I was recently asked a question regarding current medical literature. I knew the general accepted answer but also knew that ‘general accepted knowledge’ in medicine is always changing and is not constant. It was only in the late 19th century that bloodletting with leeches was a common and accepted practice. In the 1940s arsenic and mercury were used to treat syphilis. We view these practices as barbaric now, but there was a time when it was accepted as proper medicine. I mention these examples, not to make you question your medical care, but to highlight the fact that medicine is a dynamic field that is ever-changing. This made me think about my care and management.
—- A (Very) Brief History of Medicine —-
Let me first say that there are entire books devoted to the topic of the history of medicine, thus I hope my brevity in this section does not diminish from the field or its extensive history. In fact, I even considered leaving this section out, but then I realized that to even think about the present and future, the past must first be rehashed. Hence, a discussion of the current and future of medicine must start with its past.
As I mentioned, the history of medicine is an extensive one. In his book, “A Brief History of Medicine”, Paul Strathern starts the book by stating, “The practice of medicine is as ancient as humanity itself.” Medicine was born when humans first came into existence. Even cavemen used plants in hopes of curing various ailments. Any history of medicine would be incomplete without the mention of Leonardo Da Vinci; his study of human anatomy was light years ahead of his time. In 1928 Alexander Fleming (accidentally) discovered penicillin revolutionizing the treatment of infection. In 1952 Jonas Salk invented the polio vaccine, not only preventing this debilitating condition in future generations, but also changing the way vaccines were viewed and used. On July 3, 1977 the first MRI scan was performed, transforming the way disease was diagnosed and found. Although there were many significant milestones in the history of medicine, in my view, these five events seemed most important. But the question still remains, how does this impact current thinking and more specifically my care?
—- Medicine Today and Epidermoid Tumors —-
Medicine is an ever-changing field, in which accepted practices change as frequently as the seasons. Thus when I was asked about the current views on a topic, I could provide the current literature and knowledge but knew that this information would likely be obsolete in the future. Does this mean that it is useless to study medicine? Of course not, every treatment, every discovery, every invention, serve as a step toward the ultimate goal in medicine: to cure disease and to alleviate pain. The only purpose of giving examples of how the practice of medicine has changed is to point out that medicine is dynamic. I often think that if I suffered from this tumor only 30 (or so) years ago, the response by a physician would have been, “Your exam and symptoms indicate that there might be a tumor in your brain. Unfortunately, there’s no way to take it out. So let’s see how time treats it. If it grows, I’m sorry to say that there is no option.” I could have suffered an unwanted fate. Thus the question must be raised: is death a worse outcome than permanent disability? I mentioned in an earlier post that I have deliberately stayed away from scientifically researching my tumor in order to avoid bringing up any unwanted memories, but I have a hunch that the diagnosis and management of epidermoid tumors are drastically different than it was in the past. Even though this knowledge might have an impact on my diagnosis, the implications on my recovery are undeniable. It was once generally accepted that while peripheral nerves can regenerate central nerves cannot. I was taught this in medical school, but my recent conversations with a neurologist show my learned insights to be untrue- as both peripheral and central nerves are capable of regrowth. This comes as good news to me as many of my deficits are due to damage to central nerves (ie cranial nerves). So in a sense I am lucky to have had the tumor when I did. But this comes with a caveat. Maybe in 30 years my grandchildren will balk at the way I was managed as the idea of bloodletting with leeches makes us cringe today.
 Starting in January I will be writing a weekly column for the Epidermoid Brain Tumor Society, the question was actually posed by one of their board members.
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