The Greeks also knew that diet and exercise and keeping clean were important for health. Later Alexander the Great conquered Egypt. In 332 BC he founded the city of Alexandria and a great medical school was established there. Doctors in Alexandria dissected human bodies and they gained a much better knowledge of anatomy. However little progress was made in understanding disease.
This week on the Evolution of Medicine podcast, we feature, authors, Glenn Sabin and Taylor Walsh. Their book is called The Rise of Integrative Health and Medicine: The Milestones - 1963 to Present. It features over 120 of the most significant accomplishments in the field during the last 54 years. Evolution of Medicine is proud to be among the chosen milestones.
e nation's highest civilian award was established by President Harry S. Truman in 1945 to recognize notable service during World War II. In 1963, President John F. Kennedy reintroduced it as an honor for any citizen who has made exemplary contributions to the security or national interest of the United States, to world peace, or to cultural or other significant endeavors.
Elites and the popular classes alike called on divine intervention in personal and society-wide health crises, such as the epidemic of 1737. The intervention of the Virgin of Guadalupe was depicted in a scene of dead and dying Indians, with elites on their knees praying for her aid. In the late eighteenth century, the crown began implementing secularizing policies on the Iberian peninsula and its overseas empire to control disease more systematically and scientifically.
Chris Kresser: Yeah, that’s really exciting to me. I think another frontier is lab testing. I mean, that’s one of the, as a practitioner, that’s one of the things that troubles me the most, is how expensive these labs are. And in a lot of cases, the insurance isn’t covering them because they don’t deem them to be medically necessary, which just makes me want to pull my hair out, because of course, you know, if we do these labs and we identify the underlying problems initially, we’re potentially heading off tens of thousands of dollars, if not more, in medical costs to the insurance company later on down the line. So I guess it just depends on how you define medically necessary, but that’s a whole different discussion. Some of these labs can be hundreds or even thousands of dollars. So I know there are some pretty exciting, new movements out there to make this lab testing more affordable financially. And then some of the tech tools that are becoming available, like the Quantified Self Revolution, that could really help in terms of not only gathering the necessary data, but organizing it and then presenting it back to the clinician in a way that makes sense and makes it easy for the clinician to track progress. So I know this is an area of interest for both us, James. Maybe you could talk a little bit about some of them, the more exciting technologies that you’ve seen, and that people have talked about in the summit.
In 1478 a book by the Roman doctor Celsus was printed. (The printing press made all books including medical ones much cheaper). The book by Celsus quickly became a standard textbook. However in the early 16th century a man named Theophrastus von Hohenheim (1493-1541) called himself Paracelsus (meaning beyond or surpassing Celsus). He denounced all medical teaching not based on experiment and experience. However traditional ideas on medicine held sway for long afterwards.
The operation, Felkin reported, was carried out with the intention of saving both lives. The mother was partially anaesthetised with banana wine. The surgeon also used this wine to wash the surgical site and his own hands, suggesting awareness of the need for infection control measures. He then made a vertical incision, going through the abdominal wall and part of the uterine wall, before further dividing the uterine wall enough to take the baby out. The operation also involved removing the placenta and squeezing the uterus to promote contraction.
A number of Greeks speculated that the human body was made up of elements. If they were properly balanced the person was healthy. However if they became unbalanced the person fell ill. Finally Aristotle (384-322 BC) thought the body was made up of four humors or liquids. They were phlegm, blood, yellow bile and black bile. If a person had too much of one humor they fell ill. For instance if a person had a fever he must have too much blood. The treatment was to cut the patient and let him bleed.
The paper of Paul Ewald in 1980, “Evolutionary Biology and the Treatment of Signs and Symptoms of Infectious Disease”, and that of Williams and Nesse in 1991, “The Dawn of Darwinian Medicine” were key developments. The latter paper “draw a favorable reception”,page x and led to a book, Why We Get Sick (published as Evolution and healing in the UK). In 2008, an online journal started: Evolution and Medicine Review.
One of the oldest known medical textbooks is the Sushruta Samhita, written in Sanskrit in India. Its exact date is tentative, as no original version survives and it is only known from later copies, but the current consensus is that it was written in around 600 BC. Sushruta is thought to have been a physician and teacher working in the North Indian city of Benares (now Varanasi in the state of Uttar Pradesh). His Samhita – a compilation of knowledge – provides detailed information on medicine, surgery, pharmacology and patient management.
^ Nesse RM, Bergstrom CT, Ellison PT, Flier JS, Gluckman P, Govindaraju DR, Niethammer D, Omenn GS, Perlman RL, Schwartz MD, Thomas MG, Stearns SC, Valle D (January 2010). "Evolution in health and medicine Sackler colloquium: Making evolutionary biology a basic science for medicine". Proceedings of the National Academy of Sciences of the United States of America. 107. 107 Suppl 1 (suppl_1): 1800–7. doi:10.1073/pnas.0906224106. PMC 2868284. PMID 19918069.
This week on the Evolution of Medicine podcast, we welcome Dr. Jean Golden-Tevald. We continue our Success Leaves Clues series with Dr. Tevald where we feature a practitioner who has found the right tools and systems to run a successful practice. Dr. Tevald practices functional medicine at Morning Star Family Health Center in Clinton, New Jersey. We're excited to share how she has set up her membership based family practice.
A revolution of a new age of medicine. It is time to make lifestyle changes, improve our education on what we are putting into our bodies on a daily basis, how often do we get fresh air and exercise, how many hours of restful deep sleep do we receive each night? How about our stress levels? All of these and many more affect us intrinsically but most of us just wait for things to go wrong and then expect the medical professional to make us better. We have got this so wrong it is time to take back responsibility and learn what it truly means to look after our health...mentally, physically and socially. This book is pioneering this change and laying the foundations for the medical profession to step up to the challenge of providing the education and the support that we will all need to make this leap...
James Maskell: Dr. Larry Palevsky is speaking, and he’s speaking on the pediatrics day. He’s an awesome doctor. He was lecturing about the microbiome five years ago, before the human microbiome came out. And so I asked him, he spoke at my Functional Forum, and he brought up some concepts that were new, and I was sitting next to storied integrative medicine doctors who were just sort of blown away. And his thought is this: We all know now that 99% of our bacteria and fungus and viruses and so forth are mutually beneficial, and they help us, and they help with metabolism and digestion and immunity. That’s our sort of main understanding. So I asked him, “Dr. Palevsky, what are we going to learn next? What are we really going to understand next about the microbiome that we don’t understand now?” And he basically—you have to listen to it on the summit, but he basically says this—“We have trillions of non-redundant viruses in our chromosomes, in our DNA. So these are trillions of viruses that we’ve evolved with over time.” And so his question is, “When you get a viral illness, how many more viruses have to come into the body for you to get a viral illness? 10? 20? 100?” I mean, when you look at the numbers compared to what’s actually in our chromosomes and in our DNA, the numbers just don’t add up. His thought is, and his concept is, that these viruses, there’s different transmission mechanisms. His thought is that the next understanding that we’re going to have of the microbiome, the next level of understanding is going to be that the body and these viruses work together to be able to return the body to homeostasis. So when you get to a point where the body is just so stressed and there’s too many toxins and things for it to deal with, and it can’t get back to homeostasis by itself, it communes with viruses to be able to instigate what we think of as a viral illness, to be able to get the patient to just slow down, so that we can get back to homeostasis. And it made such an impression on me because I had a friend last year who got viral pneumonia. And what was happening before viral pneumonia? She was working for three months on a project about 15 hours a day. And suddenly, it finished and she did great with it, and then she was sick for a month with viral pneumonia. So what, pneumonia just came along and attacked at that moment? Obviously, not. So I’d love to get your thoughts on that. Because when he shared that, I was like, “This seems so obvious.” And I’m really excited to think what our understanding is going to be like when we start to appreciate that our evolution with viruses is a big part of our evolution, and that there may be a lot more to it than thinking a virus is just something that comes from outside all the time.
All the way through the Functional Forum and the Evolution of Medicine we've sighted the future of "primary care" to be enhanced through technology, the Functional Medicine operating systems, and coaching for behavior change and this is such a great example. One of the powerful tools that Powell has taken advantage is Nudge Coach, a behavior change technology we love. By taking advantage of their white label solution, they have a branded experience for their patients to use to track behavior change between visits.
The advances in medicine made a dramatic difference for Allied troops, while the Germans and especially the Japanese and Chinese suffered from a severe lack of newer medicines, techniques and facilities. Harrison finds that the chances of recovery for a badly wounded British infantryman were as much as 25 times better than in the First World War. The reason was that:
Meanwhile In 1875 Robert Koch (1843-1910) isolated the germ that causes anthrax. In 1882 he isolated the germ that causes tuberculosis and in 1883 he isolated the germ that causes cholera in humans. Meanwhile the organism that causes leprosy was discovered in 1879. The germ that causes typhoid was isolated in 1880. The germ that causes diphtheria was discovered in 1882 by Edwin Klebs. In 1884 the germs that cause tetanus and pneumonia were both discovered. Immunization against diphtheria was invented in 1890. A vaccine for typhoid was invented in 1896.
Maintaining a comfortable state of health is a goal shared by much of the world’s population past and present, thus the history of health and medicine weaves a thread connecting us with our ancestors’ human experiences. Yet it’s easy to assume that studying it involves either celebrating the ‘eureka moments’ of well-known heroes or laughing at outdated therapies. But, as I set out to show in my book, The History of Medicine in 100 Facts (Amberley Publishing, 2015), medicine’s past features plenty of lesser-known but equally fascinating episodes…
In 1954 Joseph Murray, J. Hartwell Harrison and others accomplished the first kidney transplantation. Transplantations of other organs, such as heart, liver and pancreas, were also introduced during the later 20th century. The first partial face transplant was performed in 2005, and the first full one in 2010. By the end of the 20th century, microtechnology had been used to create tiny robotic devices to assist microsurgery using micro-video and fiber-optic cameras to view internal tissues during surgery with minimally invasive practices.
This week on the Evolution we welcome an internationally renowned authority on health, human potential development, and Self-Leadership, Dr. Mark Atkinson. As a functional medicine physician, author, and speaker, Dr. Atkinson has inspired hundreds of thousands of people to become healthier, more effective, human beings. He’s been on the cutting edge of neuro-performance for many years and has now taken his passion to the Bulletproof organization.
This week on the Evolution of Medicine podcast, we're thrilled to welcome Danny Iny, the founder of Mirasee. Danny is a serial entrepreneur and has been involved in the online education space for more than a decade. We've been working very closely with Danny at the Evolution of Medicine to help us build out our online courses like the Practice Accelerator, the New Patient GPS, and the Membership Practice Builder.
This week on the Evolution of Medicine Podcast, we welcome, Michael Lubin, Co-Found of Hint Health. We're excited to be partnering with Hint Health on the delivery of our new training program the Membership Practice Builder featuring Tom Blue, Chief Strategy Officer of American Academy of Private Physicians. The Evolution of Medicine is always looking for innovative technology partners that make it easier to deliver Functional Medicine and Hint Health hits the mark. Hint Health is the leading membership management and billing solution for direct pay healthcare. To learn more about Hint Health, visit goevomed.com/hinthealth
The sexual revolution included taboo-breaking research in human sexuality such as the 1948 and 1953 Kinsey reports, invention of hormonal contraception, and the normalization of abortion and homosexuality in many countries. Family planning has promoted a demographic transition in most of the world. With threatening sexually transmitted infections, not least HIV, use of barrier contraception has become imperative. The struggle against HIV has improved antiretroviral treatments.
Humans evolved to live as simple hunter-gatherers in small tribal bands. Contemporary humans now have a very different environment and way of life. This change makes present humans vulnerable to a number of health problems, termed "diseases of civilization" and "diseases of affluence". Stone-age humans evolved to live off the land, taking advantage of the resources that were readily available to them. Evolution is slow, and the rapid change from stone-age environments and practices to the world of today is problematic because we are still adapted to stone-age circumstances that no longer apply. This misfit has serious implications for our health. "Modern environments may cause many diseases such as deficiency syndromes like scurvy and rickets".)
We revisit this important topic to gear up for the next Functional Forum – Evolution of Environmental Medicine from the Environmental Health Symposium. We will be connecting with more practitioners to discuss the importance of understanding where the major sources of toxicity come from and the ways to help your community of patients and clients to avoid these harmful toxins.
^ Hayward, Rhodri (2011). "Medicine and the Mind". In Jackson, Mark. The Oxford Handbook of the History of Medicine. Oxford University Press. pp. 524–42. ISBN 978-0199546497.; Scull, Andrew (2005). Most Solitary of Afflictions: Madness And Society in Britain, 1700–1900. Yale University Press. pp. 324–28. ISBN 978-0300107548.; Dowbiggin, I. (1992). ""An exodus of enthusiasm": G. Alder Blumer, eugenics, and US psychiatry, 1890–1920". Medical History. 36 (4): 379–402. doi:10.1017/S002572730005568X. PMC 1036631. PMID 1435019.; Snelders, S.; Meijman, F.J.; Pieters, T. (2007). "Heredity and alcoholism in the medical sphere: The Netherlands, 1850–1900". Medical History. 51 (2): 219–36. doi:10.1017/S0025727300001204. PMC 1871693. PMID 17538696.; Turda, M. (2009). ""To end the degeneration of a nation": Debates on eugenic sterilization in inter-war Romania". Medical History. 53 (1): 77–104. doi:10.1017/S002572730000332X. PMC 2629178. PMID 19190750.
Bodies from the Stone Age show signs of medical treatment: broken limbs that have been set and healed, dislocations replaced and wounds treated successfully. Bone needles from the Upper Palaeolithic (c.30,000 years ago) may indicate that wounds were stitched (sutured) at this time. A widespread practice from the late Palaeolithic, which flourished in Neolithic Europe (c.7,000 years ago), was trepanation (making a hole through the frontal or parietal bones of the skull). Whilst the reasons for this practice are unknown, the high survival rate of patients, indicated by the healing and remodelling of bone, proves great technical skill. Major blood vessels in the skull had to be avoided, haemorrhage was minimised by turning back the flaps of skull created by the incision and the operation site had to be kept free from infection.
During the Renaissance, understanding of anatomy improved, and the microscope was invented. Prior to the 19th century, humorism (also known as humoralism) was thought to explain the cause of disease but it was gradually replaced by the germ theory of disease, leading to effective treatments and even cures for many infectious diseases. Military doctors advanced the methods of trauma treatment and surgery. Public health measures were developed especially in the 19th century as the rapid growth of cities required systematic sanitary measures. Advanced research centers opened in the early 20th century, often connected with major hospitals. The mid-20th century was characterized by new biological treatments, such as antibiotics. These advancements, along with developments in chemistry, genetics, and radiography led to modern medicine. Medicine was heavily professionalized in the 20th century, and new careers opened to women as nurses (from the 1870s) and as physicians (especially after 1970).
Byzantine medicine encompasses the common medical practices of the Byzantine Empire from about 400 AD to 1453 AD. Byzantine medicine was notable for building upon the knowledge base developed by its Greco-Roman predecessors. In preserving medical practices from antiquity, Byzantine medicine influenced Islamic medicine as well as fostering the Western rebirth of medicine during the Renaissance.
During the 16th century there were some improvements in medicine. However it remained basically the same as in the Middle Ages. Medicine was still dominated by the theory of the four humors. In 1546 a man Girolamo Fracastoro published a book called On Contagion. He suggested that infectious diseases were caused by 'disease seeds', which were carried by the wind or transmitted by touch. Unfortunately there was no way of testing his theory.
It didn’t work against Roman armies, however, and when Mithradates was defeated by the military leader Pompey in 66 BC, the recipe supposedly arrived in Rome. Emperor Nero’s physician Andromachus developed it into a 64-ingredient composition, which became known as theriac. Most of the ingredients were botanical (including opium), but viper’s flesh was a notable component.
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.
This podcast is made possible by one of our Summit sponsors DNALife. There are few reasons why we chose this test, firstly because this test can only be ordered through a practitioner ensuring that the results will get a professional, responsible interpretation. Dr. Joffe was also centrally involved in creating this test, curating only those SNPs and other data points that have enough good research data to infer real meaning.