Conventional Medicine: A Brief History

Conventional, or allopathic, medicine focuses mostly on the diagnosis and treatment of disease, although preventive practices as part of this system have gained considerable influence in recent years.

Obviously, treatments vary according to the disorder, but all are aimed at reversing or repairing the underlying condition. If a cure is impossible, the doctor tries to manage or ease the symptoms as much as possible.

Before prescribing a specific course of treatment, a physician weighs the potential benefits against the possible risks. Sometimes the risks or costs of treatment outweigh possible benefits; in other cases, the condition may not warrant immediate treatment but require periodic monitoring. In any event, you as the patient should participate as an informed partner with your doctor in all decision making.

Types of Treatment

All conventional treatments are classified in one of three categories: preventive, noninvasive, or surgery (invasive).

Preventive medicine emphasizes taking specific action to forestall disease. Some aspects are so commonplace that we take them for granted. For example, many killer diseases of the past are now rare or, in the case of smallpox, extinct, thanks to routine immunization. Improved sanitation and other public health measures have rendered cholera, plague, typhoid fever, and tuberculosis rare in industrialized nations, but they are still rampant in undeveloped countries and, given the right circumstances, can spread to developed nations.

Often, preventive medicine calls for a wait-and-see approach in which patients have frequent checkups, but no specific therapy is prescribed. For example, if your family medical history indicates that you have a high risk of developing cancer of the breast or the colon, you will probably be advised to undergo frequent screening examinations to look for any suspicious changes. This allows your doctor to detect cancer in its earliest, most treatable stage.

In other cases, the preventive measures might include drug therapy or even surgery. For instance, low-dose aspirin and other drugs are prescribed routinely now to prevent a heart attack in a high-risk patient. Some people who have a hereditary type of colon polyps that invariably develop into colon cancer may be advised to have a preventive colectomy an operation in which the entire colon is removed.

Most often, however, preventive medicine emphasizes a healthy lifestyle. Experts now agree that our most common killer diseases can often be prevented by not smoking, by exercising regularly, eating a well-balanced diet, maintaining normal weight, and controlling stress. For many people, certain aspects of alternative medicine, such as meditation, yoga, massage, and biofeedback, have become an important part of their preventive regimens.

Noninvasive therapy usually entails taking drugs, ranging from an occasional nonprescription painkiller to an intensive regimen of chemotherapy for cancer. (Other noninvasive modalities include radiation, sound waves, and psychological counseling.) The introduction of scores of new drugs in the last 50 years has forever changed the practice of medicine. At the turn of the century, infectious diseases were the leading cause of death, and the average life expectancy was about 50 years. Today, not only do vaccines prevent many diseases that formerly lulled people in their youth, but antibiotics can also cure most bacterial infections. Consequently, life expectancy in the United States now exceeds 75 years.

Serious incurable diseases such as diabetes and high blood pressure can be controlled by drugs. Similarly, drugs help minimize the crippling effects of arthritis and control many forms of mental illness. But much remains to be done. AIDS and other deadly diseases still defy a cure; researchers hope that these will soon be conquered by drugs or vaccines.

Although drugs can be life-saving, they can also produce adverse side effects that range from minor and annoying to potentially fatal. Medications are not "magic bullets" that attack only the disease; instead, they affect the entire body. Some trigger the immune system to mount an allergic reaction; others damage healthy as well as diseased tissue; and still others produce quite unpredictable reactions. A few of the latter have led to new drug uses and discoveries. For example, the observation that certain allergy medications reduce appetite resulted in the development of new diet pills; the ability of a blood pressure drug to stimulate hair growth produced a somewhat effective treatment for baldness.

Researchers are always seeking to minimize any adverse side effects by devising new ways to deliver medications to their target tissues and bypass organs that would be adversely affected. Some of these are already in use. For example, medicated skin patches effectively deliver small, steady amounts of drugs directly into the bloodstream, thus avoiding the potential problems of having larger doses circulating at any time. Enteric coatings that cause a pill to remain intact until it reaches the small intestine protect the stomach from irritation. Cloning techniques that produce special antibodies to carry drugs make it easier to target cancer drugs on tumor cells while sparing normal tissue.

Fetuses, young children, and the elderly are especially vulnerable to adverse drug effects, and in these groups, medications should be used only under a doctors careful supervision. In general, medicines must always be used cautiously, if at all, during pregnancy, and dosages should be carefully adjusted for children and the elderly.

For anyone, the risk of adverse drug effects increases with the number of medications taken simultaneously because many drugs interact with each other. These dangers can be minimized by always giving a doctor and pharmacist a list of all medications you are taking -- including vitamins and nonprescription drugs -- before adding more. Many pharmacists now keep computer patient drug profiles, making it easy to spot potentially harmful combinations.

Surgery, an invasive procedure that requires making an incision and using various instruments to enter the body, has also made tremendous advances in recent years. It is an ancient art that was typically practiced in years past by barbers and veterinarians, rather than physicians. Until the 20th century, surgery had a high mortality rate from infection and other complications. Modem anesthesia and antiseptic techniques revolutionized the practice, making most operations painless with greatly reduced risk.

There are now hundreds of different surgical procedures. Operations are performed to repair a damaged structure, to remove a diseased organ, or to alleviate a chronic symptom such as pain. In some instances, surgery may be aimed at preventing a future disease or problem; such a case would be removal of a benign growth to prevent its becoming cancerous. Some operations, especially cosmetic plastic surgery, are intended primarily to enhance self-esteem and a sense of well-being rather than alleviate a medical problem. Doctors may also use surgical procedures, such as biopsies and exploratory surgery, to help in making a diagnosis.

In the 1970s and 1980s, surgery underwent another revolution: Development of powerful surgical microscopes and fiber optic techniques made it possible to perform delicate operations through tiny puncture incisions. For example, some back surgery that once required a long incision and weeks of recuperation can now be performed using microsurgery methods that necessitate only a brief hospital stay.

Coronary bypass surgery and other heart operations that were impossible a few decades ago are now routine. In fact, critics charge that a large percentage of bypass procedures are unnecessary, and that many patients would do just as well with medication and lifestyle changes. In non-emergency cases many insurance companies and other third-party payers now require a presurgery second opinion to make sure that the operation is really needed.

For some diseases, most notably cancer, surgery is the major treatment. But it is often combined with other approaches, such as radiation and chemotherapy, to produce even better results. Similarly, arthritis treatment may entail a combination of medication and exercise, as well as surgery.

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