The history of medicine dates from about fifty thousand years ago (arthritis in Neanderthals) so one might find it difficult to believe that during the five years that I have been writing about things medical for you in the Savannah Morning News that much of any real consequence could have happened. Not so. Consider some of these events in medicine that now or in the very near future will dramatically influence your medical care. For decades physicians have believed that a woman’s health is improved by taking replacement hormone therapy after menopause. During the past five years, that belief has been refuted and millions of ladies are being advised not to take hormones. While hot flashes may be cooled and bones made somewhat stronger, the risk of uterine cancer is heightened and heart disease is not reduced. There is now additional evidence that hormone replacement therapy may promote Alzheimer’s disease. Considering that forty percent of American women over sixty-five years of age are taking hormones, this change in the medical community must be viewed as colossal. In the field of infectious diseases, during the past five years we have witnessed advances in the development of potent anti-HIV drugs that have reduced the number of AIDS deaths and new AIDS cases in the US. Currently approximately 800,000 to 900,000 people are living with HIV disease. The number of new infections still hovers at an unacceptable 40,000 cases each year. In contrast to the correct fear of the epidemic of HIV that gripped our nation in the last years of the twentieth century, many people mistakenly believe that HIV disease is controlled. Considering that an estimated 5.3 million cases of new HIV Infections occur each year worldwide to individuals who cannot afford the drugs and who fail to understand how to prevent HIV disease, the futures of many nations are at risk while we in the US have become too complacent about the HIV virus. Other viral illness that have surfaced in the past five years include West Nile Virus, which has been in the eastern US since 1999 and the SARS (Severe Acute Respiratory Syndrome) virus that struck Asia, Africa, and Canada last year. We can only breathe a slight sigh of relief that the disease seems to have been contained. Certainly, we all became aware of just how small our planet is when we secured our airports and halted travel plans because of SARS. Finally, this year has forced us to look at the cute prairie dog in a new light as it has been identified as the carrier of the very dangerous Monkey Pox Virus. To be sure, the past five years have provided new and challenging health issues in the field of infectious diseases.

On a more positive note, the recent technical developments in medicine have been the stuff of science fiction. The forty-year history of coronary by-pass surgery has been punctuated by the development of “off pump” techniques of re-establishing blood flow to the heart. If recent successes hold up, the costs and adverse effects of coronary by-pass surgery for preventing heart deaths will be dramatically improved. In gastroenterology we have used endoscopes for thirty years to look into the stomach and the colon to diagnose and treat digestive diseases. We could not see much of the 20 feet of small intestine. We now have Capsule Endoscopy. In this procedure the patient swallows a pill that houses a camera programmed to take two pictures per second as it passes naturally through the length of the small bowel. Thousands of images are transmitted to a receiver worn by the patient. The receiver is subsequently linked to a computer that downloads and converts the images to a motion picture of the entire small bowel thus revealing disorders previously undefined. This technology was not available five years ago but is used regularly today.

Finally, the last five years has witnessed one of the greatest accomplishments in the history of medicine and science, namely the sequencing of the human genome. Knowing the complete human DNA sequence has already led to advances in the diagnosis of human disease and to the development of new treatments. This is only the beginning of a new era in multiple areas of health care including cancer, neurologic diseases such as Alzheimer’s disease and Parkinson’s disease, and in the diagnosis and prevention of inherited diseases.

“Good For What Ails You” has been around for five years. Gosh, that doesn’t seem like a long time or does it? Long or short, one thing is certain. A lot has happened.