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Jul
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Sandeep Singh Dhillon
5 medical revolutions that were once taunted – MIMS Malaysia
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By Shirley Yong

Medicine, as we all know, is an ever evolving field. Some of the medical advances that we observe today are a manifestation of sparks of visionary ideas or an experiment that scientists and clinicians courageously stood by, despite surmounting rejection and criticism by conventional wisdoms. Here, we explore 5 medical revolutions that were once fiercely resisted, only to be vindicated years later as standards of care that have saved more lives than we can ever imagine.

1) Helicobacter pylori

For decades, peptic ulcer disease (PUD) was thought to be caused by spicy food, stress, and lifestyle habits. In 1982, Dr. Barry Marshall challenged this conventional medical doctrine with his discovery of Helicobacter pylori, a bacteria that is now widely accepted as the causative pathogen of PUD. His idea however, was ridiculed by medical establishments who were firmly entrenched in their beliefs that the survival of bacteria in the stomach’s acidic environment was impossible.

Dampened by criticism, Dr. Marshall ingested the petri dish cultured with H.pylori to prove its association with PUD. Within a week, he developed symptoms of stomach ulcers, with biopsies showing severe damage to the stomach mucosa lining. The discovery was published in the Medical Journal of Australia in 1985 and subsequently, won Dr. Marshall a Nobel Prize in year 2005.

“Everyone was against me, but I knew I was right. You’ve got to be pretty thick-skinned and ready to take the blow,” said Dr. Marshall.

2) Prion in Mad Cow Disease

In 1982, neurologist Stanley Prusiner discovered that pathogens are not the only agents capable of transmitting diseases. In his breakthrough discovery, Prusiner found that infectious proteins, dubbed as prions, are the causative agents of Mad Cow disease and Creutzfeldt-Jakob disease. His idea was deemed as controversial, treated as heretical, and greeted with skepticism amongst the scientific community.

With tenacity, Prusiner continued researching further to define the precise nature of prions and link them to a list of diseases. In 1996, Britain reported the first few cases of the human-form of Mad Cow disease or Bovine Spongiform Encephalopathy, previously identified as a prion disease by Prusiner. After 25 years of research, Prusiner was awarded a Nobel Prize in 1997 for his discovery.

3) Cancer immunotherapy

When most researchers were investigating on how the immune system can be “switched on” to fight cancer, immunologist James Allison took an entirely different approach. Much to the scientific community’s disagreement, Allison designed a study based on the hypothesis that a molecule known as CTLA-4 can function as a brake in the immune system.

“Well, I wonder if we could make the immune system better at attacking cancer by temporarily disabling the brakes?” said Allison. “Everyone thought I was crazy.”

His research eventually resulted in the development of the first monoclonal antibody, Ipilimumab, for the treatment of metastatic melanoma. Allison was later faced with the challenge of seeking collaboration with biotech companies, most of whom were skeptical of the prospect of immunotherapy. A small company called Medarex took the plunge and the drug was approved by FDA in 2011.

Today, immunotherapy is deemed as a medical revolution in cancer treatment.

4) Percutaneous transluminal coronary angioplasty (PTCA)

PTCA or balloon angioplasty was developed successfully by German physician-scientist Andreas Roland Grüntzig in the 1970’s. In 1969, Grüntzig encountered a patient enquiring on the possibility of “cleaning” an obstructed artery like a plumbing work, instead of undergoing drug treatment or complex operations. Grüntzig found the idea fascinating, and soon developed his theories of therapeutic vascular interventions and the initial devices in his own kitchen.

In 1976, Grüntzig presented his results in animal studies in front of the audience of the American Heart Association annual scientific session, only to be hampered by skepticism and criticism. One year later, Grüntzig performed not one or two, but four successful coronary angioplasty procedures on live patients. He presented his cases again in the American Heart Association annual meeting, this time with a standing ovation from all members of the floor.

5) Hand Disinfection

For proposing an antiseptic handwashing protocol, which is now a fundamental medical concept, a Hungarian physician in the 19th century was ridiculed and tormented.

While working in the maternity ward, Ignaz Semmelweis introduced a hand-washing policy in the obstetric clinics. He observed that doctors may transmit “cadaverous particles” to mothers after performing autopsies, which may lead to puerperal fever that he believed was contagious. This however, was rejected by the medical community. For standing by his belief, Semmelweis was later admitted to an insane asylum against his will, where he was severely beaten and succumbed to death shortly. It was only until Louis Pasteur confirmed the germ theory years later that Semmelweis’ practice earned acceptance. MIMS



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