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    Doctors being held back from intellectual creativity a disservice to patients

    Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Ken Fisher, MD, who is an internist/nephrologist in Kalamazoo, Michigan, a teacher, author ("Understanding Healthcare: A Historical Perpsective") and co-founder of Michigan Chapter Free Market Medicine Association. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


    Dr. FisherFreed from millennia of dogma with the emergence of the scientific method, combined with Enlightenment ideas about the resourcefulness of the individual, there was an explosion of advances in medicine during the 19th century.

    Dr. Edward Jenner (1749-1823) became the father of Modern Immunology and the concept of vaccination with his work with smallpox, a viral disease that was a scourge of mankind for millennia.  It decimated large numbers of never infected individuals especially when congregated into groups.  


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    In the eighteenth century, Lady Mary Wortley Montagu returning to Great Britain from Turkey introduced the concept of variolation, the taking of infected smallpox material from a patient and inoculating it into a never infected individual.  Most became immune after having a mild disease; however, some died.  

    In spite of its dangers, when faced with a smallpox epidemic among the Continental army in 1777, General Washington used variolation to save his army, but with some casualties.  


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    Edward Jenner was aware that occasionally farmers who had cared for horses that had developed an exudate on their hoofs, without washing proceeded to milk cows.  He noticed that the cows developed smallpox, like pustules on their utters.  After milking the same cows, Sarah Nelmes developed an extremely mild case of the “pox.”   Then, in an experiment that could not be done today, he inoculated a young boy James Phipps with material from Sarah’s pustules.  James did not develop “pox” even after being inoculated with actual smallpox material.  Jenner repeated this several times with the same result and published this work in 1798. 

    He had no concept of the attenuation of the virus, but used his keen observations to develop the concept of immunization.

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    Ken Fisher, MD
    Kenneth A. Fisher, M.D. Nephrologist, and author, latest book, Understanding Healthcare: A Historical Perspective", available ...

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    • UBM User
      Dr. Fisher's historical summary of advances in medicine is an interesting list but omits what I think is the most relevant to the anti-science attitude now common in the U.S. I would suggest Semmelweis as a fine object lesson. He noted a high death rate after delivery in his hospital. He was aware that midwife deliveries at home did not have this problem. He observed that doctors and medical students went from pathologic dissection rooms to the delivery room without sanitation measures. This was standard practice in this era prior to the discovery of bacterial infection. He required those in his hospital to wash their hands after dissection in a calcium/lime solution, and was gratified with the rapid drop in the puerperal fever incidence. He made this known to his colleagues who ended his practice, digging in with current tradition and ultimately forcing Semmelweis out of the hospital and I think out of the city altogether. He wrote up his findings but they did not become standard practice until after his death. This is a fine example of tradition and anti-scientific behavior preventing the advancement of medicine.

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