Though scientific inquisitiveness is evident in human history since the early years of the common era, proper medical inquiry into diseases and their documentation burgeoned in the 19th century. Efforts to identify the causes of diseases and their management were the central focus of medical researchers. Since then, medical knowledge has grown in leaps and bounds in three main aspects — disease diagnostics, drugs, and surgery. Over the years, medical research has introduced slow but significant changes in the way illnesses are evaluated and treated. Interestingly, most of these ‘imperceptible’ changes happen over a long period of time, though they bring in path-breaking changes in the patients’ outcomes.
But there are some medical discoveries which have ushered in disruptive changes in the way certain diseases are treated. These discoveries have converted purely ‘surgical’ diseases into medical diseases. Though surgical interventions are greatly effective in improving the outcomes in a multitude of diseases, who would be delighted to go under the knife? “Can we avoid the surgery, doc?” is the standard question among all patients who necessarily require a surgery. That was the norm and only hope for such patients for some diseases in the past and this has been completely upended by certain disruptive medical innovations.
Poliomyelitis: Polio is caused by a virus, which damages the spinal cord leading to various crippling deformities. Though the affected children survived, they were left disabled for their life, causing them to depend on calipers, crutches and wheel-chairs. Surgical correction of the deformities enabled them to lead a certain level of independent life. Just two decades ago, polio correction surgical camps were very common, and for orthopaedic students, a post-polio patient was a typical patient for final exams (often, a tough one!). But the polio vaccine, a few drops of oral solution, given on a mass scale, has almost eradicated the disease. Present-day doctors would not even be able to make a diagnosis of post-polio paralysis since they rarely see one, thanks to the inexpensive and highly effective polio vaccine.
Gastric ulcer: The gastric juice, which has hydrochloric acid, does an effective job of digesting the ingested food in the stomach, breaking down all food ingredients into easily absorbable products. However, it can erode into the protective stomach wall causing ‘ulcers’ which sometimes can be fatal. Twenty years before, all surgical theatre lists will have stomach ulcer patients planned for major surgeries such as vagotomy, antrectomy, perforation closure and re-routing. In 1985, two Australian researchers, Barry J. Marshall and Robin Warren, discovered a bacterium called Helicobacter pylori and deciphered its role in gastric ulcer disease. The use of appropriate antibiotics for the bacteria coupled with anti-ulcer tablets have almost eradicated the need for surgery in ulcer patients currently. Fittingly, they were awarded the Nobel Prize in Medicine.
Club foot: It is a birth defect, where otherwise perfectly normal children, are born with curved and twisted feet. If neglected, it leads to permanent disability, chronic pain, and cosmetic concerns. Originally treated by plaster of Paris casts, many infants subsequently required surgery, often more than one, in their early years of childhood. Affecting one in 1,000 live births, surgery for club foot was very common in the past, till a wonderful casting technique was invented by Ignacio Ponsetti. This simple and organised way of applying the Ponsetti plaster casts has made these children completely normal, and currently very few children with club foot need surgery. Liberation from scarred and stiff feet, indeed!
The above three caught my attention since I had witnessed the high magnitude surgeries for these conditions and how the vaccine, tablets and plaster casts have completely converted these ‘surgical’ diseases into medical diseases in the past 25 years. There are other stupendous advances in cancer medications, which has reduced the need and magnitude of surgery in patients with cancers. Radical surgeries for cancers have significantly come down. Similarly, interventional radiology performed through small intra-vascular catheters is working wonders to reduce the necessity and enormity of certain surgeries.
Surgery of the human body is not a pleasant experience for humans. But it has remained life and limb saving for many diseases. However, I wish more such ‘disruptive medical inventions’ happen frequently so that the need for surgeries is minimal in the future.
rishiortho@gmail.com
