Lotions, Potions, Pills, and Magic: Health Care in Early America

Epilogue

>> 193 Epilogue Admittedly this book has shown a gloomy picture of the early state of health care and the medical profession. The picture since then has been quite different . Medical practice did not begin to change until the 1890s with the establishment of the first endowed graduate program in medicine at Johns Hopkins University in Baltimore, an institution that drew on the model of the German universities and was staffed with German-trained physicians, which in fact reversed the trend of medical nationalism. Americans had come to accept the radical new ideas spreading from European laboratories that specific germs, not an imbalance of imaginary humors in the individual, caused disease and that the answer to medical advancement was through scientific method. With funds for research, the Johns Hopkins medical school was not dependent on student fees and could focus on the advancement of laboratory-based science and evidence-based clinical trials, which had long been practiced in European universities. The 1890s thus marked a new era in American medical history and a sharp break from the old. It was, however, only a beginning. 194 > 195 more coordinated quarantine measures under the aegis of the federal government . The creation of the Food and Drug Administration and the first National Health Service inspired by the Progressive Movement early in the twentieth century contributed to further improvement in health and the quality of food. Physicians were important in all these developments. They had regained a place in setting public policy. Greater strides were made by the 1950s. The United States was coming of age in its use of medical science with the continual acceptance of overseas developments. European-discovered antibiotics—sulfonamides in the late 1930s and penicillin in the 1940s—reduced death from infectious diseases from 32 percent of all deaths in 1900 to 5 percent in 1960 in the United States. In the years since even more infectious diseases have been conquered with added vaccines, the elimination of smallpox from the world, more effective treatments for AIDS, and new genetic therapies. Surgical technology improved dramatically. Many of the new contributions came from American laboratories that have achieved unparalleled successes since the Second World War. Those who might have died from infectious diseases now live to a much older age and are subject to a host of problems that affected only a small number in the past—heart attacks, strokes, cancer , and psychiatric disorders. Many common chronic diseases such as diabetes , arthritis, thyroid deficiencies, and varieties of anemia can be treated successfully but not cured. These are much more intractable problems, but there are high expectations that the medical profession will someday cure all disease. Life expectancy has risen steadily in the last seventy-five years, although the Europeans today generally outlive Americans, a reversal of the situation in the early period. The Center for Disease Control and Prevention (CDC) notes that infant mortality in the United States continues to lag behind other industrialized countries. The United States stands at twenty-nine, ranking along with Poland and Slovakia. Japan exceeds all nations with a life expectancy of about eighty-three years and is third in infant mortality. At the same time Americans spend twice as much on health care as the comparable countries. There is good reason to ask, if we are the leaders in biomedical research, why are we behind the rest of the world in our own health at such an exorbitant cost? Is there something in the medical delivery system of other countries with their superior health outcomes that we should follow? Are we again falling into the trap of American exceptionalism, believing that our system is superior to others because we think we are different from or better than others? There is a renewed tension between those who claim we 196 > 197 ironically are based on those older unscientific therapies and practices. Few of the alternative systems have been subject to rigorous scientific investigation to give proof of effectiveness or safety. In spite of the strides made by the modern medical establishment to cure disease, heal bodies, and successfully treat all kinds of disorders, millions of people have turned to practices that have long been discredited. They ask that their bodily fluids be depleted, that they be detoxified, or look for magical rituals to accompany the ingestion of drugs, or attempt bizarre and unbalanced diets, or depend on the promise of a one-nostrum cure all, or tap into their mystical vital force. They have turned to non-Western...