Introduction

It’s tempting to start right off with an apology for the word “breakthrough,” a word that—depending on your point of view—can be as tedious as an overhyped headline or seductive as a brightly wrapped gift. Either way, it’s hard to resist wondering, What breakthrough? A cure for cancer, an easy way to lose weight, the secret to living forever? But this isn’t that kind of book, and apologies seem unnecessary when you’re talking about the ten greatest breakthroughs in all of medicine. Sadly, none involve easy weight loss or living forever. However, all are arguably more important because they meet three essential criteria: 1) They saved, improved, or reduced suffering in millions of lives; 2) They changed the practice of medicine; and 3) They transformed our understanding of the world. That last item is too often overlooked. All medical “breakthroughs” profoundly impact health and how physicians work; far rarer are those that open our eyes to a fundamentally new way of seeing the world, giving new meaning to not only such questions as, Why do we get sick, and how do we die? but also, How are we put together and what connects us to the rest of nature?

Each of these ten breakthroughs came at a time in history when they struck humanity like a thunderbolt—a jolt of awakening followed by a palpable rise in human consciousness. What? Illness is caused by natural forces and not evil spirits or angry gods? Inhaling certain gases can take away pain and not kill the patient? A machine can take pictures of the inside of your body? We often take it for granted today, but at one time, millions of people couldn’t believe what they were hearing. They refused to believe it. Until they finally did. And then the world would never be the same.

Critics often have a field day with top ten lists. Motives are immediately suspect, every selection second-guessed, many “better” alternatives offered. But objectivity tends to crumble when one tries to measure how much any one discovery has impacted suffering, illness, and death. Nevertheless, one valid criticism is that top ten lists are overly simplistic. In our celebrity-obsessed times, the spotlight’s glare on a handful of superstars too often blinds us to the many individuals who helped pave the way. Yet what often makes a great discovery most fascinating is understanding the many smaller steps that often made the final “leap” possible. This book celebrates these steps and shows how—milestone by milestone—they led to ten final breakthrough discoveries.

Don’t embark on these journeys expecting tales of calculating genius and easy success. In fact, the greatest breakthroughs in medicine represent a wildly unpredictable collage of human stories and emotion. Even if you’re not surprised to learn how many discoveries relied on one individual’s dogged persistence despite failure and repeated rejection, you may be shocked to learn how many discoveries resulted from sheer dumb luck, if not divine intervention. The number of “coincidences” that led to Alexander Fleming’s discovery of penicillin might tempt some atheists to reconsider their assumptions. Also surprising is how many individuals had no idea their work would one day lead to a major breakthrough. One example is Swiss physician Friedrich Miescher, who discovered DNA in 1869—more than 70 years before scientists would figure out its role in heredity.

But though ignorance in the pursuit of truth is forgivable, it’s harder to sympathize with those throughout history who ridiculed a discovery because fear and rigid thinking prevented them from letting go of outdated beliefs and tradition. The examples are many: from the rejection of the pioneering work in germ theory by John Snow and Jacob Semmelweis in the early 1800s to the dismissal of Gregor Mendel’s laws of genetics in the 1860s when—despite ten years of hard work—one eminent scientist snorted that Mendel’s work had “really just begun.” No doubt, many of the greatest discoveries in medicine were made by courageous individuals who dared shake the foundations of a long-held, and usually wrong, view of the world. And no surprise that, once the discovery was finally accepted and solid footing regained, the world found itself in a very different place.

* * *

And yet the nagging question remains: why these ten breakthroughs and these rankings? If you have other ideas and some free time on your hands, you could try creating your own list by, for example, typing “medical breakthrough” into Google. However, you might want to set aside the morning to narrow down your choices from the 2.1 million hits that came up in one search conducted in 2009. Fortunately, my task was simplified by a 2006 poll conducted by the British Medical Journal (BMJ) in which readers were asked to submit their nominations for the greatest medical breakthrough since 1840 (the year the BMJ was first published). After receiving more than 11,000 responses, votes were narrowed down to a final 15.

Entries that did not make the BMJ’s final 15 ranged from the disingenuous (plastic, the iron bedstead, the tampon, Viagra, and the welfare state) to the sincere (blood tests, the defibrillator, clot-busting drugs, insulin, nurses, and caring for the terminally ill). However, the final 15 had a curious feel of being both idiosyncratic and (mostly) right: 1) sanitation (clean water and sewage disposal); 2) antibiotics; 3) anesthesia; 4) vaccines; 5) discovery of DNA structure; 6) germ theory; 7) oral contraceptives; 8) evidence-based medicine; 9) medical imaging (such as X-rays); 10) computers; 11) oral rehydration therapy (replacement of fluids lost through vomiting and diarrhea); 12) risks of smoking; 13) immunology; 14) chlorpromazine (first antipsychotic drug); and 15) tissue culture.

The BMJ’s top 15 is fine but hardly the final word. Another list published in 1999 by the Centers for Disease Control and Prevention’s publication Morbidity and Mortality Weekly Report (MMWR) offered an interesting twist with its “Ten Great Public Health Achievements” in the United States from 1900 to 1999. The MMWR did not rank its selections but shared some similar items with the BMJ list (vaccines and “control of infectious diseases”), while offering some other valid entries, including improvements in motor vehicle and work place safety, safer and healthier foods, declines from heart disease and stroke, and recognition of tobacco use as a hazard.

While the BMJ and CDC lists influenced my selection of the top ten breakthroughs, both had limitations, such as excluding medical breakthroughs before 1840 (a decision Hippocrates and a few others might take issue with). In addition, it seemed more interesting and relevant to morph the BMJ’s “discovery of chlorpromazine” into the more inclusive “Medicines for the Mind.” As described in Chapter 9, this breakthrough covers one of the most remarkable ten-year periods in the history of medicine: From 1948 through the 1950s, scientists discovered drugs for the four most important mental disorders to afflict the human race: schizoprenia, manic-depression, depression, and anxiety.

Another question likely to arise when considering the “top ten” of anything is: What’s that doing there? For example, many people associate “medical breakthroughs” with various technological marvels (MRI imaging, lasers, artificial body parts), surgical feats (organ transplants, tumor removal, angioplasty), or miracle drugs (aspirin, chemotherapy, cholesterol lowering agents). Yet, while one can point to numerous examples in each of these categories, none rank among the top ten when the previously mentioned criteria are considered. In fact, it’s interesting to note that two of the BMJ’s top 15 rankings are decidedly low-tech: sanitation (#1) and oral rehydration therapy (#11). Yet both are clearly high-yield in terms of lives saved. It’s estimated, for example, that over the last 25 years, oral rehydration therapy has saved the lives of some 50 million children in developing countries.

Along the same lines, others may argue against some of the breakthroughs included here, such as the rediscovery of alternative medicine. I’m thinking of one former editor of the New England Journal of Medicine who declined to review this book in part because “There is no such thing as ‘alternative medicine’—only medical methods that work and those that don’t.” I understand the point but respectfully disagree. There are many ways of addressing the pros and cons of alternative medicine—some of which I hope are reasonably covered in Chapter 10, “A Return to Tradition.” However, when all factors are considered from a larger perspective—a very large canvas that covers pretty much all of human history—I stand by its inclusion.

The first and easiest explanation for including alternative medicine is to point to the partnerships now forming between alternative medicine and scientific medicine and the recent birth of a new philosophy of healing that draws on the best practices of both traditions. This new and rapidly developing field, called “integrative medicine,” is now supported by many practitioners in both alternative and scientific medicine. A second point is that even lacking the methodology of scientific medicine, alternative medicine has had a remarkably positive effect on the health and spirits of millions of people who don’t necessarily subscribe (or prescribe) to a purely Western scientific model of health and disease. But a third and perhaps more important point is that taking a closed-minded view toward nonconventional approaches to medicine has an uncomfortable feel to it, a queasy reminder of lessons learned throughout the history of medicine, as taught to us by those who rejected William Harvey’s theory of circulation, the value of René Laennec’s stethoscope, Edward Jenner’s vaccine for smallpox, the theory that germs can cause disease, Mendel’s laws of genetics, the value of ether in surgery, the idea that penicillin can stop bacterial infections, that...

Well, you get the point.

* * *

Perhaps the best thing about the top ten breakthroughs in medicine is the stories they reveal about people from all walks of life—physicians, scientists, patients, and ordinary folk. The stories cover a wide range of emotion, from the disbelief and awe of witnessing a deep secret of nature suddenly revealed, to the relief and joy of discovering a new tool that saves patients from pain and certain death. But always, they are the stories of how the human spirit pushes the boundaries of knowledge in new and surprising ways, such as:

It’s often moving to read the stories of people who couldn’t imagine how their efforts and suffering would one day impact millions of lives and change our view of the world. Ironically, we’re just as much in the dark today every time we learn of a new discovery, whether in the news or among the two million hits that come up in a Google search. No one can say which will stand as a true breakthrough two years, much less two centuries, from now. Quite possibly, it will be tomorrow’s discovery of a new cancer cure, easy weight loss, or infinite longevity. In the meantime, here are ten that we know have stood the test of time. Without them, we might not have the luxury of such speculation—or perhaps of having been born at all.