DiversityNursing Blog

The Evolution of Medicine

Posted by Alycia Sullivan

Fri, Apr 04, 2014 @ 11:03 AM

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Modern medicine has helped lead to a surge in average life expectancy, which was only about 36 in the late 1800s. With humans routinely living into their 100s, advances in medical science are to thank. Let’s take a journey through the history of medical advancements.

Life expectancy by year
1850 36.6
1890 39.7
1900 48.3
1911 50.2
1921 55.7
1931 60.9
1941 64.5
1951 67.1
1961 70.3
1971 71.4
1981 73.1
1990 73.7
1992 74.2
1993 74.8
1995 73.9
1997 74.2
1998 74.5
1999 74.7
2000 74.8
2001 75.1
2002 75.4
2003 77.9
2004 78.3
2005 77.8
2006 77.7
2007 77.9
2010 78.7
2011 78.7

BC

Cancer
400 BC: Hippocrates uses the term “karcinos” to describe tumors. “Karcinos” evolved into cancer. It’s not yet known what causes cancer, with theories including imbalanced “humors” in the body.
Immunization and disease prevention
400 BC: Hippocrates describes mumps, diphtheria, epidemic jaundice and other conditions.
Mental illness
400 BC: Mental disorders are understood as diseases rather than symptoms of demonic possession or signs of having displeased the gods.

2nd century AD

Cancer
2nd century AD: Galen describes surgical treatments for breast cancer, which include removing early-stage tumors. But the surgeries are brutal and often fatal. For centuries, these rudimentary surgeries are the only treatment for cancer.

1100s

Immunization and disease prevention
1100s: The variolation technique is developed, involving the inoculation of children and adults with dried scab material recovered from smallpox patients.

1400s

Mental illness
1407: The first European establishment specifically for people with mental illness is probably established in Valencia, Spain.

1500s

Surgery and medical technology
1540 AD: English barbers and surgeons perform tooth extractions and blood-letting.

1600s

Mental illness
1600s: Europeans increasingly begin to isolate mentally ill people, often housing them with handicapped people, vagrants and delinquents. Those considered insane are increasingly treated inhumanely, often chained to walls and kept in dungeons.

1700s

Immunization and disease prevention
1798: Edward Jenner publishes his work on the development of a vaccination that would protect against smallpox. He tests his theory by inoculating 8-year-old James Phipps with cowpox pustule liquid recovered from the hand of a milkmaid, Sarah Nelmes.
Mental illness
Late 1700s: After the French Revolution, French physician Phillippe Pinel takes over the Bicêtre insane asylum and forbids the use of chains and shackles. He removes patients from dungeons, provides them with sunny rooms and allows them to exercise on the grounds. Yet in other places, mistreatment persists.

1800s

Surgery and medical technology
1818: Human blood is transfused from one person to another for the first time.
Mental illness
1840s: U.S. reformer Dorothea Dix observes mentally ill people in Massachusetts, seeing men and women of all ages incarcerated with criminals, left unclothed and in darkness and forced to go without heat or bathrooms.
Cancer & surgery/medical technology 
1846: Anesthesia becomes widely available, helping expand options for surgery. Among cancer patients, surgery to remove tumors takes off.
Surgery and medical technology
1867: British surgeon Joseph Lister publishes Antiseptic Principle in the Practice of Surgery, extolling the virtues of cleanliness in surgery. The mortality rate for surgical patients immediately falls.
Immunization and disease prevention
1881: Louis Pasteur and George Miller Sternberg almost simultaneously isolate and grow the pneumococcus organism.
Mental illness
1883: Mental illness is studied more scientifically as German psychiatrist Emil Kraepelin distinguishes mental disorders. Though subsequent research will disprove some of his findings, his fundamental distinction between manic-depressive psychosis and schizophrenia holds to this day.
Surgery and medical technology
1885: The first successful appendectomy is performed in Iowa.
Mental illness
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.
Cancer
1889: William Halsted develops the radical mastectomy to treat breast cancer; the technique includes the surgical removal of the tumor, breast, overlying skin and muscle.
Surgery and medical technology
1890s: Chemical agents are used to minimize germs. Carbolic acid is put on incisions to minimize germs and decrease infection rates.
Cancer
1895: Wilhelm Conrad Roentgen invents X-rays. Radiation therapy follows.
Surgery and medical technology
1895: The first X-ray is performed in Germany.

1900s

Mental illness
Early 1900s: The primary treatments of neurotic mental disorders, and sometimes psychosis, are psychoanalytical therapies (“talking cures”) developed by Sigmund Freud and others, such as Carl Jung.
Immunization and disease prevention
1914: Typhoid and rabies vaccine are first licensed in the U.S.; tetanus toxoid is introduced.
Immunization and disease prevention
1915: Pertussis vaccine is licensed.
Immunization and disease prevention
1918: The Spanish influenza pandemic is responsible for 25 million to 50 million deaths worldwide, including more than 500,000 in the U.S.
Cancer
1919: A chemical in the mustard gas used during World War I is found to reduce white blood cells. Chemotherapy is born.
Surgery and medical technology
1922: Insulin is first used for treatment of diabetes, allowing diabetics to survive after diagnosis.
Surgery and medical technology
1928: Antibiotics dramatically decrease post-surgical infections.
Mental illness
1930s: Drugs, electro-convulsive therapy, and surgery are used to treat people with schizophrenia and others with persistent mental illnesses. Some are infected with malaria; others are treated with repeated insulin-induced comas. Others have parts of their brain removed through lobotomies.
Surgery and medical technology
1937: The first blood bank opens, helping make more surgery possible by treating bleeding during the procedure.
Immunization and disease prevention
1943: Penicillin becomes mass-produced.
Mental illness
1946: President Harry Truman signs the National Mental Health Act, calling for the National Institute of Mental Health to conduct research into the brain and behavior and reduce mental illness.
Cancer
1947: Chemotherapy records its first, though temporary, success with the remission of a pediatric leukemia patient.
Mental illness
1949: Australian psychiatrist J. F. J. Cade introduces the use of lithium to treat psychosis. Lithium gains wide usage in the mid-1960s to treat those with manic depression, now known as bipolar disorder.
Surgery and medical technology
1950: John Hopps invents the cardiac pacemaker.
Cancer
1950s: Findings related to DNA give rise to molecular biology.
Mental illness
1950s: A series of successful anti-psychotic drugs are introduced that do not cure psychosis but control its symptoms. The first of the anti-psychotics, the major class of drug used to treat psychosis, is discovered in France in 1952 and is named chlorpromazine (Thorazine). Studies show that 70 percent of patients with schizophrenia clearly improve on anti-psychotic drugs.
Mental illness
1950s: A new type of therapy, behavior therapy, suggests that people with phobias can be trained to overcome them.
Surgery and medical technology
1953: A heart-lung bypass machine is used successfully for the first time.
Immunization and disease prevention
1955: The first polio vaccine is licensed, pioneered by Dr. Jonas Salk. The Polio Vaccination Assistance Act is enacted by Congress, the first federal involvement in immunization activities.
Surgery and medical technology
1957: William Grey Walter invents the brain EEG topography (toposcope).
Cancer
1964: A U.S. surgeon general’s report establishes an undeniable link between smoking and cancer.
Mental illness
Mid-1960s: Many seriously mentally ill people are removed from institutions. In the United States they are directed toward local mental health homes and facilities. The number of institutionalized mentally ill people in the United States will drop from a peak of 560,000 to just over 130,000 in 1980. Many people suffering from mental illness become homeless because of inadequate housing and follow-up care.
Immunization and disease prevention
1966: The Centers for Disease Control and Prevention announces the first national measles eradication campaign. Within 2 years, measles incidence decrease by more than 90% compared with prevaccine-era levels.
Surgery and medical technology
1967: A heart transplant is performed by South African physician Christian Barnard. The heart recipient survived 18 days until succumbing to pneumonia.
Cancer
1971: President Richard M. Nixon signs the National Cancer Act.
Cancer
1972: The development of computed tomography (CT) revolutionizes radiology.
Cancer
1973: Dr. Janet Rowley shows chromosome abnormalities in those with cancer.
Surgery and medical technology
1978: A baby conceived via in-vitro fertilization is born.
Mental illness
1980s: An estimated one-third of all homeless people are considered seriously mentally ill, the vast majority of them suffering from schizophrenia.
Cancer
1981: FDA approves the first vaccine against hepatitis B, one of the primary causes of liver cancer.
Surgery and medical technology
1982: The Jarvik-7 artificial heart is used.
Surgery and medical technology
1985: The first documented robotic surgery is performed.
Mental illness
1986: Prozac is developed to treat various mental illnesses.
Cancer
Early 1990s: For the first time, overall cancer death rates begin to fall.
Mental illness
1990s: A new generation of anti-psychotic drugs is introduced. These drugs prove to be more effective in treating schizophrenia and have fewer side effects.
Immunization and disease prevention
1994: The entire Western Hemisphere is certified as “polio-free” by the World Health Organization.

2000s

Surgery and medical technology
2000: Robotic surgical systems win U.S. Food and Drug Administration approval.
Cancer
2001: The FDA approves Gleevec, the first drug to target a specific gene mutation.
Surgery and medical technology
2003: The sequence of a complete human genome is published.
Immunization and disease prevention
2006: A vaccine is developed to prevent cervical cancer due to human papillomavirus.
Immunization and disease prevention
2009: The vaccine court rules that the mumps/measles/rubella vaccine, when administered with thimerosal-containing vaccines, does not cause autism.

Source: Best Medical Degrees 

Topics: history, change, evolution of medicine

Prescription for change

Posted by Alycia Sullivan

Fri, Jul 12, 2013 @ 01:51 PM

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AMERICA’S hospitals are the most expensive part of the world’s most expensive health system. They accounted for $851 billion, or 31%, of American health spending in 2011. If they were a country, they would be the world’s 16th-largest economy. And they are in the midst of dramatic change, much of it due to the “Obamacare” health reforms.

The most visible change so far is that big hospital companies are getting bigger. In the latest of a string of recent mergers and takeovers, on June 24th Tenet Healthcare said it would buy Vanguard Health Systems for $4.3 billion including debt. The combined group will have 79 hospitals and 157 outpatient clinics.

Others are going further, turning the industry’s business model on its head. In Massachusetts, Steward Health Care Systems is trying to drive patients out of its hospitals and into cheaper clinics. The pace of change varies from one hospital group to the next. But beneath the shift is an argument—by politicians, insurers, patients and some investors—that the old business ways of hospitals are untenable.

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America has more than 5,700 hospitals, with non-profits outnumbering for-profits by nearly three to one. Most of these share a familiar business model: sell as many services as possible at the highest price. This bodes ill for those who pay, whether employers, the government or patients themselves. Doctors receive a fee for each treatment, so there are few financial incentives to keep patients well. And since the health market has the transparency of a concrete bunker—patients usually do not know the price of treatment until after they have received it—American hospital stays are unusually expensive (see chart). It is little wonder that health spending overall accounts for nearly a fifth of GDP.

This dysfunctional system will welcome millions of new patients next year. Obamacare requires everyone to have some form of health insurance from 2014. To that end it expands Medicaid, the government’s insurance scheme for the poor, and subsidises private insurance policies which will be offered via new exchanges to be set up in each American state. More people with insurance should mean more patients seeking treatment, so the reforms would seem to herald a golden era for hospitals. Indeed, hospital shares have soared since the Supreme Court upheld the health law’s constitutionality a year ago.

Nevertheless, hospitals face mounting pressure to change. In recent years the volume of patients at most hospitals has been flat at best. The recession is partly to blame, since sacked workers lose their insurance. The shifting of some treatments to outpatient clinics has undercut some hospital revenues. And employers have increasingly required their workers to make out-of-pocket contributions towards the cost of their health care, which makes them a bit less likely to seek treatments.

Obamacare itself is not all good news for hospitals. It will bring revenue from newly insured patients. But it will also cut the rates the government pays for Medicare, the health scheme for the old. By 2019 these will cancel each other out, reckon analysts at Bank of America Merrill Lynch. And the Medicare cuts already announced may not be the last. The reforms may create fewer new patients than expected: some people may ignore Obamacare’s “mandate” to buy insurance, since the penalties are small. State and federal officials are scrambling to get the exchanges ready in time. Some Republican governors are refusing to expand Medicaid.

Obamacare also includes incentives for hospitals to provide quality, rather than quantity, of care for publicly insured patients. Medicare will penalise hospitals that discharge patients only for them to return within 30 days. Groups of doctors and hospitals can apply to be designated as accountable-care organisations, or ACOs, which will be rewarded for keeping the cost of Medicare patients’ treatments below a certain level. (They thus have broadly similar aims to health-maintenance organisations, or HMOs, a type of private health plan that pays a fixed fee to doctors and hospitals for the patient’s care).

Last month the Obama administration opened another line of attack on hospital costs by publishing their price lists. These showed huge variations. In practice, insurers negotiate special rates, and these remain mostly hidden. But scrutiny of prices is likely to intensify, as more members of employers’ health schemes are forced to shop around for treatments.

Physician, know thy costs

The reforms, and the other pressures on the hospitals, have prompted them to launch a big efficiency drive. The well-respected Cleveland Clinic is offering shared medical appointments: a doctor tells several patients how to manage diabetes, rather than counselling them individually. Robert Kaplan and his colleagues at Harvard Business School are helping hospitals measure their costs. Many do a poor job of recording how much each type of treatment costs them in terms of doctors’ and nurses’ time, materials consumed and so on.

Hospitals are also seeking economies through dealmaking. All sorts of combinations are being seen, says Martin Arrick of Standard & Poor’s, a credit-rating agency: big, stockmarket-listed chains like Tenet and Vanguard are merging; Catholic hospitals are getting ecumenical with non-Catholic ones; and non-profit outfits are partnering with for-profits. There were more than 200 such deals in 2011-12, according to Irving Levin Associates, a research firm. This does not include many purchases by hospitals of doctors’ clinics.

The combined Tenet and Vanguard will have hospitals and clinics across 16 states. This will make it easier to standardise clinical practice, get discounted supplies and make the most of investment in new medical technology. Most important, a bigger firm will have more clout in negotiating prices with health insurers.

The most seismic shift, however, is the move away from the fee-for-service model. How can a hospital profit from delivering fewer services, when it is organised to deliver more? HCA, a quoted company with 156 hospitals in 20 states, is all but ignoring the question. Vanguard is one of few listed chains to have started looking for answers, including taking part in ACOs.

Steward, which is only three years old, seems to be the most ambitious in embracing change. It was created when Cerberus, a private-equity firm, bought a struggling chain of Catholic hospitals in 2010. Steward does not aspire to have the best hospitals in America—indeed it sends its most complex cases to a rival medical centre in Boston. What it wants to offer is good, convenient, reasonably priced care. Steward has signed up as a Medicare ACO and also has contracts with private insurers that reward it for keeping patients well as opposed to paying it by quantity of treatments. The company has 11 hospitals, up from six in 2010, and a network of 2,900 affiliated doctors, up from 1,100.

Steward is making efforts to ensure that patients do not suffer expensive relapses: nurses scroll through records to confirm that patients have collected their prescriptions and had their check-ups; more home visits are being made to recently discharged inpatients. But it is unclear overall whether such efforts will boost profits, or indeed lower America’s health spending, let alone both. Large hospital chains, thanks to their clout with insurers, are more likely to raise prices than cut them. Steward’s prices are lower than Massachusetts’s most expensive hospitals, but higher than those of some competitors.

As for ACOs, they have had a good start: more than 250 have been formed so far. But their success is difficult to predict. ACOs are responsible for the costs of a given set of patients, but those patients can seek treatments outside the group of providers that form the ACO. This may make it hard to contain their costs.

George Clairmont, who leads a doctors’ group that partners with Steward, is excited by the prospect of a new era. “We are part of a major change in health care that we haven’t seen since the beginning of the 20th century.” But like a novel treatment for a chronic ailment, the cure for America’s bloated hospital industry will need careful monitoring for side-effects.

Topics: change, quality care, United States, expensive, healthcare

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