Epilogue
“The greatest obstacle to discovery is not ignorance; it is the illusion of knowledge.”
—Daniel J. Boorstin (American author and historian)
“A wild idea...” that is “at variance with established knowledge.”
—The English Royal Society, rejecting Edward Jenner’s discovery of the first vaccine
As the ten greatest breakthroughs in medicine have repeatedly shown, knowledge is a risky business. It can blind us from the very discoveries we seek. It can be so corroded by tradition that it blinds others. And, despite how much we try to accumulate, it can be overmatched by simple dumb luck. Somehow the individuals in this book navigated these challenges to arrive at ten breakthrough discoveries: 1) medicine itself; 2) sanitation; 3) germ theory; 4) anesthesia; 5) X-rays; 6) vaccines; 7) antibiotics; 8) genetics and DNA; 9) drugs for mental illness; and 10) alternative medicine. Looking back on their journeys, four lessons stand out as guideposts and advice for those seeking the next great breakthrough.
Lesson 1: Pay attention to the peculiar—and the obvious
In the early 1800s, René Laennec was walking through a park when he noticed two children tapping signals to each other through a long stick held up to their ears. A short time later, while struggling to listen to the heart of an obese woman, his sudden recollection of that curious memory inspired him to roll up a tube of paper and invent the stethoscope, a milestone event that influenced the development of modern medicine. (Chapter 10)
In the early 1830s, when John Snow was sent to help miners who had been stricken by an outbreak of cholera, he noticed two odd things: 1) The workers were so deep underground that they couldn’t be exposed to the “miasmatic” vapors thought to cause the disease, and 2) The miners ate their meals in close quarters to where they relieved their bowels. Fifteen years later, both observations helped inspire his revolutionary theory that cholera was transmitted by contaminated water, a key breakthrough in the discovery of germ theory. (Chapter 2)
In 1910, biologist Thomas Hunt Morgan found it peculiar when, after having bred millions of fruit flies with red eyes, he found a fly that had been born with white eyes. Following up on this peculiar finding ultimately led Morgan and his students to the milestone discovery that the basic units of heredity—genes—are located on chromosomes. (Chapter 8)
Lesson 2: Stick to your convictions despite doubt and ridicule
In the late 1700s, Edward Jenner discovered that people could be protected from deadly smallpox infections by inoculating them with the far less dangerous cowpox. Despite a storm of protest from those who objected on scientific, religious, and moral grounds, Jenner persisted with his investigations. Within several years, his vaccine was saving countless lives throughout the world. (Chapter 6)
When Ignaz Semmelweis theorized in 1847 that a deadly infection was being spread through his hospital by physicians’ unclean hands, he instituted a handwashing procedure that subsequently saved countless lives. Although the medical community ridiculed his belief that hand-washing could stop disease transmission, Semmelweis refused to back down and is now credited with playing a major role in the discovery of germ theory. (Chapter 3)
In 1865, after ten years of experiments and growing thousands of pea plants, Gregor Mendel discovered the new field—and the first laws—of genetics. Although biologists ignored or downplayed his findings for the next three decades, Mendel contended until he died that “The time will come when the validity of the laws...will be recognized.” Mendel was right; today, he is recognized as the father of genetics. (Chapter 8)
Lesson 3: Have the good sense to embrace your good luck
In 1928, Alexander Fleming returned to his laboratory after a long vacation and found that one of his experiments had been ruined by a mold that he found growing in one of his bacterial cultures. Fleming turned this odd bit of fortune—and several other coincidences he wasn’t even aware of—to his advantage and subsequently discovered penicillin, the first antibiotic. (Chapter 7)
In 1948, John Cade was studying patients with manic-depression, hoping he might find a toxic substance in their urine that would explain their bizarre behavior. But instead of finding a substance that caused mania, he stumbled upon a chemical that prevented it. Pursuing this unexpected turn of fate, Cade developed lithium carbonate, the first effective drug for mania. (Chapter 9)
In the early 1950s, James Watson and Francis Crick were among the many scientists struggling to figure out the structure of DNA. Then, in early 1953, Crick had the good fortune of being shown an X-ray image of DNA made by a competitor scientist, Rosalind Franklin. A short time later, the image sparked a flash of insight that helped Crick solve the mystery of DNA. (Chapter 8)
Lesson 4: Be willing to face down blind authority and tradition
It’s unclear how much flack Hippocrates took when he claimed in 400 BC that disease is not caused by evil spirits, but natural factors. Nevertheless, his courageous assertion broke with a cultural belief in superstition that dated back at least 600 years. Thanks to this and other milestone insights, Hippocrates is now credited with the discovery of medicine. (Chapter 1)
During the Renaissance of the sixteenth and seventeenth centuries, the work of two individuals—Andreas Vesalius with his stunning revelations of human anatomy and William Harvey with his landmark discovery of how blood circulates—gave birth to a new world of scientific medicine. But just as remarkable was their willingness to contradict the ancient teachings of Galen, whose authority had gone unquestioned for more than 1,200 years. (Chapter 10)
Traditional and alternative medicine have long advocated healing methods that focus on nontoxic therapies, restoring inner balance, and the healer-patient relationship. After standing up to two centuries of criticism and suppression by Western scientific medicine, alternative medicine re-emerged in the late 1990s by overwhelming patient demand. Today, this breakthrough is part of a new “integrative” and holistic medicine that offers the best of both worlds. (Chapter 10)
The H1N1 outbreak: lessons learned?
In the spring of 2009, a highly contagious epidemic broke out and spread like wildfire across the globe. No, not the H1N1 (swine) flu virus, but the behavioral epidemic that followed in its wake. Consider some of the social changes that resulted as an epidemic of fear swept across the world....
One of the first signs of the outbreak was the disappearance of hand sanitizer bottles from store shelves and their reappearance in purses, pockets, children’s backpacks, and gym bags. By summer, the transportation industry had shifted into gear, as bus drivers and airline crews were trained to not only wipe down all surfaces with disinfectants, but to ask passengers how they felt and, if a fever was suspected, wave them good-bye. By fall, the world of religion had seen the light and was adopting new rituals, from Catholic priests withholding the public sharing of consecrated wine, to the installation of electronic dispensers that released holy water like so many squirts of soap in a public restroom. By November and December, Happy Holidays had become the Nightmare Before Christmas, as families opted for 10-hour drives in the hermetic safety of their cars rather than 90 minutes of incubation in an airplane cabin. Mall Santas, meanwhile, were tucking bottles of Purell behind the fuzzy cuffs of their shiny, black boots. By the end of 2009, other sightings of the ongoing behavioral epidemic included new ways to sneeze (into your bent elbow) and congratulate opponents after sports competitions (elbow bumps instead of hand shakes).
And so the question: What did the global response to H1N1 tell us about how much the world has changed since the breakthrough discoveries of sanitation, germ theory, vaccines, and others? It’s easy to argue that little has changed since Ignaz Semmelweis demonstrated 160 years ago that handwashing can reduce hospital infections and deaths. For example, although nearly 100,000 people in the United States die each year from hospital-acquired infections, about one out of every two physicians still fails to follow recommended hand-washing guidelines. Public adherence is even worse, with one study showing that only 34% of men washed their hands after using the toilet. At the same time, many people today still regard vaccines with a feeling of queasy ambivalence. As some physicians have noted, the H1N1 epidemic showed how public reaction can go through cycles of fear: When H1N1 first broke out, people stormed their physicians’ offices clamoring for a vaccine, fearful that the next Bubonic plague was underway. Six months later, after the initial panic died down, many of the same people ran the other way, fearful that the H1N1 vaccine might be harmful, despite many reports documenting its safety.
Nevertheless.
There’s little doubt that the greatest breakthroughs in medicine have saved countless lives and changed our view of the world. While ignorance, carelessness, and irrational fear may be endemic to the human condition, every medical advance helps inoculate us a little better against our own worst natures. If that were not true, many of the responses against H1N1—from Purell bottles in Santa’s boots to automated holy water dispensers—would not have occurred in the first place. It’s impossible to know how deadly H1N1 or any other recent epidemic would have been without such transformations, but it seems safe to assume that the toll would have been much worse.
Perhaps one take-home lesson common to all ten breakthroughs is that regardless of where in the body the latest discovery impacts health and disease, its success will largely be determined by its influence on one area in particular—the human mind.