More miraculous medical advances

crutchfieldsquareMy previous three columns have described several discoveries in medicine that have enriched the quality and prolonged the lives of humankind. This week’s column features more magnificent medical advances that have changed the way we live.

Preventing disease: vaccination generation  

Before vaccination, the best we could do was to treat disease. The concept of preventing disease was revolutionary.

British physician Edward Jenner is generally regarded as the inventor of vaccination, but there are reports of vaccination-like efforts over 500 years earlier in China using a rudimentary vaccination technique called variation.

Dr. Jenner realized that milkmaids who had encountered cows infected with cowpox seemed to be protected against developing smallpox. Smallpox was a devastating disease that killed 25 percent of those who contracted it and was extremely disfiguring for those who survived it.

Dr. Jenner took material from the cowpox lesions and exposed humans to it (via a cut in the skin) and found that it offered immune protection against smallpox! The cowpox and smallpox viruses are similar enough in design that the immune system can be tricked into being exposed to one and then developing immunity against the other one.

The best part of vaccination is that the immune system can have a long “memory,” that is, be exposed to a disease at one time and be able to remember and fight it off years later. By 1979, smallpox was the first disease eradicated from the planet.

Pharmaceutical companies became involved and developed multiple types of sophisticated and effective vaccines for many other infectious diseases. Vaccines can now be swallowed, injected, or introduced via nasal spray. Vaccines can be made from live viruses, dead or inactivated viruses, or even from just part of a virus that is enough to cause an immune response.

Currently, vaccines are available against anthrax, chicken pox, diphtheria, hepatitis, human papillomavirus virus, Influenza, Influenza type B, Measles, Meningococcal , Mumps, Pertussis, pneumococcal, polio, rabies, rotavirus, rubella, shingles (zoster), tetanus, typhoid, varicella (chicken pox), yellow fever and several  others.

Although the inventor is debated, the vaccine revolution that may have started with Dr. Jenner and the cowpox milkmaids has resulted in dozens of different types of vaccines that save millions of lives a year.

 

Sexual health helper: Viagra

Viagra (chemical name sildenafil) is a revolutionary treatment for erectile dysfunction. Oddly enough, it was not designed to treat erectile dysfunction. It was originally developed to treat high blood pressure and chest pain associated with cardiovascular disease.

Unfortunately, it was not very good at treating these ailments, but test subjects did report a dramatic improvement in their previous inability to obtain an erection. With this new information at hand, the company (Pfizer) decided to switch their efforts to using it as an erectile dysfunction medication, and the rest, as they say, is history.

This is one of the most remarkable and oddly accidental discoveries in the history of medicine. With the trade name Viagra, it was approved by the F.D.A. in 1998. Sales topped an unbelievable $1 billion in sales in its very first year.

Viagra, “the little blue pill,” works by increasing blood flow in blood vessels after relaxing them. It is also used to treat pulmonary hypertension, a disease causing high blood pressure in the blood vessels of the lungs. First in its class, Viagra has led to the development of several other similar medicines that have improved the sexual health of countless people.

 

The masters of inflammation: corticosteroids 

 

Corticosteroids are a group of medicines that are very similar to hormones produced by the adrenal glands. Their main function is as a mediator of inflammation — that is, they act as anti-inflammatories. Corticosteroids also mediate the body’s physiologic response to stress.

They were first isolated in the 1930s, and their use in successfully treating arthritis resulted in a Nobel Prize awarded to researchers at the Mayo Clinic in 1950.

They named the hormone “cortisone.” Corticosteroids are used to treat a variety of inflammatory conditions (usually as the form called “prednisone”) including, but not limited to, rheumatoid arthritis, asthma, lupus, inflammatory bowel disease, inflammatory and obstructive lung disease, and dermatitis-eczema.

Unfortunately, steroids are not without significant severe side effects including high blood pressure, fluid retention, adverse skin effects, diabetes exacerbation and eye damage. Nevertheless, the invention and medical use of corticosteroids have relieved the suffering of millions of people worldwide.

 

Acne cure: Retinoids

Retinoids are a group of medicines that are variations of vitamin A. They have been used to treat acne, wrinkles, psoriasis, and even some types of cancers (e.g. Kaposi’s sarcoma). They function by controlling the growth and development of cells. As a result, they are involved in maintaining good bone health, vision health, cancer suppression and immune system health.

An oral (pill) version called isotretinoin is the most effective treatment of acne available and truly has the ability to cure acne, not just improve it. As a result, it has increased the self-esteem of untold people and prevented the lifelong disfigurement of acne scars suffered by so many before its availability.

As with other medications, retinoids have serious side effects and must be used under the direction of a trained and certified physician.

In the final installment next week, we will talk about medicines that control reproduction and some new medicines of the future.

 

Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.