1. History Of Medical Science

2. 2 Why History Matters b Constant Change for 150+ Years Limited Development of Societal ConsensusLimited Development of Societal Consensus Always Ahead (or Behind) The LawAlways Ahead (or Behind) The Law b Classic Divisions Still Prevail ShamanismShamanism Greco-Roman RationalismGreco-Roman Rationalism b The Best and Worst of Times

3. 3 Shamanism b Oldest Medicine b Primitive Tribes b Alternative Medicine b Integrates Religion And Medicine b Persists Even Today In So Called Modern Cultures

4. 4 Explicitly Ministers To The Psyche And The Body b Driven By Myths b Trial And Error And Careful Observation b Often Sophisticated Rituals And Herbals b Some Cure, Most Do Not b Leviticus Public Health CodePublic Health Code Rules Reduce Food PoisoningRules Reduce Food Poisoning

5. 5 Useful Pharmacopeia b Ethnobotany Study Of Plants Used By Ritual HealerStudy Of Plants Used By Ritual Healer Many Drugs Have Been Discovered This WayMany Drugs Have Been Discovered This Way Witches Used Foxglove - DigitalisWitches Used Foxglove - Digitalis b Medicinal Chemists Refine And Modify BotanicalsRefine And Modify Botanicals b Conflicts Over Ownership of Indigenous Remedies

6. 6 Greco-Roman Rationalism b Galen And Successors b Driven By Rational Theories b Religion Is Left To Priests b Observations Forced To Fit Into The Theory Plato Was Terrible About ThisPlato Was Terrible About This Mistakes Are Not CorrectedMistakes Are Not Corrected b Predominant Until 16th Century b Still Lurks in Clinical Decisionmaking

7. 7 Modern Medicine/Scientific Medicine b Not The Philosopher's Scientific Method b The Imperative To Disprove Theories b The Full Disclosure Of Information b Science Is Constantly Questioning And Rethinking

8. 8 Systematic Observation is the Key b Diseases Have Variable Courses b Patient's Have Variable Conditions b Serious Participant-Observer Problem b Controlled Studies Are Key

9. 9 Problems With Controlled Studies b CCU Cannot Control Variables WellCannot Control Variables Well Many Things Do Not WorkMany Things Do Not Work Rating The Severity Of The Patient's ConditionRating The Severity Of The Patient's Condition b Treatment Of Controls Someone Gets The Old/No TreatmentSomeone Gets The Old/No Treatment Cannot Use Drugs Until Trials Are OverCannot Use Drugs Until Trials Are Over b AIDS Example

10. 10 Science Versus Scientists b Scientists Are Just People Probably More Honest Than MostProbably More Honest Than Most Some Are CorruptSome Are Corrupt Some Are NaïveSome Are Naïve b Science Is Process, Not People Weeds out the Bad StuffWeeds out the Bad Stuff Can Take TimeCan Take Time b Lawyers Seek Out The Worst

11. A Brief Chronology of Medicine

12. 12 Paracelsus b Philippus Aureolus Theophrastus Bombastus Von Hohenheim b Early 16th Century b Transition From Alchemy b Experiments And Systematic Observations b Antimony

13. 13 Anatomy And Function b Andreas Vesalius Mid 16th CenturyMid 16th Century Accurate AnatomyAccurate Anatomy b William Harvey Early 17th CenturyEarly 17th Century Flow Of The Blood And Operation Of The HeartFlow Of The Blood And Operation Of The Heart

14. 14 Edward Jenner b Smallpox b Major Killer b Wiped Out The Indigenous Peoples b 1798 – Published His Book On Cowpox

15. 15 John Snow b Cholera In London b Broad Street Pump b Proved Cholera Is Waterborne b 1854

16. 16 Ignaz Philipp Semmelweis b Childbed Fever b Fellow Medical Student Died b Controlled Studies b 1849

17. 17 Louis Pasteur b Scientific Method b Germ Theory b Vaccination For Rabies b Pasteurization b 1860s-1880s

18. 18 Foundation of Modern Surgery b William Morton AnesthesiaAnesthesia 18461846 b Joseph Lister AntisepsisAntisepsis 1867-1880s1867-1880s b Surgery Became Big Business b Drove Development of Hospitals

19. 19 Infectious Diseases b Koch’s Postulates - 1880s Agent Must Be Present In Every Case;Agent Must Be Present In Every Case; Agent Must Be Isolated From The Host And Grown In Vitro [In A Lab Dish];Agent Must Be Isolated From The Host And Grown In Vitro [In A Lab Dish]; Agent Must Cause Disease When Inoculated Into A Healthy Susceptible Host; AndAgent Must Cause Disease When Inoculated Into A Healthy Susceptible Host; And Agent Must Be Recovered Again From The Experimentally Infected Host.Agent Must Be Recovered Again From The Experimentally Infected Host. b Limitations

20. 20 Tuberculosis Control - 1900 b The Major Killer b Koch And Pasteur b Sanatoria b Pasteurization Of Milk b Disease Control Of Dairy Herds

21. 21 Drug Chemistry – 1880s b German/Swiss Dye Industry b Bayer b Hoffman La Roche b Ciba

22. 22 Antibiotics b Sulfa Drugs In The 1930s b Penicillin Alexander Flemming – 1928Alexander Flemming – 1928 Purified By Chain And Florey In 1939Purified By Chain And Florey In 1939 World War II - Coconut Grove Fire (1942)World War II - Coconut Grove Fire (1942) b Streptomycin – 1944 First Antituberculosis DrugFirst Antituberculosis Drug Selman Abraham Waksman – 1944Selman Abraham Waksman – 1944 (Coined The Term Antibiotic(Coined The Term Antibiotic

23. 23 Post World War II b Conquering Microbial Diseases VaccinesVaccines AntibioticsAntibiotics b Chronic Diseases Better DrugsBetter Drugs Better StudiesBetter Studies LeukemiaLeukemia

24. 24 Technology b Microelectronics MonitorsMonitors PacemakersPacemakers VentilatorsVentilators Heart-Lung MachinesHeart-Lung Machines b Dialysis b Most Depend On Drugs InfectionsInfections RejectionsRejections

25. 25 New Challenges b Aging Population b Failure of Public Health b Antimicrobial Resistance b Justice Issues How To Pay For Health CareHow To Pay For Health Care How To Deliver Health CareHow To Deliver Health Care b Should Health Care be a Right?