Looking back over the past 100 years, the pace of medical innovation and its eventual impact on health, healthcare and life expectancy has been extraordinary. Over the course of a century, the world has witnessed life-changing and life-saving events and discoveries that have forever changed us: from the advent of family planning and birth control; cardiopulmonary resuscitation (CPR); DNA technologies leading to the cloning of genes and even mammals; to the first-ever 3D printing of human organ tissue.
Medical Clinics North America, a medical review journal, celebrates its 100th anniversary this year by looking back at some of the most significant medical innovations it has covered over the past 100 years. And, while they are too numerous to mention in this article, my picks for those that have had the most significant impact on both individual and global health are the following:
The development of antibiotics has saved billions of lives over the past century, starting with the discovery of penicillin in 1928. Nine years later, the term “antibiotic” was coined to describe a compound that harms bacteria without being toxic to human cells. In 1943, the antibiotic streptomycin was discovered, which revolutionized the treatment of tuberculosis and other diseases. Since then, hundreds of new drugs have been developed in a continuing battle with bacteria, viruses and parasites that have increasingly become more adaptive.
Life expectancy in the 20th century increased markedly, primarily as the result of widespread vaccination, development of antibiotics and improved sanitation. Key discoveries include the development of the first influenza vaccine in 1945; the polio vaccine in 1955, which ultimately eradicated infantile paralysis; the measles vaccine in 1964, and the chicken pox vaccine in 1974. In 1986, the first vaccine produced by DNA technology for hepatitis B was approved by the U.S. Food and Drug Administration (FDA). Vaccines for bacterial diseases such as pneumococcal pneumonia and Haemophilus meningitis have added a new and valued dimension to this domain.
Organ transplantation and substitution
Biological and technological replacement of some of the body’s major organs/processes has extended and enhanced millions of lives. Technological substitutes can support major functions for brief or episodic time periods, such as dialysis, developed in 1943, and cardiopulmonary bypass, demonstrated in animals in 1935 and used clinically in humans for the first time in 1953. Biological transplantation to completely replace the functions of a damaged organ for an extended period of time was first demonstrated in 1954 when a kidney transplant was performed between identical twins. The first human heart transplant was performed in 1967, and in the ensuing half century we have seen transplants of lungs, the liver, cornea, pancreas, bone marrow and face, among others. The intersection of these approaches – long-term functional replacement with a technological substitute– first became reality with artificial joints and is now extending into computer-supported organs such as artificial cochlear and eye implants.
The discovery of the structure of DNA in 1953 and breaking of the genetic code eight years later set the stage; the completion of the human genome sequence in 2000 produced the outline. Since then, other innovations have led to the exploding world of medical applications of genomics. Genomic testing to assess disease risk, identify cancer subtyping and determine drug responsiveness are now in wide clinical use. In recent years, the development of gene editing innovations such as CRISPR-Cas9 have made genetic modification at scale possible, showing promise in treating conditions such as muscular dystrophy and leukemia. At the same time, its huge potential power has led to rigorous social and ethical debate over where it should and shouldn’t be used. We have finally reached the era where genomics is fulfilling its tremendous potential for driving precision medicine and addressing major disease problems.
The development of safe and widely available birth control methods is a huge advance that impacts population health globally. Although birth control techniques have been around for centuries, the advent of the diaphragm in the 1930s and oral contraceptives in 1960 have made birth control reliable and convenient for millions. Later innovations, including the IUD (1968), safer low-dose pills (1980s) and long-lasting implantable contraceptives (1990), have increased the safety, reliability and flexibility of birth control. Similar to genomic medicine, the history of birth control innovation also includes the continuing social, ethical and religious debate about its use.
A Look Ahead
Given the impressive track record of medical innovation over the past 100 years and accelerating growth of technology, it is almost inconceivable to predict where health innovation will be 100 years ahead. Looking at just the next 10 years, however, we can at least speculate on what key advances and opportunities lie ahead, such as:
Simply put, the world needs to discover a more fundamental method of treating infections. Right now, the “arms race” between bacteria and antibiotics is escalating, and medicine is losing the latest battles. We must find new methods that circumvent the resistance mechanisms of bacteria, just as the bacteria “discovered” mechanisms, through natural selection, to circumvent antibiotics.
Many more applications of genomics, proteomics and metabolomics will be developed, supported by the growing focus on personalized medicine. Hopefully, we’ll see solutions that address areas such as: identifying and managing overweight individuals who are insulin resistant; identifying the relationship between nutrition and growth in healthy children; or determining the cellular response of malignant tumors to hypoxia.
Analytics and Clinical Decision Support
Information technology will help us understand where problems lie and what can be done about them for a single patient or an entire population. Analytics can identify which patients in which situations can benefit from modifying their personal health and medical treatment plan. Clinical decision support can make the clinician and patient aware of these findings and identify the best diagnostic and treatment steps to prevent errors, optimize care and maximize health. While both technologies are advancing in capabilities and availability, we still must improve their overall sensitivity, specificity and usability. Innovations in these two related technologies will have a profound impact on healthcare effectiveness, especially when combined.
Although this is a field barely in its adolescence, we have already seen it evolve from building plastic toys to printing biological tissues, vascular systems, prosthetics and entire internal structures. Expect to see materials, techniques and applications expand rapidly.
Future Challenges: Innovation in Quality of Life
The future of medicine and healthcare holds many opportunities and promises. It also presents some critical, thought-provoking challenges. Medicine today is arriving at a point where there is less concern about preserving life and more about enabling a happier, healthier life. The dilemma facing us is that increasingly, thanks in part to the medical advances we have witnessed over the past 100 years, people are outliving their happiness and spending too many years in a frail state physically, mentally and emotionally.
During our training, physicians are often taught that preserving life is everything. But, along with focusing our research on life-extending innovation, it will be equally as important to prioritize the cure and mitigation of conditions that end minds, relationships, happiness, mobility and resources, such as stroke and Alzheimer’s disease. It would certainly be wonderful if everyone who lives to 85 arrives as a bright, happy and healthy 85 who still recognizes and engages with their family. The question is, what innovations – whether social, technological, biochemical or otherwise – can preserve the identities of our loved ones for as long as modern medicine has now preserved their lives? This will perhaps be the most significant issue for individuals, families and society as a whole in the years ahead.
It is almost mind-boggling to consider how medicine has evolved over the past 100 years. That pace will continue to accelerate as science and technology evolves. As we imagine where medicine will be in the next 10 to 20 years or so, we need to advance our social framework and sense of priorities so that innovation continues not only to increase lifespan but to increase the net quality of life. It is well poised to do both.