Twenty years ago, December 1999, I asked my fellow physicians in Healdsburg what they thought were the major medical advances of the twentieth century. Their responses were extensively covered in the Healdsburg Tribune.
The responses were interesting, somewhat specialty related, but the development of immunizations led the list, and freeing the world of diseases like smallpox which used to kill hundreds of thousands per year. Other things mentioned were antibiotics, X-rays, CT scans, MRI’s, new surgical techniques like laparoscopic gall bladder surgery, much improved medical treatment for chronic diseases like diabetes (insulin first used in 1922), high blood pressure, high cholesterol, improved treatment and detection of cancers (think mammograms and Pap smears), recognition of the dangers of smoking and other potential hazards, and of course joint replacements and much improved treatment for heart attacks and strokes. One doctor even mentioned seat belts and MADD (mothers against drunk driving).
I think for most doctors, including me, this was an optimistic view of medicine and what we had accomplished. We had expanded the life expectancy in the U.S. from 47 years in 1900 to 70 for men by 1999, and from 49 years to 80 years for women. So we had a reason to be optimistic. We expected further improvements and developments.
So what has happened in the last 20 years? First let me say these are mostly my thoughts, although I have spoken to a few physicians about these things. As we have all read, the life expectancy has actually fallen in the last few years. Much of the reason for this is related to people dying young of drug overdoses, especially opioids. These were happening in 1999 (16,900 deaths) but not nearly to the same extent it is happening now (70,200 in 2017). This will be an ongoing long-term battle; fortunately we have made some small strides in Sonoma County. The dangerous use of e-cigarettes by youths has expanded dramatically and this must also be dealt with.
But here are some concerns that are not so widely reported. First, overuse of antibiotics and thus the development of organisms that are resistant to most of the antibiotics we have in our arsenal is very troubling to me. I read almost daily of someone who has died from a bacteria that is resistant to all antibiotics. And what may be more worrisome is the recent discovery of a bacteria that can share its drug resistant gene with other bacteria. So we must be much more careful and limit the wide use of antibiotics or we will accelerate and worsen this problem. One very worrisome illness is known as MRSA, or Methicillin Resistant Staph Aureus. This means the highly dangerous Staph aureus is now resistant to methicillin, which used to be able to treat this infection. It is estimated there are 20,000 deaths each year from MRSA in the US.
Here is another abbreviation to be aware of: C. diff. This is an infection in the colon from Clostridium difficile and commonly comes from the use of antibiotics that wipe out the normal bacterial makeup of the colon. Treatments include surgical removal of the entire colon, and even “fecal bacterial transplant” may be used. This infection can also occur by transmission from one infected person to another. One estimate was that there were 450,000 cases of C. diff in the U.S. in 2017 with 29,000 deaths. The numbers may be even higher, as all cases were not reported.
Now compare these numbers: 49,000 deaths from MRSA and C. diff in one year, at least partially related to overuse of antibiotics; 41,000 deaths from breast cancer per year; and 34,500 deaths from motor vehicle accidents per year. So in my view, the overuse of antibiotics should be as high on our radar screen as breast cancer and motor vehicle accidents.
And then the biggest concern of mine for world health and sustainability: the soaring world population. The population of the world is 7.8 billion as of late 2019 (yes, you read that right: almost eight billion people.) In 1800 it was about 1 billion, in 1900 it was about 1.5 billion, so you can see the rapid and scary population growth since 1900. To me this will not only lead to greater strife and combat in the world, plus more human disasters as people lack food water and shelter. We already see issues of famine and starvation throughout the world, our continent included (one estimate was that 35 million people died worldwide of starvation in 2019). This population growth will also hasten global warming, which is another of my major health concerns. There obviously are no simple or even complex methods of dealing with this, but the huge population growth must be talked about and considered as a major threat to mankind.
So, in 1999, I was doctor somewhat optimistic about the field of medicine continuing to make strides in the health of the world. As you can see, I am no longer optimistic about what we can accomplish.
Dave Anderson, M.D., is a retired Healdsburg physician who currently serves on the board of directors of the North Sonoma County Healthcare District.
