Within five years of the birth of the NHS, a mass vaccination programme was in place to immunise children against some of the most serious diseases of the day: tuberculosis, smallpox, diphtheria and whooping cough. In 1956, the polio vaccine was introduced, followed in 1968 by a vaccine for measles. The next big step forward was the introduction of the measles, mumps and rubella (MMR) vaccine in 1988, and by the early 2000s, children were also receiving vaccines against different forms of meningitis. The HPV vaccine to protect girls against cervical cancer was introduced in 2008. Vaccination has been hugely successful, eradicating smallpox altogether and nearly eradicating polio and other diseases such as diphtheria; only a handful of such cases are now reported each year and they rarely prove fatal.
Keyhole surgery, or laparoscopy, in which surgeons make small incisions through which they insert thin instruments and a tiny camera to see what they’re doing, has been widely used since the 1990s. An operation that would once have involved a large incision can now be carried out with minimum impact. Helgi Johannsson, a consultant anaesthetist at Imperial College Healthcare, describes keyhole surgery as “one of the greatest advances in surgery of recent times”, adding that it has “significantly reduced complication rates, pain, and the time in hospital. Operations that previously would have resulted in a long stay in hospital now [allow patients to] go home after a few hours, thanks to keyhole surgery and improvements in anaesthetic drugs and techniques.”
The discovery of penicillin by Alexander Fleming in 1928 arguably represents the greatest medical advance in the 20th century, though a team of researchers at the University of Oxford carried out the critical steps that enabled the substance to be used to cure bacterial infections. Other antibiotics soon followed, and diseases that once killed millions of people, such as tuberculosis, could now be cured. The NHS now issues more than 30m prescriptions a year for antibiotics, but a new threat has emerged: 5,000-12,000 people die each year in the UK from antibiotic-resistant infections. Unless we alter prescribing patterns, warns Dr Hamira Ul-Haque, medical officer at Push Doctor, we could “potentially return modern medicine to the pre-antibiotic era of untreatable and fatal infections.”
X-rays have been available since the 19th century, but the 1970s saw the advent of two other revolutionary technologies: the computed tomography (CT) scan, sometimes referred to as a Cat scan, and the magnetic resonance imaging (MRI) scan. Both can produce very clear images of the inside of the body, including internal organs, blood vessels and bones, making it possible to detect and diagnose diseases such as stokes and cancer, as well as joint damage or internal organ damage. The number of scans carried out by the NHS rises annually, however, it currently stands at 40m a year, a figure that includes X-rays and ultrasound as well as MRI and CT scans. Combined with a growing shortage of radiologists, this increased demand is adding to the pressure on the NHS.
In 1954, just six years after the NHS was founded, surgeons Joseph Murray and J Hartwell Harrison in Boston, US, carried out the first successful organ transplant, taking a kidney from one donor and transferring it to his identical twin brother. Other organ transplants followed, including the first successful heart transplant in 1967, carried out by Dr Christiaan Barnard. The same year saw the first successful liver transplant. In 2016-17, the NHS carried out 4,139 organ transplants, the vast majority from donors who had died, though the figure includes 921 kidney transplants and 30 partial liver transplants from living donors. Many more lives could be saved, however, if more people joined the Organ Donor Register: about 7,000 people in the UK are waiting for an organ transplant at any one time.
Safety culture in anaesthesia
Sometimes the simplest of changes can make a huge difference. “There have been enormous strides forward in understanding how human behaviour causes error,” says Johannsson. He cites the introduction of the WHO Surgical Safety Checklist in 2008, which has a series of checks to make before and after surgery, as having a major impact – research has shown that implementation of the checklist reduces complication resulting from surgery by one-third and deaths from surgery by half. Safety checks include confirming enough blood is on hand and medical staff introducing themselves, which is crucial to clear communication in an operating environment that contains health professionals of different specialisms and backgrounds.
The cardiac pacemaker was invented in 1949 by a Canadian electrical engineer, John Hopps, who discovered that electrical stimulation could keep the heart beating in hypothermic dogs. Nine years later, Arne Larsson, a 43-year-old Swede, was suffering from cardiac arrhythmia, which had worsened as a result of a viral infection, and had a heartrate of only 28 beats a minute. Cardiologist Rune Elmqvist carried out the operation to insert the pacemaker, after which Larsson survived to the age of 86. Today, about 25,000 people in the UK have a pacemaker fitted each year. GP May Jay Ali has seen the impact on patients with a very slow heartrate: “They go into hospital and have a pacemaker and come out two days later – and that’s their life saved. It has been significant.”
Antiretroviral therapy for HIV
When Aids, caused by the HIV virus, took hold in the 1980s, there was no cure. The first case of Aids was diagnosed in the UK in 1981 and over the next few years Aids/HIV became an epidemic, killing almost 9,000 people before 1994. Development of a treatment using a combination of antiretroviral drugs in the late 1990s means that HIV can be managed: approximately 100,000 people are now living with the virus in the UK. “When I was a medical student in 1994 HIV was a death sentence,” Johannsson recalls. “The HIV wards were overflowing with incredibly sick patients and death was a daily occurrence. Two years later when I returned, the service had transformed, and death was rare. However, there is still a long way to go to eradicate HIV worldwide.”
Understanding the human genome
Since the human genome was mapped in 2003, it has helped scientists better understand diseases caused by mutations in a single gene inherited from parents, such as cystic fibrosis or sickle cell disease. Doctors now hope that they will be able to treat inherited diseases through gene therapy, which involves either introducing “good” genes into targeted cells to treat a patient, or modifying the genes in egg or sperm cells. In other diseases, combined mutations in multiple genes can lead to a predisposition to certain illnesses, such as breast cancer. By understanding a patient’s genetic make-up, doctors will be able to predict the development of a disease and intervene early. There is still a long way to go, but genetics holds out a great deal of promise.
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