In this review, the endlessness evolution of medical science and medical technology, and its effects on disease metamorphosis and increased life expectancy are discussed. In certain instances, the past will be compared with the present and predictions for the future will be outlined. Further, the constant role of the physician in maintaining the health of human beings is emphasized in this endlessness evolution.
Late 1800s: The expectation in the United States that hospitals for the mentally ill and humane treatment will cure the sick does not prove true. State mental hospitals become over-crowded, and custodial care supersedes humane treatment. New York World reporter Nellie Bly poses as a mentally ill person to become an inmate at an asylum. Her reports from inside result in more funding to improve conditions.
Greek historian Herodotus stated that every Babylonian was an amateur physician, since it was the custom to lay the sick in the street so that anyone passing by might offer advice. Divination, from the inspection of the liver of a sacrificed animal, was widely practiced to foretell the course of a disease. Little else is known regarding Babylonian medicine, and the name of not a single physician has survived.
Chris Kresser: Yeah, sure. I’m sure a lot of my listeners know this about me, but for those people who are new to this especially, I think Paleo—and I’ve said this before—is a fantastic starting place, but it’s not a destination. What I mean by that, is we know that Paleo foods are safe and well tolerated for most of us because we’ve eaten them for such a long period of time. And by we, I mean human beings. And they’re the least likely to cause problems, allergies, food intolerances, and issues like that, because human beings have been consuming them for thousands of generations. But that doesn’t mean that we absolutely need to restrict our diet to those foods, because even though we’re largely the same genetically as we were 10,000 years ago, there have been significant changes. In fact, as much as 10% of our genome shows evidence of recent selection. And the pace of genetic change today is occurring at a rate 100 times faster than the average over 6 million years of hominid evolution. So we’re similar to our Paleolithic ancestors, but we’re different in some important ways. And those differences actually do affect our tolerance of certain agricultural foods, like full-fat and fermented dairy products, even legumes and grains, some of the newly introduced foods like alcohol and chocolate and coffee. These are all foods that modern research actually suggests can be beneficial when they are well tolerated, but I call them gray-area foods because our tolerance of them really depends on the individual. So for one person who is casein intolerant or intolerant to some of the proteins in dairy, eating any dairy is going to be problematic. But for someone who has no problem with casein or lactose, the sugar in dairy, all of the research on full-fat dairy suggests that it’s beneficial and may reduce the risk of cardiovascular and metabolic disease, and even obesity. So those are just a few examples of how our diet has changed. And I think as a healthcare practitioner, my focus is always on the science—what the science shows, and what I see in the clinic in my work with patients. And I’m generally kind of allergic to extremely rigid, dogmatic approaches, especially when they’re not flexible enough to evolve and adapt with what the changing science tells us. So that was one of the big focuses of my talk at the summit.
James Maskell: Yeah. Well, obviously, you have, some of the ideas you talked about there are perfect I think. I just wrote a blog for The ZocDoc Blog about why doctors should curate their patient education. And curating resources is much more efficient than just telling people stuff. You don’t need people to do that, you just need to use the resources that are available. And so actually, one of the ways that we designed this summit was that it would be almost like the perfect thing for a doctor to curate for their patient—because there is a patient track. It’s going to basically teach the patient how to be a great patient and how to look after the four major modifiable causes of chronic disease: diet and stress, toxicity, immunity, and the microbiome. These are all things that patients have the majority of control over. This is not medicine that’s done to you. And so, we were just—so that’s part of the track in the doctor track. I think the curation of patient education can take a lot of the time out of the appointments, because you see one of the biggest things about functional medicine is that it takes a lot of time to do it, because you have to listen and so forth. So that’s one of the things. But like you said, technology can play a key role. And we have doctors in the summit that are talking about how they’re using technology even in poorer, rural areas of the country, where they’re building community-orientated practices that serve a blue-collar type of patient, and it’s working. And if it could work in rural Indiana, it can work anywhere. And that’s really exciting. You know, our vision for this, Chris, is just a nationwide network of remarkable community-orientated functional practices. In the same ways you saw the natural response to Walmart was farmers’ markets—you know, going directly to the farmer and having that direct interaction—I think the natural reaction to big medicine is these small micropractices that deliver exceptional value to patients in local areas into the community.
The Greeks were also surgeons and some of the equipment they used is recognizable today. Some of the tools of the Greek physicians included forceps, scalpels, tooth-extraction forceps and catheters, and there were even syringes for drawing pus from wounds. One instrument, the spoon of Diocles, was used by the surgeon Kritoboulos, to remove the injured eye of Phillip of Macedon without undue scarring. Finally, the Greeks knew how to splint and treat bone fractures, as well as add compresses to prevent infection.
The Department of the History of Medicine at Johns Hopkins is proud to introduce new online CME modules that provide a historical perspective on issues of relevance to clinical practice today. Our first module, which launched in January 2018, explores the social, political, and economic forces that continue to shape the dynamic boundaries of the medical profession. Medical professionalism is...
Chris Kresser: Yeah, that’s pretty amazing. I talked with Mark Hyman a little bit about the Cleveland Clinic Functional Medicine Program. And just for the listeners, what this is—and James, you might know a little bit more about it than I do—but just from what Mark said, the Cleveland Clinic, for those who don’t know, is a major institution in the field of medical research and pioneering new treatments and approaches to disease from the more mainstream perspective. They basically invited Mark Hyman to create a functional medicine group within the Cleveland Clinic that is funded and actively looking for strategies. Basically, how to scale functional medicine and make it more viable within the healthcare model that we have. And that is a really much-needed step because, as I’m sure all the listeners know, right now in functional medicine, everything is paid for out of pocket. Insurance doesn’t cover it. That really limits the number of people who will be able to take advantage of it. So getting some mainstream recognition like this for functional medicine is a huge step in terms of making it more accessible and available to the majority of people out there.
1899 Felix Hoffman develops aspirin (acetyl salicylic acid). The juice from willow tree bark had been used as early as 400 BC to relieve pain. 19th century scientists knew that it was the salicylic acid in the willow that made it work, but it irritated the lining of the mouth and stomach. Hoffman synthesizes acetyl salicylic acid, developing what is now the most widely used medicine in the world.
In the paper, Radin explores how frozen colonial pasts operate in the service of biological futures. Radin’s research refigures sample collection, induction and cryogenic suspension as modes of colonial science. Following histories of frozen blood samples collected from indigenous populations in the postwar period, Radin reveals a cryopolitics of “not letting die,” in the service of some future biological development. Radin’s impressive body of work offers unique contributions to the study of Cold War, postcolonial technoscience, genomics, big data, climate history, extinction, science fiction and speculative futures.
This week on the Evolution of Medicine, we continue our series called The Future of Patient Compliance with Mac Gambill from Nudge Coach. Nudge Coach is lifestyle coaching software that aims to better connect practitioners with their patients. It allows practitioners to empower patients through online lifestyle coaching through technology in between visits.
The development of modern neurology began in the 16th century in Italy and France with Niccolò Massa, Jean Fernel, Jacques Dubois and Andreas Vesalius. Vesalius described in detail the anatomy of the brain and other organs; he had little knowledge of the brain's function, thinking that it resided mainly in the ventricles. Over his lifetime he corrected over 200 of Galen's mistakes. Understanding of medical sciences and diagnosis improved, but with little direct benefit to health care. Few effective drugs existed, beyond opium and quinine. Folklore cures and potentially poisonous metal-based compounds were popular treatments. Independently from Ibn al-Nafis, Michael Servetus rediscovered the pulmonary circulation, but this discovery did not reach the public because it was written down for the first time in the "Manuscript of Paris" in 1546, and later published in the theological work which he paid with his life in 1553. Later this was perfected by Renaldus Columbus and Andrea Cesalpino. Later William Harvey correctly described the circulatory system. The most useful tomes in medicine used both by students and expert physicians were De Materia Medica and Pharmacopoeia.
James Maskell is the host of our podcast and flagship show, the Functional Forum, the world’s largest integrative medicine community. He is on a mission to create structures necessary to evolve humanity beyond chronic disease. He lectures internationally and has been featured on TEDx, TEDMED and HuffPostLive and also founder of KNEW Health, a payer solution for chronic disease reversal.