Modern advances in medicine and surgery

Modern medicine has tremendous resources. Advances in ‘spare part’ surgery have meant that replacement with bioengineered organs, rather than repair, is a viable alternative for many damaged organs. Hearing can often be restored by replacing the tiny ossicles of the ear by man-made components, and artificial lenses are available for insertion in the eye after a cataract operation. Artificial limbs are so sophisticated that a false arm, for example, can be moved by miniature electric motors in response to electrical impulses from the muscles of the amputee’s stump. Special chemically inert metal alloys and strong polyethylene plastics can be used to replace damaged joints within the body. Damaged heart valves can be replaced with artificial ones and an electronic pacemaker implanted under the skin of the chest, attached by wires to the heart to regulate its beat. Synthetic tubes can be used to replace damaged blood vessels.

Although the function of major organs can to some extent be taken over by mechanical replacements, the kidney dialysis machine, for example, or the heart-lung machine (which enables open-heart surgery to be performed), attempts to miniaturize and implant artificial organs of this complexity within the body have so far proved unsuccessful. Living tissue and organs can now be much more successfully transplanted from one person to another. New immunosuppressive drugs and advances in ‘tissue-typing’, which assesses the compatibility between donor and recipient tissues, have reduced the risk of rejection by the host body of a donor kidney. Heart transplants, too, can often provide several more years of normal life, but liver transplants have so far achieved no more than brief success. Modern techniques allow for far more accurate diagnosis than even a couple of decades ago. Ultrasound scanning and other body imaging techniques, such as positron emission tomography (PET scanning), nuclear magnetic resonance (NMR or nuclear scanning) and magnetoencephalography, can build up very accurate pictures of structures and processes within the body.

Test-tube babies are a reality today; microsurgical techniques make it possible to extract a ripened egg from a woman’s ovary, fertilize it and then re-implant it in the womb.

Life expectancy

In most parts of the world human beings are living longer than ever before. In Western countries life expectancy has almost doubled in the last hundred years. But are we any healthier? Recent surveys have suggested that we are not. More and more working days are lost each year through sickness. Over half the men and more than two-thirds of the women interviewed reported that they had chronic or recurrent health problems.

Over a third of the interviewees said they habitually take some medication. This suggests that nearly one-quarter of the population are constant users of prescribed medication.

Iatrogenic disorders

Even the Hippocratic writings acknowledged the existence of iatrogenic disorders (those that are in some way caused or induced by a doctor, his advice or his treatment, for example the side-effects of medicines given to treat another disorder) by admonishing physicians: ‘At least do no harm.’ The bleedings and purgings of the past, and the surgery carried out without the benefit of aseptic conditions, probably killed almost as often as they cured. More recently, drugs that seemed initially to provide almost miraculous cures, often proved to have unpleasant, even dangerous, effects when used over a long period. The steroids, for example, were found to have enormous short-term benefits in the treatment of arthritis and skin disorders. But just because they were so effective, they were used widely, indiscriminately and for long periods, and their long-term use proved to have damaging and often permanent side-effects.

Drug treatment has other dangers too. There is the risk of addiction, seen most often in the case of amphetamines, barbiturates and, most recently, tranquillizers. There is also the risk of increasing our vulnerability to infections by producing resistant strains of bacteria through over-prescribing or misusing antibiotics.

And last, but not least, there is the risk of’curing’ only symptoms, and not the underlying disorder. This may seem convenient in the short-term, but it may also make the patient negligent about adjusting his lifestyle to the demands of his body.

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