Medicine

B

Research Funding

Until World War II (1939-1945), most money for medical research in the United States was donated by wealthy individuals, industry, and universities. Scientists resisted government funding because they feared losing the intellectual freedom to study as they chose. Since the 1940s, however, the Federal Government has taken a major role in funding biomedical research.

The National Institutes of Health (NIH) in Bethesda, Maryland, is the biggest government source of research funds. NIH is an agency within the U. S. Department of Health and Human Services. In 2001, the NIH planned to spend about $20.3 billion on biomedical research, distributed to scientists in colleges and universities to conduct specific research projects.

The pharmaceutical industry spent about $26 billion on research in 2000. The next largest source of funds is the Howard Hughes Medical Institute (HHMI), which spends about $554 million annually. Other major funding sources are private foundations and voluntary health organizations. Private foundations are organizations established by wealthy individuals. Among those active in biomedical research are the Charles A. Dana Foundation, the Lucille P. Markey Foundation, and the Whittaker Foundation. Voluntary health organizations are charities supported by contributions from members and the public. Major voluntary health organizations include the American Cancer Society, the American Heart Association, and the American Diabetes Association.

C

Research Costs

Research is expensive. During the late 1990s the NIH often spent more than $130,000 per year to fund an average research project. Drug manufacturers estimate that they spend an average of $359 million to develop one new drug.

---

---

The availability of funding often determines what medical research is conducted. Voluntary health organizations and other groups act as advocates in urging or lobbying the government to spend more on their own particular disease. Governments in developed countries usually spend most heavily on diseases that affect their own citizens, and these diseases are typically different than those commonly found in developing countries. Pharmaceutical companies also emphasize development of the most profitable new drugs, usually for diseases that occur in developed countries.

As a result, little research is done on diseases that kill millions of people in developing nations. In 1998, for instance, the NIH planned to spend only $116 million on malaria and other tropical diseases. While rare in industrialized nations with developed health care programs, malaria kills 1.5 million to 2.7 million people in developing countries each year.

VI

History of Medicine

Our understanding of prehistoric medical practice is from the study of ancient pictographs that show medical procedures, as well as the surgical tools uncovered from anthropological sites of ancient societies.

Serious diseases were of primary interest to early humans, although they were not able to treat them effectively. Many diseases were attributed to the influence of malevolent demons who were believed to project an alien spirit, a stone, or a worm into the body of the unsuspecting patient. These diseases were warded off by incantations, dancing, magic charms and talismans, and various other measures. If the demon managed to enter the body of its victim, either in the absence of such precautions or despite them, efforts were made to make the body uninhabitable to the demon by beating, torturing, and starving the patient. The alien spirit could also be expelled by potions that caused violent vomiting, or could be driven out through a hole cut in the skull. This procedure, called trepanning, was also a remedy for insanity, epilepsy, and headache.

Surgical procedures practiced in ancient societies included cleaning and treating wounds by cautery (burning or searing tissue), poultices, and sutures, resetting dislocations and fractures, and using splints to support or immobilize broken bones. Additional therapy included laxatives and enemas to treat constipation and other digestive ills. Perhaps the greatest success was achieved by the discovery of the narcotic and stimulating properties of certain plant extracts. So successful were these that many continue to be used today, including digitalis, a heart stimulant extracted from foxglove.

Several systems of medicine, based primarily on magic, folk remedies, and elementary surgery, existed in various diverse societies before the coming of the more advanced Greek medicine about the 6th century bc.

A

Egyptian

Egyptian medicine was marked by a mystical approach to healing, as well as a more empirical or rational approach that was based on experience and observation. Common diseases of the eyes and skin were usually treated rationally by the physician because of their accessible location; internal disorders continued to be treated by the spells and incantations of the priest-magician.

The physician emerged around 2600 bc as an early form of scientist, a type distinct from the sorcerer and priest. The earliest physician whose name has survived is Imhotep (lived about 2600 bc), renowned for his studies of pathology and physiology as well as his expertise as a pyramid builder and an astrologer. The Egyptian physician normally spent years of arduous training at temple schools in the arts of interrogation, inspection, and palpation (examining the body by touch). Prescriptions contained some drugs that have continued in use through the centuries. Favorite laxatives were figs, dates, and castor oil. Tannic acid, derived principally from the acacia nut, was valued in the treatment of burns.

Although Egyptians practiced embalming to preserve bodies after death, their knowledge of anatomy was minimal. As a result, they attempted only minor surgical procedures, with the exception of trepanning. According to reports of the Greek historian Herodotus, the ancient Egyptians recognized dentistry as an important surgical specialty.

B

Mesopotamian

Medicine in Assyria and Babylonia was influenced by demonology and magical practices. Surprisingly accurate terra-cotta models of the liver, then considered the seat of the soul, indicate the importance attached to the study of that organ in determining the intentions of the gods. Dreams also were studied to learn the gods' intentions.

While magic played a role in healing, surviving cuneiform tablets indicate a surprisingly empirical approach to some diseases. The tablets present an extensive series of medical case histories, indicating a large number of medical remedies were used in Mesopotamia, including more than 500 drugs made from plants, trees, roots, seeds, and minerals. Emollient enemas were given to reduce inflammation; massage was performed to ease gastric pain; the need for rest and quiet was stressed for some diseases; and some attention was paid to diet. Water was regarded as particularly important, since it was the sacred element of the god Ea, the chief among the numerous healing gods. The serpent Sachan was also venerated as a medical deity.