Defining Moments In Medicine

MJA 2001; 174: 9-11

Analgesic nephropathy: In the 1960s, analgesic abuse in Australia caused a fifth of all cases of end-stage renal disease needing dialysis or transplantation. Priscilla Kincaid-Smith and her group in Melbourne and the Brisbane pathologist A F Burry clearly established that it was the mixture of phenacetin, aspirin and other analgesics that was the culprit. Since legislation banning the sale of "over the counter" compound analgesics in 1979 the condition has virtually disappeared.

Smoking: The definitive demonstration by English cancer epidemiologist Richard Doll in 1976 that smoking caused lung cancer provided the first hard evidence that smoking was harmful. Since then tobacco has been implicated in pulmonary, cardiac and peripheral vascular disease. Australia has been one of the leaders in the abolition of smoking in public places.

Treatment and management of hypertension: Effective pharmacological therapy for hypertension only became available after 1950. Australian researchers and the 1982 Australian National Blood Pressure Study (ANBP1), in particular, established that effective control of blood pressure significantly reduced morbidity and mortality from hypertension.

Transplantation: Transplantation, to which Australians have contributed at a basic and scientific level, has now become an accepted therapy for renal, liver, heart and lung failure, as well as for bone marrow replacement in hematological and oncological diseases. Organ donation and availability is now the limiting factor in successful transplantation programs.

AIDS: The AIDS epidemic vividly illustrated that we have not yet conquered infectious diseases and posed new threats to public health and social attitudes. Fortunately, Australia, by concerted medical and public health initiatives and an extensive public information and education campaign, is one of the countries which have been most successful in containing and limiting the impact of AIDS.

Non-invasive imaging: Ultrasound, computed axial tomography (CAT scanning), nuclear medical scans and magnetic resonance imaging have substantially improved the accuracy of diagnosis. They have been particularly important in neurological and spinal diseases, oncology and cardiology.

Haemopoietic growth factors: Don Metcalf, working at the Walter and Eliza Hall Institute in Melbourne, first developed the concept of a colony-stimulating factor for cultured haemopoietic cells, then identified, purified and applied them therapeutically. Erythropoietin (for anaemia) and GM-CSF (for stimulating white blood cells) are now widely used and indications for their use increase every year.

Vaccination: The ability to produce molecular designed vaccines or to genetically modify organisms has led to the increasing availability of effective vaccines against measles, pneumococcus and hepatitis B and C. The challenge for the future is to develop successful vaccines against infantile gastroenteritis, malaria and AIDS.

Cholesterol and cholesterol lowering: Americans Michael Brown and Joseph Goldstein received the Nobel Prize in 1985 for unravelling the cell receptor related to cholesterol metabolism. Since then potent specific drugs for lowering blood cholesterol have been developed and their use has shown unequivocally that reducing cholesterol levels significantly lowers morbidity and mortality from cardiovascular disease. Nevertheless, it remains our number one killer.

Helicobacter pylori, peptic ulcer and gastritis: The discovery, in 1979-1981, by pathologist Robin Warren and gastroenterologist Barry Marshall, in Perth, of the role of the infectious agent Helicobacter pylori in the pathophysiology of gastritis and gastric ulcer was at first met with great scepticism and generated heated debate at congresses. It is now firmly established and eradication of H. pylori is a key aim in therapy for ulcers.

Asthma: Australia and New Zealand have the highest incidence of asthma in the world, and the disease is increasing at an alarming rate. The past 50 years have seen great improvements in the overall management, treatment and education for asthma (including the introduction of Australia's Asthma Management Plan) led by Ann Woolcock and her colleagues in Sydney.

Ageing, Alzheimer's and osteoporosis: The increase in life span in Australia (currently 82 years in women and 76 years in men) has increased the number of elderly people in the population, and geriatrics has been established as a specialty. Australian doctors and researchers have contributed to identifying Alzheimer's disease and osteoporosis as new diseases associated with ageing.

Alternative medicine: It is ironic that the growth in alternative medicine and therapies in the last decade of the 20th century coincided with the era of evidence-based medicine. Chinese medicine, acupuncture, life-style practitioners, herbal medicine and many alternative therapies are being used by Australians almost as often as traditional medical treatments.

Human genome and molecular biology: The unravelling of the human genome, although as yet of no direct clinical benefit, will undoubtedly change clinical medicine dramatically. Molecular biology has already made substantial contributions to diagnostics and therapeutics.

Colin I Johnston
Professor of Medicine, and Senior Principal Research Fellow
Baker Medical Research Institute, Melbourne, VIC

Mark E Cooper
Professor, Department of Medicine Melbourne University
Austin & Repatriation Medical Centre, Melbourne, VIC

Andrew J Taylor
Cardiovascular Research Fellow

James A Shaw
Cardiovascular Research Fellow
Cardiovascular Medicine, Alfred & Baker Medical Unit
Alfred Hospital, Melbourne, VIC

Above photograph courtesy of the Medical Illustration Department, Royal Perth Hospital.

©MJA 2001
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