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Book Review : A Look at 100 Significant Years of Medical History

October 20, 1987|LEE DEMBART

The Health Century by Edward Shorter (Doubleday: $19.95; 312 pages, illustrated).

In his autobiography, "The Youngest Science," Lewis Thomas describes his entrance into the medical profession as an intern in 1937. Until that time, Thomas writes, doctors could do little more than provide reassurance and hold the patient's--and the family's--hands. Their ability to affect the course of diseases was extremely limited.

Then, suddenly, there were sulfa drugs and their successors, penicillin and other antibiotics, and the course of medicine and human health changed. "We became convinced, overnight, that nothing lay beyond reach for the future," Thomas said. "Medicine was off and running."

That was 50 years ago, and, according to Thomas, only in that brief time have doctors actually been able to cure disease.

Historically Helpless

Edward Shorter agrees that for most of history, doctors were hamstrung in attempting to intervene on their patients' behalf. They could set broken bones and ease pain somewhat, but otherwise they had to stand by and let diseases take their course.

But Shorter dates the start of modern medicine not with the discovery of sulfa drugs in the 1930s but with the founding in 1887 of what is now the National Institutes of Health. The last 100 years, he says, have witnessed the application of science to medicine and given rise to what he calls "The Health Century."

This book, which is a companion to a PBS television series, is a celebration of the tremendous accomplishments of medicine in that time. Infectious diseases, which at the turn of the century were the major cause of death, are no longer serious health problems. No one in this country dies of tuberculosis any more.

Instead, people now live long enough to contract heart disease and cancer, which are now this country's two major killers. But, Shorter argues, medicine has made important advances against these two killers as well, in the development both of drug therapies and of surgical procedures.

But there is also something missing from this paean to medicine and biomedical research. Nowhere does Shorter ask any of the difficult questions that are increasingly associated with medical miracles.

Nowhere, for example, does Shorter mention the cost of high-tech medicine. Nowhere does he mention that on average, 50% of a person's lifetime medical bills are

run up during the last six months of life. Nowhere does he ask whether the effort and expense are worth it. (One's answer depends on whether one is the patient or not.)

But this is to take nothing away from the story that Shorter does tell, which is nothing short of miraculous. He shows how the commitment of the National Institutes of Health to research and pure science has made possible important applications to virtually every area of medicine.

The list is staggering, and Shorter makes clear that biotechnology--genetic engineering--promises to do much more. The next hundred years will probably be more impressive than the last.

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