In searching through the fantastic New England Journal of Medicine (NEJM) site — recently revamped with a searchable online archive of 150,000 articles dating back to 1812 — what struck me was not how much medicine has evolved, but how constant its forward march has been, thanks in no small part to the sharing of information.
For instance, leeches were a major therapy for many different medical problems back in 1812. In fact, authors referenced leeches more than 1,000 times in NEJM articles between 1812 and 1850. The little critters have not gone away completely in modern medicine. In fact, the FDA approved leeches and maggots as the first “live medical devices” in 2004 for such specialty applications as helping heal and restore blood circulation to skin grafts. Their use is quite rare, however.
The main point is that more conventional treatments, equipment and medications have eliminated the need for medical practitioners to go down to ye olde swamp and catch a bowl of leeches. Cleaner, safer and more effective medicine has all but eliminated their use.
What enabled the constant improvement of medicine since 1812? Innovation driven by information sharing. A major venue for that is the peer-reviewed journal, NEJM being one of the more enduring of those. The nation’s health IT leaders — now struggling to implement electronic health record systems and comply with government standards and reporting requirements — should keep their eyes on one of the big prizes of the technology rollout: public health benefits. Not only does a facility benefit from the efficiency and quality-of-care improvements of EHRs, but the researchers who are writing articles for future issues of peer-reviewed journals.
Physicians — and the IT leaders who keep their networks running securely — have a chance to share information about their patient populations with researchers around the world through health information exchanges. A cure for many kinds of cancer seems impossible now, but what if researchers had faster, real-time access to patient information throughout the 50 states? Solving some of the fatal “orphan diseases” that affect only a few patients and therefore are unattractive to commercial medical companies? Their cures might seem plain as day — and not expensive — once the health care system aggregates its data better.
Who knows, we might look back on the years preceding 2010 — the last gasps of the “paper era” — sort of the way we now view the era when leeches were the preferred therapy for many ills: quaint, but misguided. Hard to understand how anyone got anything done back then, before the golden age of health care informatics came in. We’re hoping that will be the case, and are cheering on health care providers undergoing — in some cases, painful — IT makeovers.