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July 25, 2006

Thinking about progress in health care

This NY Times article tells the fascinating story about the assassination of President James A Garfield back in 1881 while noting an exhibit commemorating the 125th anniversary of Garfield’s assassination at the National Museum of Health and Medicine on the campus of the Walter Reed Army Medical Center.

President Garfield was shot on July 2, 1881 in Washington by a disgruntled federal job-seeker, Charles J. Guiteau, who made his move while Garfield was waiting for a train. What is not as well-known is that neither of the shots that hit Garfield should have fatal even by the more primitive medical standards of the 1880's. As my late father once observed to me while discussing Presidential assassinations, "Garfield's assassin just shot him. Garfield's doctors killed him."

The Times article reminds me of another interesting medical case that Dr. Donald J. DiPette, chair of the Department of Internal Medicine at Texas A&M University Medical School, presented earlier this year during the Walter M. Kirkendall Lecture that the University of Texas Medical School conducts annually in honor of my father. Dr. DiPette's subject was how advances in clinical research on hypertension had contributed to our understanding and knowledge of related medical problems that are related to high blood pressure, and he used a case study of a man in his mid-50's in the late 1930's who was showing signs of acute hypertension as an example of how that understanding can change the world.

The negative impact of hypertension on an individual's health was not well-understood in the late 1930's and 40's, and Dr. DiPette showed how the patient's health in the case study deteriorated at an accelerated rate as his blood pressure readings increased markedly from 1937 to 1945. By 1945, the patient -- who was still working in an important and high-pressure job -- had blood pressure that was off the charts and was experiencing a combination of associated medical problems that would have landed him in a hospital these days. Nevertheless, the patient continued to work and, about a month after a particularly important work-related meeting, the patient died of a massive stroke.

Only at the end of his lecture did Dr. DiPette reveal the name of the patient in his case study -- President Franklin D. Roosevelt. Dr. DiPette's point was that President Roosevelt's acute hypertension clearly affected his performance at the Yalta Conference, and his doctors would likely have never allowed FDR to participate in that history-changing event had they known what we know now about the effects of hypertension. Thus, lack of knowledge about hypertension -- which began to be understood just a decade after FDR's death -- changed the course of the 20th century.

Remember that as you contemplate the negative impact on clinical research of this, this and this.

Posted by Tom at July 25, 2006 06:33 AM

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Posted by: GRG51 at July 25, 2006 09:39 PM

Posted by: Steven Solomon at September 5, 2006 07:32 AM

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