synthesis of knowledge came about and what it has meant for the future of medicine are the subjects of this lecture. No practitioners of the art and science of medicine should be deprived of visiting these corridors where in its walls meticulously hanged are the sketches of the professionals they have become today.
Transplants: The surgeons' journeyFrom stopping bleeding and removing gangrenous portion of the body surgery has steadily and in almost quantum leaps transformed the medical world. Nowhere else than in the transplantation of organs can the immense complexities of man's biology be fully exposed as well as his desire to know thyself. The study of the humane, legal and scientific convolutions of the transplant world is a good vantage point from where to scan the horizon ahead of us. Immunology, technical craftiness, legal consent, and social responsibility are just few of the facets of this brilliantly cut diamond. The surgeon's journey describes the historical arch of men which reaching into the past project themselves into a future of almost infinite possibilities.
The Creation of the NIH, the Flexner Report, and Their Impact in Public HealthTwo individual figures loom over the Public Health sphere of the United States and by extension for what they did over the world. One, was the forefather to the NIH, one of the most important US Federal Institutions , responsible for the conduct and support of basic and clinical research that has resulted in saving and/or improving the quality of life for millions of people throughout the world. The other, transformed the nature and practice of medical education in America. Both, synthesized the ultimate goal of public health and which is one of societal responsibility for the welfare of its members and the adequate preparation of those selected to carry the task. The lives of Joseph James Kinyoun and Abraham Flexner are examples of service on behalf of public health. Understanding the origin of these two institutions, the NIH and the American Medical Education System may allow us to better serve them and in turn protect their legacy.
The Institutional Review Boards (IRBs): The genesis of the protection of human subjects from unethical experimentationHuman experimentation constitutes one of the most sensitive and delicate aspects of the practice of medicine and its quest for new solutions to health problems. Man has always being aware of this and across different centuries this awareness has been expressed in codes of conduct and regulations of human experimentation. To the obvious horrors of the Second World War we had to add a systematic practice of human experimentation absent of any concern for the welfare of the participants and practiced on humans whose qualification to be subjects of such experimentation was that they were prisoners of war. This was led to the creation of the Nuremberg Code, the primordial source of the modern Institutional Review Boards. This lecture describes how IRBs became to be and how despite some of the flaws that accompanied their creation, have become the most important regulatory bodies for the advancement of clinical research.
The AIDS Crisis and the Hippocratic OathToday one of the most heralded achievements of contemporary medicine is the development of effective anti-HIV treatments in less than 25 years from the beginning of this terrible epidemic. But, is that true? How do we measure what happened during the AIDS Crisis against the tenets of The Hippocratic Oath, written in antiquity and which principles are held sacred by doctors to this day? Using the AIDS Crisis as a background this lecture will examine the meaning of the Hippocratic Oath and will argue for its relevance to today's physicians. It will be a discussion that will remind us, paraphrasing The Plague by Albert Camus, of what had to be done, and what assuredly would have to be done again, by all who while unable to be saints strive their utmost to be healers.
Splendid Solution: Jonas Salk and the polio vaccineSeveral months before he died at the age of 80, Jonas Salk was juggling papers, government clearances, and working on an AIDS vaccine. He asked his son Peter, "What do I have to do now?" "Nothing," Peter said quietly, "There's nothing you have to do."
This series last lecture uses the archetypal life of Jonas Salk to illustrate in one individual the summation of many of the sweeping themes previously discussed. He had done it all—physician, public health servant, and researcher. The story of the polio vaccine is a giant canvas that evokes the best medicine has to offer and the fulfillment of the promise encapsulated in the words of poet Robert Frost to those who dare:
To find that the utmost reward
Of daring should be to still dare
And in the words of Salk himself: "The reward of work well done is the opportunity to do more."
* From: Kluger, Jeffrey (2006-02-07). Splendid Solution (p.320). Penguin Gruip US. Kindle Edition.