What we ‘knew’ then

“Today’s modern medicine is providing us with healthier bodies and many cures.” That message has been communicated—overtly or implied—to our patients for many decades, at least 60 years in my experience.

Many times that statement is true. But also many times, with continuing advances in medical research, it comes back to bite us—and hard.

Early in my practice (late 1940s), when a radiologist reported on an infant’s x-ray for possible pneumonia that there was a persistent thymus gland, I “knew” that the correct treatment was to have the gland irradiated. And I sent many little children for such radiation.

That was the current thinking, that was medical fact, and I am sure I (and many of my colleagues) said something like my lead sentence to parents—maybe even adding that we were lucky to have such advanced knowledge. Today, we “know” that such treatment is not indicated and that by using it, we would be exposing children to unneeded and potentially harmful radiation.

Another therapy from those days: Many doctors “knew” that a tonsillectomy and adenoidectomy (T&A) were indicated in most cases of recurrent throat infections with persistent enlargement of the tonsils and of lymph glands. It became almost routine because we “knew” the facts. In some instances, multiple members of the same family were subjected to T&As—some for treatment and some prophylactically—often operated on the same day.

Further research and study established that the indications were fewer than we “knew,” and we were doing too many T&As. Today we do a small fraction of the number of T&As that were done then.

I went into practice in the earliest days of antibiotics. At the time of my graduation, we had only sulfanilamide and aqueous penicillin—two miracle discoveries. But few physicians consciously anticipated that more were to come and that these were not the be-all and end-all of infection therapy. Thank goodness, what we “knew” was not the ultimate. And perhaps what we have today will soon be old-fashioned.

For gallstones and cholecystitis, the accepted treatment of the day was surgical removal of the gallbladder, an intensive and extensive procedure. I observed (not treated) many such surgical patients, when I was an intern and later among members of my family. The pain and suffering and prolonged recovery were horrible. Who would ever dream that something so much simpler—laparoscopic removal—would replace what we “knew” then.

And there were many other things we “knew” that turned out to be false.

I often wonder whether what we “know” today will be replaced with something newer and better (occasionally, unfortunately, not better). I think it will. Yes, throughout my career and throughout the careers of those still in practice, physicians give the impression that each decade’s medical developments represent medicine’s greatest achievements. On the contrary, I believe that the best treatments are—and will always be—yet to come.

So maybe we should not communicate—specifically or indirectly—that we are providing the ultimate with everything we do. Maybe we should communicate to patients that this specific treatment or procedure we are suggesting is today’s best and that we hope even better solutions will come from medical science and research in the future. While explaining today’s “miracles,” we must also communicate hope for a brighter outlook.

All of this reminds me, as a confirmed chocoholic all my life, that for years I jokingly predicted that some future discovery would establish that chocolate is good for our health. We now know that dark chocolate (the one with the most cacao in it) does contain antioxidants and flavonoids, and is healthy for us—especially for heart patients and pregnant women.

Ahem, pass the chocolate bars, please—again! I “know” they are good.