Why History of Medicine?

By Barron Lerner, MD, PhD

Barron Lerner, MD, PhDHistory is a key subject within the humanities and, not surprisingly, the history of medicine is a key subject within the medical humanities. What can history teach modern health care professionals?

On one level, history can inform us about the successes and failures of past endeavors. Although many historians cringe when people quote George Santayana’s simplistic phrase—“Those who cannot remember the past are condemned to repeat it”—it does contain an element of truth.

Medicine has countless cautionary tales. For example, Nineteenth-Century physicians, concerned about their prestige, stubbornly held onto outdated theories about the value of “heroic” treatments, such as bloodletting, in the treatment of certain diseases. There is an extensive, often sordid, history of quackery in medicine, in which patients were victimized by unorthodox physicians who promised them miracle cures. For much of the Twentieth Century, researchers routinely enrolled vulnerable and unsuspecting populations into potentially harmful experiments, such as injecting cancer cells into non-cancer patients, exposing healthy people to radiation and preventing African-American syphilitic men from being treated. Telling these stories to modern students, clinicians and patients can prevent such abuses from happening again.

Of course, there are many positive lessons from medicine’s past. Scientists like Louis Pasteur and Robert Koch faced severe opposition when they argued that diseases such as tuberculosis were caused by unseen microorganisms. But their rigorous scientific experiments proved that they were right. Joseph Lister, a late Nineteenth-Century contemporary of Pasteur and Koch, used carbolic acid to decontaminate surgical fields, prevent postoperative infections and save lives. Despite the fact that all of his earliest patients died, Twentieth-Century surgeon Thomas Starzl persisted. By developing better surgical techniques and immunosuppressive medication regimens, he propelled the field of transplant medicine. Patients have been heroes as well, such as the women in the 1970s who successfully challenged the outdated dominance of the Halsted radical mastectomy in the treatment of breast cancer. Today, better scientific evaluation of medical interventions and direct involvement of patients in decision-making is routine. It is instructive to recall how we got to this point. The path has rarely been a straight one.

On a second level, history reminds us that medicine has been—and always will be—a social process. That is, even as we learn more about the molecular and genetic basis of disease, and use increasingly sophisticated statistical methods to evaluate our interventions, this knowledge does not provide “objective” truths. Rather, those who generate such scientific information do so within a complicated cultural and political setting. For example, when historian Gerard Geison reviewed Pasteur’s actual notebooks, he found evidence that the great scientist had manipulated his data and schemed against his rivals. The surgeons who championed radical breast surgery in the 1950s and 1960s did so less because of data than a military “more is better” mindset that emanated out of their World War II experiences and surgical training programs. The enormous use of Premarin to “treat” menopause in this same era stemmed from an aggressive marketing campaign by drug giant Wyeth and the strategic alliances that the company made with physicians.

Perhaps the best example of the interplay between sociocultural and scientific factors is the modern debates over screening for breast and prostate cancers. Different researchers can look at the same data for mammography and prostate specific antigen testing and—based on their training, ideological bent and, at times, financial conflicts—come up with dramatically different conclusions. At this point, we probably need less data and more discussions about why decades of research have not provided us with better answers. History can help point us in this and other helpful directions.

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Barron H. Lerner, MD, PhD is a member of the faculty of the Department of Medicine, Division of General Internal Medicine and will also have a significant role in the Division of Medical Humanities.

Formerly a Professor of Medicine at Columbia College of Physicians and Surgeons, Dr. Lerner has an extensive bibliography dealing with aspects of bioethics, medical history, narrative medicine, and medical humanities. His writing appears in the New York Times and other widely read venues, and his books have received significant attention.

His The Breast Cancer Wars (2002) received the Washington Irving Book Award and was noted to be one of the most outstanding books in the field of medical history within the preceding five years by American Association for the History of Medicine in 2006. When Illness goes Public (2007) also received a Washington Irving Book Award. Dr. Lerner’s most recent book has had exceptional reviews (One for the Road: Drunk Driving Since 1900, 2011).