1: Our belief that progress happens gradually over time is all wrong.
Nowhere is this fact more accurate than medicine, Dr. Peter Attia writes in his book Outlive: The Science and Art of Longevity.
The notion of continual progress over time from ancient times to today is “a complete fiction,” he writes.
“It seems to me that there have been two distinct eras in medical history.”
The exciting fact? We may be on the verge of a promising third period in medicine. But first, some information on the first two eras.
The first era, Peter calls “Medicine 1.0,” began with the ancient Greeks around 400 B.C. and continued until the mid-1800s.
“Its conclusions were based on direct observation and abetted more or less by pure guesswork, some of which was on target and some not so much,” Peter notes.
The ancient Greek physician Hippocrates “advocated walking for exercise, for example, and opined that ‘in food, excellent medicine can be found; in food, bad medicine can be found,’ which still holds up.
Yet other other Medicine 1.0 “treatments” were just plain wrong.
“Dd your head hurt? You’d be a candidate for trepanation, or having a hole drilled in your skull,” writes Peter. “Strange sores on your private parts? Try not to scream while the Doktor of Physik dabs some toxic mercury on your genitals. And then, of course, there was the millennia-old standby of bloodletting, which was generally the very last thing that a sick or wounded person needed.”
That was the way medicine was practiced for more than two thousand years.
2: Until the advent of “Medicine 2.0.”
Until that point, illnesses were thought to be spread by bad air. Germ theory revolutionized our understanding of illness.
“This led to improved sanitary practices by physicians and ultimately the development of antibiotics,” Peter writes.
But change did not happen quickly.
“It’s not as though one day Louis Pasteur, Joseph Lister, and Robert Koch simply published their groundbreaking studies, and the rest of the medical profession fell into line and changed the way they did everything overnight,” he observes.
“In fact, the shift from Medicine 1.0 to Medicine 2.0 was a long, bloody slog that took centuries, meeting trench-warfare resistance from the establishment at many point along the way.”
Exhibit one: the Hungarian obstetrician Ignaz Semmelweis.
Who was concerned that so many mothers were dying following childbirth at his hospital in Vienna.
“He concluded that their strange ‘childbed fever’ might somehow be linked to the autopsies that he and his colleagues performed in the mornings, before delivering babies in the afternoons—without washing their hands in between,” Peter writes.
“His observations were most unwelcome. His colleagues ostracized him, and Semmelweis died in an insane asylum in 1865.”
The year of Ignaz’s death, Joseph Lister operated on a young boy using sterile techniques at his hospital in Glasgow.
“It was the first application of the germ theory of disease,” Peter notes.
Ignaz had been right all along.
The underpinning for Medicine 2.0 was the development of what we now call the scientific method by Sir Francis Bacon in 1628.
“This represented a major philosophical shift, from observing and guessing to observing, and then forming a hypothesis,” Peter notes. “The next step is crucial: rigorously testing that hypothesis/guess to determine whether it is correct, also known as experimenting.
“Instead of using treatments that they believed might work, often despite ample anecdotal evidence to the contrary, scientists and physicians could systematically test and evaluate potential cures, then choose the ones that had performed best in experiments.”
The best word to describe Medicine 2.0? Transformational.
“It is a defining feature of our civilization, a scientific war machine that has eradicated deadly diseases such as polio and smallpox,” Peter writes. “Its successes continued with the containment of HIV and AIDS in the 1990s and 2000s, turning what had seemed like a plague that threatened all humanity into a manageable chronic disease.”
Progress continues up to the present day with “the rapid development of not just one but several effective vaccines against COVID-19, not even a year after the pandemic took hold in early 2020. The virus genome was sequenced within weeks of the first deaths, allowing the speedy formulation of vaccines that specifically target its surface proteins.”
3: Still, for all its victories against acute illnesses and injuries with shorter event horizons, Medicine 2.0 has proven far less effective in curing long-term diseases like cancer.
“While books like this always trumpet the fact that lifespans have nearly doubled since the late 1800s,” writes Peter, “the lion’s share of that progress may have resulted entirely from antibiotics and improved sanitation, as Steven Johnson points out in his book Extra Life.”
Peter references the research of Northwestern University economist Robert J. Gordon, who analyzed mortality data going back to 1900. When we subtract deaths from the eight top infectious diseases, “which were largely brought under control by the advent of antibiotics in the 1930s, overall mortality rates declined relatively little over the course of the twentieth century.”
Chronic diseases like heart disease, cancer, neurodegenerative disease, and type 2 diabetes build slowly over time. Once they become established, it’s often too late.
Which is why Medicine 3.0, with its focus on prevention, may prove to be as transformational as Medicine 2.0.
Our goal becomes to “delay or prevent these conditions so that we can live longer without disease, rather than lingering with disease.”
More tomorrow!
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Reflection: How grateful am I for modern medicine?
Action: Discuss with a friend or colleague.