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Thursday, January 25, 2007

British Medical Journal Medical Milestones: Antibiotics and Vaccines

     BMJ poll results of the most important medical advances since 1840 were released in January 2007.  Antibiotics (#2) and vaccines (#4) ranked among the top advances together with sanitation (#1) and anesthesia (#3).  The results certainly ring true in the field of pediatrics.  My grandmother is 97 years old and still healthy due to an amazing constitution.  However, her oldest sister Mary was not so lucky; she died at the age of 13 from scarlet fever.  Her youngest sister Anna almost lost her life to diphtheria and her illness kept her quarantined for many months; she was one of the lucky few to survive.  In today's world of medicine, childhood would be thankfully different for Mary and Anna because many diseases of the past are now prevented by immunization or readily treated with antibiotics, medical tools that were not yet discovered in the early 1900's.  In 1900, one third of deaths were due to infectious diseases such as diarrhea, diphtheria, measles, pneumonia, influenza, scarlet fever, tuberculosis, and whooping cough.  In 1900, >3 percent of children died between their first and 20th birthday.  Fortunately, parents are no longer faced with these forbidding statistics.  Between 1900 and 1998, the percentage of childhood deaths attributable to infectious disease declined from 61.6% to 2% in large part due to immunizations and antibiotics.  Today we focus on disease prevention.  Pediatricians use an immunization schedule that protects against 16 different diseases.  The DTP vaccine of today would have prevented Anna from contracting diphtheria.   In addition, we judiciously use antibiotics to treat infections.  Penicillin, the 'first antibiotic' was discovered in 1928 and developed for medical use in the 1940's to treat sick and wounded soldiers.  Antibiotics are used to treat and cure many infections including scarlet fever, the disease that resulted in Mary's untimely death. These advances translate into a remarkably different landscape for pediatricians today.   It is no longer commonplace for parents to lose their children to infectious disease as it was in my great-grandparents' day.  When it comes to our children, these medical milestones give us a great deal to be thankful for.  The BMJ poll results can be viewed in detail at: