Importance of the History of Medicine and Science
Why should we be concerned about past advances and discoveries in both medicine and science? Shouldn’t we be focused on moving forward rather than looking back? The truth is that if there isn’t an understanding of the past new hypotheses and theories cannot be formulated. A case in point is the discovery of the smallpox vaccine by Edward Jenner in 1796. His crude method involved taking infectious material from the blister of a person infected with cowpox and inoculating it by scratching it into the arm of the recipient, who Jenner later challenged with material from a smallpox blister to confirm immunity. Advances during the time since he performed his first vaccination have seen the discovery of viruses, development of the germ theory of disease, and the understanding of immunological processes. His discovery and promotion of the smallpox vaccine resulted in the eradication of smallpox by 1980. Without scientists learning from and building on Jenner’s methods, vaccination success rates would not be what they are today.
The glory of medicine is that it is constantly moving forward, that there is always more to learn. The ills of today do not cloud the horizon of tomorrow, but act as a spur to greater effort.—William James Mayo (Cofounder of the Mayo Clinic)
Why Do We Need to Remember?
We have to know where we have been to get to where we are going. Historical precedent makes medicine and science better. Most science researchers and medical professionals know basic historical data about discoveries made within their specialties, but few know the details that led to these discoveries. Understanding the past can bring to light details that have influenced the scientific process allowing researchers to learn from past mistakes. In addition, an often overlooked and underappreciated element in scientific discovery today is serendipity, which occurs when researchers make an unexpected discovery because of the specific procedures that they followed in their experiment. These procedures led to a serendipitous discovery while different methods may not have done so. Looking back on instances where this has shaped knowledge about an unknown area of research is essential for future exploration. An example of this has been described about the Nobel Prize-winning discovery of Helicobacter pylori by Marshall and Warren: “At first plates were discarded after 2 days, but when the first positive plate was noted after it had been left in the incubator for 6 days during the Easter holiday, cultures were done for 4 days.” This chance occurrence led to the discovery of one cause of peptic ulcers and completely changed the treatment of this disease.
Advancements in technology and pharmaceuticals continue to increase exponentially, which creates new ethical concerns that have not yet been encountered. The study of ethics is ever-evolving, and understanding its history is critical when teaching ethical behavior to new scientists and medical professionals. The Hippocratic Oath is the earliest (5th century BC) written example of ethical guidelines for physicians, which was updated after World War II when the medical experiments inflicted upon Jews were discovered. The Declaration of Geneva was approved in 1948 by the World Medical Association as its successor. The changes have been crucial when considering past transgressions like the Tuskegee syphilis experiments on African-American men, the inappropriate use of HeLa (Henrietta Lacks) cells, and human experimentation by Louis Pasteur. These infringements on human rights need to be remembered when entering new ethical grounds in areas such as the use of genetic discoveries, end-of-life decisions, patient confidentiality, and informed consent in research studies.
CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats)-Cas9 (CRISPR-associated protein 9), a genetic engineering tool that can edit genomes, is an example of the unchartered ethical territory that we will have to approach through insights gained from past experiences. While CRISPR offers new therapeutic possibilities for diseases that have no cure and are difficult to manage, there are huge ethical dilemmas regarding alteration of a person’s genetic makeup and the potential safety concerns that remain unknown at this point. The International Summit on Human Gene Editing convened in 2015 to discuss ways in which CRISPR technology can be applied and favored somatic genome editing (non-reproductive cells) but not genomic modification for enhancement. Human heritable genome editing isn’t allowed currently; however, the committee cautiously agreed that,
“In light of the technical and social concerns involved … heritable genome-editing research trials might be permitted, but only following much more research aimed at meeting existing risk/benefit standards for authorizing clinical trials and even then, only for compelling reasons and under strict oversight.”
As CRISPR and new technologies evolve, the discussions about the foundational ethical and legal frameworks comprising its uses will be dynamic and ongoing. Guidelines from national and international organizations with diverse disciplines will have to draw on past cases to determine which best practices and regulations institutional review boards will be required to enforce. The goal is to minimize any potentials risks and maximize the benefits that CRISPR technology offers to science and medicine.
What are we going to do with these amazing new technologies and how will history play a part in their development? As with many discoveries, ‘mistakes or errors’ in research create portals to areas and fields that are currently unknown. The ethical applications of these new findings will depend on the moral fortitude and integrity of scientists involved; historical precedent will set the stage for in-depth discussions and a broader understanding of the elements involved.