Best Breakthrough Since Sliced Bread, or At Least Since the Wheel

On the way to a flight to Baltimore (note:  it is freaking cold in Baltimore) I picked up The Atlantic (November 2013 issue) to read the article entitled “The 50 Greatest Inventions Since the Wheel.”  While these kind of sweeping generalization lists are always subjective, this particular list was compiled through a voting process that included a panel of 12 renowned scientists, engineers, technology historians, and entrepreneurs.  I was curious to see how many of the 50 would relate to health and medicine, particularly given the incredible advances we have seen even in just the past 100 years, must less the past several millennia.

This list has an interesting variety of usual and unusual suspects, ranging from the combine harvester and the assembly line to television, personal computer and nuclear fission.  Number 1 on the list was the printing press, which itself has huge implications for the advancement of medicine and all other areas of learning. Of course, the wheel, itself, was not on the list as the list was specifically intended to capture those great inventions that post-dated this, the enabler of ambulance-chasing.

But on the list there were 6 actual medical entries.  They are:

• Number 46: anesthesia, introduced in 1846
• Number 33: pasteurization (more public health than medical, but close enough), introduced in 1863
• Number 20:  The birth control pill, introduced in 1960
• Number 8: vaccinations, introduced 1796
• Number 5: optical lenses (glasses), introduced in the 13^th Century
• Number 3:  penicillin, introduced 1928

I wasn’t sure and am still not sure how I feel about this list.  Is it the right number of items related to our health (12%), which so many people feel to be the most important aspect of life? Are the right things represented?  Really? Nothing from field of medical advancement since 1928, except the Pill?  In contrast, 15 (30%) of the non-medical breakthroughs on the list come from the 20^th Century.

Clearly without anesthesia and penicillin there could be no modern surgery and all of the subsequent advancements we have experienced there would be absent from our lives.  But it is intriguing to me that there is nothing else here from the modern medical age, except for birth control.  If I were going to pick one pill that was the most important medical advance, it might be aspirin.

I am also surprised that there is no mention of chemotherapy/radiation or other treatments for cancer; I think they should somehow be represented here considering how big a difference these breakthroughs have made in the lives of millions.  Missing also are all of the life-saving interventions related to heart disease (everything from beta blockers/ace inhibitors to cardiac/cardiovascular surgery in its many forms), this being the number one killer of all Americans.  I would think that blood testing should be a pretty meaningful breakthrough, as it enables physicians to know what is going on inside the body.  It is specifically noted in the article that the sequencing the human genome didn’t make the cut, but might in 50 years when it has a chance to have a more meaningful human impact.  If I get a chance to see this list in 50 years and genomics isn’t on it but social networking is, I will be very disappointed (and probably Tweet about it).

Vaccinations are an obvious winner in my view and clearly belong on the list, as they have prevented horrific epidemics and saved or extended hundreds of millions of lives worldwide.  Optical lenses are also an obvious one; without them none of you could read the small font on my blog much less know you are being chased by a predator.  But the field of medical imaging is missing from the list entirely (xray, ultrasound, MRI, CT, etc.) , and without it we would still be guessing at many medical conditions and procedures.

It is worth noting that the group of 12 experts who compiled The Atlantic’s list of the 50 greatest breakthroughs since the wheel included no physicians, no medical researchers and no medical company executives.  IBM and Cisco were represented, but not Medtronic or Merck or the National Institutes of Health.  Of course every list such as this is derived through the lens of experience of those who create it, so I wish the list of technology experts and historians and commentators had a little more diversity in its composition.  It is interesting that all of the health and medical breakthroughs of the 20^th-21^st Century are largely absent from the list; I wonder if that is a commentary on how our nation’s technology experts view the field or if it is just happenstance.

Very interestingly there is a sidebar from fellow, if far better known venture capitalist John Doerr of Kleiner Perkins, who lists his prediction of the two most significant impending breakthroughs of the comings years as 1) battery technology and 2) digital health.  Digital health, by which Doerr really means healthcare information technology applied to all manner of health functions to move us from a world of sick care to health care, has become a hot topic among the entrepreneurial crowd but has yet to take hold consistently throughout medicine.  But it is coming.  Given the ability to turn massive amounts of data into real information to improve health at low cost of technology, Doerr should be correct.  It will be up to our healthcare system, and that of our neighbors around the world, to truly commit to this paradigm shift in a world (healthcare delivery) where inertia, cynicism and perverse financial incentives drive too much decision-making.

I hope Doerr is correct and that digital health or its first cousin, healthcare information technology, would be an obvious choice for a “greatest breakthroughs of our lifetime” type of list.  I am particularly supportive of this concept given that I am in Baltimore for the annual HIMSS mHealth Summit, where Doerr’s predictions unpin the careers of a myriad of the conference attendees.  The opportunity for healthcare information technology, aka digital health, is so incredible to change the way we live our lives.  In particular it can help us and our kids make choices that prevent the next generation from having the kind of chronic disease burden that our current generation has earned through unhealthful living.

Unhealthful choices seem to be highly correlated with the advent of convenience-based living and technologies that keep butts in office chairs and on couches and in booths at McDonalds and Dairy Queen.  Perhaps the great breakthrough we really need is an ejection button that prevents sedentary behavior or a pill that triggers immediate aversion to foods with poor nutrition and 32-oz Diet Cokes.  I’m looking forward to those entries on the list in 2063!