key: cord-0823376-m4so4il0
authors: Riley, David
title: Looking Back, Looking Forward
date: 2014-01-01
journal: Glob Adv Health Med
DOI: 10.7453/gahmj.2014.001
sha: 9be839381833cc5da620a0c6c25da09c3a0ea961
doc_id: 823376
cord_uid: m4so4il0

nan

I n the mid-1700s, the medical establishment believed that scurvy was a disease of putrefaction that was treatable with an elixir of vitriol and wort. The benefit of citrus was dismissed as unproven despite the fact that its regular consumption to prevent scurvy had been used by some cultures since antiquity and the English military had recommended citrus for scurvy for more than 50 years. In 1747, Scottish physician James Lind chose 12 sailors suffering from scurvy for a clinical trial. Those treated with citrus fruit quickly recovered. In Lind's day, it was not known that vitamin C was necessary for the maintenance of healthy connective tissue. Today, people around the world are spending billions of dollars annually on vitamins and supplements despite limited scientific evidence that regular supplementation is useful for the prevention of disease. A recent article concluded that "β-carotene, vitamin E, and possibly high doses of vitamin A sup ple ments are harmful" and that "other antioxidants . . . are ineffective for preventing mortality or morbidity." 1 How and when are vitamins and supplements useful?

In 1900, the annual mortality rate from infectious diseases in the United States was approximately 800 per 100 000, falling to 63 deaths per 100 000 in 1996. 2 In 2013, the US Food and Drug Administration issued voluntary "guidance rules" to reverse the steady increased usage of antibiotics to promote animal growth that accounts for 80% of the antibiotic usage in the United States. According to the US Centers for Disease Control and Prevention, more that 20 000 people die annually from an antibioticresistant infection. Have we entered an era in which one of the foundations of modern medicine is marginalized?

The emergence of H7N9 influenza virus, a virus with a high case-fatality rate (50 deaths) in the populationdense areas of Asia, is a concern, as is the reappearance of the H1N1 influenza strain that caused the worldwide pandemic in 2009 and the Middle East respiratory syndrome, which has a primary case-fatality ratio of almost 75%. Can we develop vaccines that are safe and effective in a timely fashion?

Statins are routinely prescribed for the prevention of cardiovascular disease. The statin industry, driven by industry-sponsored trials, has been a spectacular commercial success, overshadowing the need for attention to lifestyle interventions, exercise, and nutrition. A recent randomized trial showed that a Mediterranean diet reduced the risk of diabetes among persons at high risk for cardiovascular disease. 3 Do the new risk prediction algorithms 4 derived from industry-sponsored trials encourage overtreatment 5 at the expense of a healthy diet and lifestyle in the prevention of cardiovascular disease?

Will there be a shortage of more than 91 000 physicians in the United States by 2020? 6 Legal battles continue to test the practice boundaries of clinicians who are not medical doctors. Can clinicians such as advanced practice registered nurses, chiropractors, naturopaths, and traditional Asian medicine practitioners deliver primary care within the scope of their training and licensure and collaborate in team care?

The Chinese Ministry of Education recently an nounced programs to train Chinese medical researchers in ethics and methodology. These efforts encourage increased collaborations among the global science community as convergences in health and medicine support the development of a worldwide research infrastructure.

In 2013, an international group of experts met at the University of Michigan, Ann Arbor, to create reporting guidelines for case reports: the CARE guidelines. 7 These guidelines were presented at the International Congress for Peer Review and Biomedical Publication in September and published in multiple medical journals. When case reports are systematically collected and aggregated into larger datasets, that information can be analyzed using techniques matched to Big Data, offering real-time, datadriven insights into what works for which patients.

Will this transform how we think about the creation of "evidence" and support the development of communities around data liquidity, transparency, and meaningful use? Will we ask why a patient has a diagnosis and integrate the promotion of health with the treatment of disease as our attitude toward "observation" shifts? Can systematically collected data from patient care be integrated with the best available research evidence to provide comparative effectiveness information that can measurably improve healthcare delivery and outcomes?

Stop wasting money on vitamin and mineral supplements

Trends in infectious disease mortality in the United States during the 20th century

Prevention of Diabetes with Mediterranean Diets

ACC-AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults

Statins: new American guidelines for prevention of cardiovascular disease

Association of American Medical Colleges. GME funding: how to fix the doctor shortage

The CARE guidelines: consensus-based clinical case reporting guideline development