Global Health

The World Health Organization

The emergence of a new era in international health, fostering postwar global cooperation, was symbolized by the World Health Organization (WHO). In the 19th century, Europe made early attempts at health collaboration, culminating in the 1851 International Sanitary Convention and its 1892 revival to combat cholera.

From the early 20th century, international health agencies like the Pan American Health Organization (1902), L’Office International d’Hygiène Publique (1907), and the Health Organization at the League of Nations (1923) emerged, focusing on disease control, eradication, and quarantine measures.

Formally established on April 7, 1948, inheriting tasks from previous organizations, the WHO was mandated to promote the highest possible level of health globally. Initially working with a $5 million budget, it tackled malaria, tubercullsis, venereal diseases, leprosy, trachoma, and children’s health.

The WHO Today

By 2020, the WHO had 194 member states and a $4.2 billion budget. Key functions included issuing global health guidelines, sanitary regulations, health education, mass vaccination campaigns, and collecting global health data. The WHO’s notable achievement was smallpox eradication.

In the face of the 2020 COVID-19 pandemic, the WHO served as a global information centre, providing advice, scientific updates, and global mortality figures. World Health Day on April 7 commemorates the WHO’s establishment, aiming to promote global health awareness.

Dialysis

Chronic kidney failure poses a serious threat to health, as the kidneys, vital for eliminating excess salts, fluids, and waste materials, can become life-threatening if their function falters. Understanding and effective treatments for kidney problems were scant until the 1940s. Dutch physician Willem Kolff’s breakthrough with a kidney dialysis machine in the late 19th and early 20th centuries marked a turning point.

In the 1920s, German physician Georg Haas pioneered early kidney dialysis attempts on human patients. Using various machines of his design, he initially employed leech saliva’s hirudin as an anticoagulant, causing allergic reactions. Shifting to heparin later, a naturally occurring anticoagulant in humans, Haas faced challenges as his procedures were too brief to yield therapeutic effects, leading to no patient survival.

Kolff’s Innovation

The pivotal moment arrived in 1945 when Kolff conducted a week-long dialysis on a 67-year-old patient with acute kidney failure. Employing a rotating drum dialyser, the precursor to modern kidney dialysis machines, Kolff ingeniously crafted the apparatus using wooden bed slats, cellophane sausage casing, and an electric motor. Blood, mixed with heparin, traversed cellophane tubes around the rotating drum through an electrolyte solution (dialysate). This innovative process filtered toxins through diffusion, achieving equilibrium before the purified blood returned to the patient.

Evolution to Modern Dialysis

Hemodialysis, employing a dialyser to filter blood, remains the predominant method, but peritoneal dialysis emerges as a viable alternative for approximately 300,000 kidney patients globally. This at-home procedure involves dialysis solution flowing into the abdomen via a catheter, where the peritoneum filters out waste products, which are subsequently drained from the body. Patients can perform this process multiple times a day or opt for machine-operated dialysis during sleep.

While the technology pioneered by Kolff thrives, the primary challenge lies in the overwhelming number of kidney failure patients. With over two million people worldwide undergoing dialysis (90,000 of whom receive kidney transplants), it is estimated to address only a fraction of the tenth in dire need due to barriers to access and affordability.

Rheumatoid arthritis, an autoimmune condition, arises when the immune system mistakenly targets and assaults the healthy cells lining the joints, leading to inflammation and swelling. First described in 1800 and officially named in 1859, this condition baffled medical understanding for years, with limited relief options for the associated pain. American physician Philip Hench initiated the study of this disorder in the 1930s, setting the stage for groundbreaking revelations.

Cortisol’s Curative Power

The pivotal turning point occurred in 1948 when the discovery revealed that cortisol, a hormone naturally produced in the adrenal cortex, could effectively alleviate rheumatoid arthritis. This breakthrough laid the foundation for the development of a novel class of anti-inflammatory drugs known as corticosteroids or steroids. Hench, along with colleagues Edward Kendall and Swiss researcher Tadeus Reichstein, was awarded the Nobel Prize in Physiology or Medicine in 1950 for their groundbreaking contributions.

Jaundice Clues and Insights

In the mid-19th century, British physician Alfred Garrod’s distinction between rheumatoid arthritis and gout provided crucial groundwork for subsequent research. By the 1920s, the prevailing belief linked most cases of rheumatoid arthritis to infections, but Hench questioned this hypothesis. Notably, in 1929, while leading the Mayo Clinic’s rheumatic diseases department, Hench observed that a patient’s rheumatoid arthritis improved after developing jaundice. Further exploration revealed similar relief in patients with various arthritic conditions during jaundice or pregnancy.

Lithium and Bipolar Disorder

In 1949, Australian psychiatrist John Cade achieved a significant milestone in bipolar disorder treatment by introducing the drug lithium. His exploration began with autopsies revealing physical manifestations, such as blood clots, in the brains of bipolar patients, hinting at a potential organic cause for the disorder. Cade theorized that manic episodes were linked to an excess of a specific chemical, while melancholic states resulted from a deficit of the same.

The Guinea Pig Experiment

Intrigued by his hypothesis, Cade conducted experiments injecting urine from bipolar patients into guinea pigs. Astonishingly, urine from manic patients proved more lethal for the animals than urine from non-bipolar individuals. Upon introducing lithium, a former treatment for gout, into the equation, Cade observed a significant reduction in toxicity. Large doses of lithium also induced passivity in the guinea pigs. Drawing parallels, Cade administered lithium to ten bipolar patients, witnessing remarkable improvements. Despite minimal recognition when published in 1949, these findings spurred further exploration of lithium’s potential.

Conditioning Behavior

Skinner’s theories were built upon the research of earlier behaviorists Ivan Pavlov and John Watson. Pavlov’s classical conditioning experiments with dogs in the 1890s showcased learned responses. Skinner expanded on this concept, introducing “operant conditioning” in 1938. This process involved shaping behavior through positive or negative reinforcement, rewarding steps toward desired behavior and discouraging undesired conduct.

Cognitive Revolution

The 1960s marked a cognitive revolution, challenging Skinner’s exclusively behaviorist approach. Cognitive therapists like Aaron Beck argued that conditioned responses alone couldn’t explain all behaviors; distorted or dysfunctional thinking played a crucial role. Beck’s cognitive approach involved identifying, evaluating, and correcting negative perceptions or automatic thoughts, anchoring the foundation of cognitive therapy.

The Intricacies of Trisomy

Current genetic understanding affirms that the presence of an additional copy, termed trisomy, can occur during meiosis, the process of producing sperm and egg cells in reproductive organs. While trisomy can manifest in any chromosome, trisomy 21, leading to Down syndrome, is the most prevalent, impacting approximately one birth in every 1,000. This genetic anomaly results in distinct physical features, such as a flatter facial profile and poor muscle tone, alongside a spectrum of learning disabilities from mild to moderate.

Beyond Down syndrome, trisomy 18 can cause Edwards syndrome, characterized by heart defects, affecting around one in 6,000 newborns. Marthe Gautier’s pivotal discovery, coupled with subsequent genetic insights, has significantly enhanced our comprehension of these chromosomal abnormalities and their diverse impacts on human development.

Interferon

From Bulky Beginnings to Miniature Marvels
In 1951, Canadian engineer John Hopps pioneered the first functional pacemaker—an external, cumbersome, mains-powered apparatus that patients manoeuvred on a trolley. Seven years later, Swedish engineer Rune Elmqvist and cardiac surgeon Åke Senning, leveraging small batteries and compact transistors, crafted an implantable pacemaker, marking a pivotal shift from external to internal cardiac regulation.

In a courageous leap, Else-Marie Larsson convinced Elmqvist and Senning to test the device on her ailing husband, Arne. Racing against time, Elmqvist fashioned components from resin in a plastic cup, and on October 8, 1958, Senning implanted the prototype. While the initial model needed replacement the next day, a subsequent iteration functioned flawlessly. Larsson, receiving 25 more pacemakers over 43 years, passed away at the age of 86.

The 1960s heralded patient-controlled, variable-rate pacemakers, enhancing adaptability. Lithium batteries, introduced in 1972, extended battery life from a mere two years to a decade. Recent strides feature pill-sized pacemakers and sensors enabling automatic adjustments in heart pace based on body activity, exemplifying the ongoing commitment to refining cardiac care.

The FDA and Thalidomide

In 1937, a harrowing incident unfolded as over 100 US citizens, including numerous children, succumbed to the effects of a new drug named elixir sulfanilamide. The elixir, evaluated solely for taste and appearance, lacked toxicity testing. While sulfanilamide itself was benign, the solvent diethylene glycol in which it was dissolved proved fatal. The ensuing public outcry catalyzed the passage of the 1938 Food, Drug, and Cosmetic Act, laying the foundation for drug control mechanisms in the U.S. The law mandated companies to establish the safety of new drugs and permitted government inspections of manufacturing facilities.

The British Doctors Study

In 1951, epidemiologists Richard Doll and Austin Bradford Hill initiated the British Doctors Study, aiming to quantify the connection between smoking and lung cancer. Surveying over 40,000 physicians, including a majority of smokers in the tobacco-heavy era, the study spanned until 2001. By 1965, it unequivocally established that smokers faced elevated risks of lung cancer and other ailments, with those commencing smoking before World War II losing an average of ten years of life. To fortify their findings, Hill applied the Bradford-Hill criteria, ensuring resilience against challenges from tobacco companies.

While radon gas, asbestos, and air pollution contribute to lung cancer, around 8% of cases have genetic origins linked to mutations on chromosomes 5, 6, or 15. However, the predominant cause remains tobacco smoke, laden with carcinogens triggering cancer. These substances activate oncogenes and suppress natural tumour suppressor genes, propelling abnormal cell proliferation.

Triggering Cancer

Conditions like emphysema and bronchitis, induced by inhaled particulates, heighten lung cancer susceptibility. Treatment advancements, from the first pneumonectomy in 1933 by Evarts Graham to radiotherapy in the 1940s and chemotherapy in the 1970s, have improved outcomes. Despite modern approaches combining radiotherapy, chemotherapy, and surgery, lung cancer prognosis remains challenging.

Treating Lung Cancer

In the quest for effective lung cancer treatment, TRAIL therapy emerges as a promising avenue. TRAIL, or CD253, a cytokine targeting specific cancer cells, holds the potential for destruction without harming healthy tissue. Administered intravenously, TRAIL faces challenges of cancer cell resistance, yet ongoing trials persist in the pursuit of groundbreaking treatments that may revolutionize cancer cures.

Contemporary Palliative Care