PBIO3440: Evolution of Medicine
PBIO3440: Evolution of Medicine PBIO 3440
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This 9 page Class Notes was uploaded by Brittany Ariana Borzillo on Wednesday September 28, 2016. The Class Notes belongs to PBIO 3440 at University of Georgia taught by Affolter in Fall 2016. Since its upload, it has received 5 views. For similar materials see Medicinal Herbs Spices and Plants in Plant Biology at University of Georgia.
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Date Created: 09/28/16
Evolution of Medicine Hippocrates (460-377 BCE) The Greek “father of medicine” Considered illness to be a natural cause rather than a supernatural phenomenon o Medicine should not include ritual ceremonies or magic Holistic approach by comparison to western approach o “It is more important to know what sort of person has a disease than to know what sort of disease a person has.” o “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” o “Natural forces within us are the true healers of disease. o “Cure sometimes, treat often, comfort always.” Theory of the Four Humors o Four principal fluids exist within the body Yellow bile Fire Blood Air Black bile Earth Phlegm Water o Balance of these fluids determine a person’s character and health Imbalance of the humors resulted in illness Galen (131-201 CE) Developed highly theoretical system on illness based on the humoral theory o Gave physicians a theoretical framework to work within while ignoring pragmatic results o Led to the divergence between professional physicians and traditional healers Allopathic physicians looked down on healers Medicine became professional o Prevailed in Europe for more than 1500 years “Heroic Medicine” o took Socrates quote to mean something that it didn’t mean at all “desperate cases need the most desperate remedies” ~Hippocrates o Europe was swept away by terrible plagues from the Middle Ages o Mercury was somewhat effective in treating syphilis Became prescribes for any and all conditions o Illness was thought to result from overstimulation of blood and the nervous system o Treatment consisted of draining off excess “humors” by a variety of means Bleeding – venesection (opening a vein) and cupping Dosing with mercury – mercury, antimony, and other heavy metals were used as powerful purgatives which was inevitably very poisonous Blistering – adding hot plasters to skin to promote blistering; the blisters were drained which was considered as lessening humors Emetics – induced vomiting Dr. SamuelHahnemann and Homeopathy German physician was appalled by heroic medicine Took some cinchona bark (quinine) and developed similar symptoms to malaria o Law of Similars “like cures like” o Cinchona Bark, Cinchono spp. Large forest tree to Andes Bark is source of quinine Interferes with metabolism of the malarial parasite plasmodium Principals of Homeopathic Medicine o Every person has energy (referred to as a vital force or self-healing response) which can become disrupted o Homeopathy stimulates the body’s own healing response o Treatment involves giving very small doses of substances (“remedies”) that would produce similar symptoms of illness in a healthy person if given in larger doses Like cures like Homeopathy Paradox o Law of Infinitesimals More dilute agents have greater healing powers o Systematically dilute a substance with vigorous shaking at each step of dilution until the remedy is extracted into a solute (which is the most effective form) o Most remedies come from plant, animal, or mineral sources o Clinical trials are inconclusive about use and safety Placebo effect a beneficial effect, produced by a placebo drug or treatment, that cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient's belief in that treatment Samuel Thompson (1769-1843) appalled by heroic medicine “all diseases are caused by cold” emphasized emetics, purgatives, stimulants, and steam baths principal herbs o lobelia emetic, relaxant, and panacea o Cayenne Pepper Stimulant o Both increase body temperature and dilate blood vessels Included 65 total herbs o Drew heavily from Native American uses of medicine Approached medicine empirically o Allopathic doctors focused more on theory, so if something was known to be a certain way, that’s the advice that was taken instead of paying attention to the patient’s feelings and opinions Strong determined advocate who was opposed by the medical establishment o Had many followers but was not accepted by the wealthy or well educated Dr. Wooster Beach (1794-1868) and Eclectics Came from a relatively privileged background but was appalled by heroic medicine Apprenticed with an herbalist in New Jersey Earned an allopathic medical degree o Wanted to change the system from within Considered Thompson’s theories to be overly simplistic Sought to combine new scientific knowledge with the best of herbal tradition o Formed eclectic medicine o Developed a medical college in Ohio Was considered a “festering thorn in the side of Regular American Medicine” Shakers United Society of Believers in Christ's Second Appearing o Christian sect founded in the 18th century in England o known as "Shaking Quakers" because of their ecstatic behavior during worship services o women assumed leadership roles within the sect Herb Farm o Thriving wholesale herb business by the mid 1800s o Gathered, grew, and processed more than 400 species of medicinal plants o Sold directly to physicians and pharmacists o Emphasis on quality control Known for consistent product o Relied on European introductions and native species Patent Medicines Usually contain 25%-50% alcohol Often contained powerful drugs such as opium, senna, antimony, and ipecac (emetic) Advertised as blood purifiers “one dose for a man, two doses for his horse” Ipecac, Psychotria ipecacuariha tropical shrub native to brazil dried roots are the source of alkaloids (emetine and cephaeline) expectorant at low temperatures o used to treat bronchitis strong emetic at high doses Lydia Pinkhams Vegetable Compound herbal recipe for “female complaints” that became a profitable patent medicine business encouraged women to take control of their own health and offered tips for healthy living secret recipe included Black Cohosh marketing strategy targeted both men and women Gradual Ascendancy of Organic (“Bench”) Chemistry while many medicinal practices remained barbaric, modern science medicine was gaining steam during the 19 century o developed microscopes, germ therapy, and x-rays pharmaceutical businesses were growing o made in a lab came to mean more reliable, safer, and more effective than herbal remedies mainstream medicine was at odds with herbal medicine at the end of the 19 th century American Medical Association gained momentum in the early 1990s American herbalists were holding their own at the turn of the century o 10,000 Allopathic Practitioners o 8,000 Homeopathic Practitioners o 8,000 Eclectic Practitioners o several thousand other alternative medicinal practices AMA was dominant but not in complete control of healthcare In 1905 the Journal of the AMA announced it would start accepting advertisements from pharmaceutical companies o Started in Europe and AMA noticed that it was resourceful income Disarming Realization o There were too many doctors in the early 1900s and the AMA thought there was too much competition from “irregulars” (referring to non- Allopathics) o 1901—non-Allopathics were welcomed to join regular medical societies as long as they gave up formal allegiance to competing schools and sects many accepted the offer which weakened the non-Allopathic societies Strategic Importance of Medical Schools too many badly-trained doctors were graduating from too many low-grade schools 1902: AMA formed Council on Medical Equation to address untrained doctors o council representatives were meant to visit medical schools both allopathic and homeopathic and rank them o 1907: started visiting all schools in the country o rankings were based on entry requirements, lab and teaching facilities, faculty research, etc. o Obstacles No power of enforcement There was no way to make changes once judgements were made Couldn’t claim to be impartial or standardized Were way against homeopathic medicine – basically had a vendetta Project was very expensive o Exposed some genuinely terrible schools but were prejudice against homeopathic medicine and clearly judgmental of certain schools Carnegie Endowment and the Flexner Report Carnegie Foundation for the Advancement of Teaching agreed to fund the survey and provide the surveyor Abraham Flexner o Experienced educator o Not a physician o Conducted 15-month survey of about 168 North American medical schools o Moved too fast to make fair conclusions “you don’t need to eat a whole sheep to know its tainted” o Two Thumbs Down for the American Medical Training Known as the Flexner Report Published in 1910 Bombshell on American public standards, poor equipment, and non-existent clinical facilities Almost all homeopathic and Eclectic practices stressed that medicinal plants were strongly criticized o Flexner’s Principles of Modern Medicine Laboratory sciences are central to curriculum Anatomy, pathology, bacteriology Emphasis on pharmacology Botany no longer necessary in medicine o Impact of Report 29 medical schools closed during the 4 years following the Flexner Report by 1920 there was only one Eclectic school left and their enrollment was cut in half by 1920 today no US medical school can operate without AMA approval Food and Drug Legislation Food and Drug Act (1906) o Abolished plant medicine and meat-packing frauds in response to public outcry o Prohibited adulterated or misbranded drugs o Did not address safety FDA Gains Authority in Response to Drug Tragedies o Elixir of Sulfanilamide (1930s) The liquid was meant to be easier to take A production company told a chemist to just make a liquid form Dissolved in ethylene glycol though elixir usually implies alcohol 100 people dies o mostly kids doctors didn’t know or expect that anything would be wrong because the pill form was always fine 1938: Food, Drug, and Cosmetic Act required that drugs must be proven safe o Thalidomide Deformities (1960s) Drug was developed in Europe Was suggested it would treat morning sickness well women who took it during pregnancy had children who were lacking limbs and appendages Frances Kelsey New member of the FDA Prevented the drug from being made available in the US o Felt it wasn’t safe o Didn’t feel that it was tested enough to be put on the market 1962 Kefauver-Harris Amendments drugs must be proven safe and effective Pharmacists Show Herbs the Door acceptable evidence for safety and efficacy of herbal medicines as drugs did not exist herbs migrated to health food stores and co-ops where they’re sold as teas and supplements labels limited to common names of plants o could not claim that they were effective at treating any specific thing 1994 Dietary Supplement Health and Education Act (DSHEA) defines herbs as dietary supplements and not drugs prior approval by the FDA isn’t required products are taken off market only after they have been proven toxic o burden of proof on the FDA they have to prove that something is toxic or that it works a certain way they don’t want to invest the time and money in providing anything generalized claims are okay but no specific reference to medicinal benefits are acceptable Uncertainties without FDA Screening may not contain plant species specified contain higher or lower amounts of active ingredient than indicated on the label may be contaminated with pesticides, other species, or pharmaceuticals Good Manufacturing Practices established in 2007 1994 DSHEA authorized the FDA to produce GMPs for Dietary supplements established roles for handling, processing, labeling, and sorting products standards now included quality control standards, record keeping, qualifications for technical staff, handling customer complaints, etc. o employing qualified staff o having physical plants designed or built to protect against adulteration o use of appropriate equipment and utensils o us of master manufacturing and batch production records o employing quality control procedures o holding and distributing dietary supplements and manufacturing materials in ways that ensure quality is not negatively effected o recording each product GMP-related Adverse Event Reporting federal legislation passed in 2006 requires supplement manufacturers to report adverse events to the FDA in 2008, 604 adverse events were reported including at least 5 deaths ranging from “isn’t working to serious illness” 482,154 adverse reports for prescription drugs in 2007 Independent Testing Programs consumerlab.com o product reviews for consumers and voluntary certification program for manufacturers US Pharmacopeia o Verification programs for manufacturers who choose to participate USP Verified Mark on Dietary Supplements Contains the ingredients listed on the label, in the declared potency and amounts Does not contain harmful levels of specified contaminants Will break down and release into the body within a specified amount of time Has been made according to FDA current Good Manufacturing Practices using sanitary and well-controlled procedures German Commission E German government accepted standard of “reasonable certainty” German equivalent of our FDA established a panel of experts to oversee use of herbal medicines in Germany Panel produced monographs on efficacy, side effects, precautions, medical interactions, and dose Led to much more widespread and more effective use of medicinal plants in Europe than in US
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