THE DOCTOR'S WORLD; So Many Advances in Medicine, So Many Yet to Come
By LAWRENCE K. ALTMAN, M.D.
Published: December 26, 2006
After President Dwight D. Eisenhower suffered a heart attack in the middle of the night on Sept. 24, 1955, his physician told Mamie Eisenhower to snuggle with her husband in bed to keep him warm.
The physician, Dr. Howard M. Snyder, injected morphine and other drugs, none specific for a heart attack or for Eisenhower's falling blood pressure and irregular pulse. Dr. Snyder, a general surgeon, let Eisenhower sleep until noon at Mamie's family home in Denver, where he was staying. Then he called a cardiologist to do an electrocardiogram. Later, the president went by car to a hospital. There, he was largely confined for almost seven weeks to bed, chair rest and limited physical activity.
Eisenhower's care shows how little doctors could do for heart attacks in 1955, three years before I entered medical school, where we were taught that medicine would be a lifetime of learning. My professors could not have known how powerful the advances that followed would be.
As a reporter for The New York Times for 37 years, I have witnessed many important medical events, from new treatments to new diseases. In reflecting on that panorama, it is clear that technology has accounted for the greatest changes in medicine. Technology has improved laboratory testing; allowed for the development of CT scans, magnetic resonance imaging exams and positron emission tomography, or PET, imaging to improve diagnostic accuracy; and produced new drugs and devices. Basic science, too, has deepened our understanding of disease, and much of that work depends on technology.
At the same time, the care for many ailments has been greatly improved by ancillary developments like better nursing care, newer antibiotics, transfusions of platelets to prevent bleeding, the insertion of monitoring tubes in major veins, and better organization of some services.
The gains, though, have also led to new challenges, like the risk of developing Alzheimer's disease, strokes, arthritis and other ailments that increase in frequency with age.
When Eisenhower had his heart attack, heart disease was the No. 1 killer of Americans, and it remains so today. But more deaths would occur without these advances. Men and women with chest pain are now told to call 911, setting off an emergency response that often results in medical care within minutes, not the hours as in Eisenhower's case.Emergency medical technicians sent to the scene can transmit electrocardiograms to a base hospital. They can inject drugs to dissolve clots and can correct potentially fatal heart rhythms at the scene or in an ambulance on the way to a hospital. These measures can stop a heart attack before it scars heart muscle.
Coronary-care units for round-the-clock monitoring were just being created during my training. Now they are standard. Doctors urge patients to become physically active as soon as possible, and most go home a few days after a heart attack.
Eating sensibly and exercising regularly are today's central messages for preventing heart disease. A variety of drugs are widely prescribed to lower cholesterol and high blood pressure, two problems that increase the risk of heart attacks.
Angiogram X-rays can detect coronary arteries that are clogged with deposits of cholesterol and other fats. An angioplasty procedure can clear the arteries, and stent devices can keep the new channels open. Heart bypass surgery is available when angioplasty and stents will not work.
For me, an electrifying moment came in the early 1960s. Dr. Bernard Lown of Harvard reported how a shock of direct current applied to the skin over the chest at a precise point in the heart beat could safely correct a number of dangerous heart rhythms. Alternating current could not be used because such shocks were often lethal. But application of the direct current technique helped make open-heart surgery -- and many other advances -- possible.
In time, pacemakers came along. Now we have implanted devices that serve as both pacemakers and defibrillators. They can automatically detect a life-threatening abnormal rhythm and then shock the heart.
Vice President Dick Cheney, who had a sophisticated pacemaker and defibrillator implanted in 2001, is perhaps the most prominent recipient of these advances.
Few people appreciate that medicine has advanced more since World War II than in all of earlier history. Newer drugs and devices and better understanding of disease mechanisms have vastly improved the care of patients. For male babies born in this country in 1960, the life expectancy was 66.6 years; for female babies, it was 73.1 years. In 2004, the figures, respectively, were 75.2 and 80.4. Medical advances account for much, though not all, of the gain.
As a specialist in internal medicine in the 1960s, I could prescribe about 7,000 drugs approved by the Food and Drug Administration. That number is now more than 11,700 drugs, including many new classes of medication.
Powerful drugs help patients live longer with heart failure.
The mid-1960s saw the introduction of Lasix (furosemide), a vastly more powerful diuretic than any before it. With its help, patients with heart disease and other disorders, whose bodies swelled with gallons of fluid, could eliminate the fluid through urination within hours.