Sanitation named modern medicine's greatest milestone

Computers, evidence-based medicine get nod
in BMJ poll

By Sam Solomon

What do you think has been the greatest medical advance in the last century and a half? The IV drip? The (still-evolving) electronic medical record? The double helix? Socialized medicine? According to readers of the British Medical Journal (BMJ), sanitation rose to the top of the tank, flushing its competitors right out of the water.

In a special supplement to its first issue of the new year, the BMJ presented a list of the 15 most important breakthroughs to have graced the journal's pages since its launch back in 1840. Over 11,000 readers cast their votes and the winner was officially crowned on January 18 (see "Best of the best", right, for full results).

Together, these advances have saved countless lives and ushered the practice of medicine into the new millennium. Here's a closer look at a few of the more notable entries, including one Canadian breakthrough.

SANITATION
In 1854, London doctor John Snow discovered that cholera was transmitted by water, not by air as had been previously believed. The ensuing improvements in sewage and clean water supplies led to vastly reduced rates of disease. Unfortunately, the problem of poor sanitation and its contribution to the spread of disease persists in the developing world to this day: over a million and a half deaths in 2001 were directly attributed to unsafe water.

EVIDENCE-BASED MEDICINE
It's increasingly difficult to imagine what medical practice was like before the widespread acceptance of what's now called evidence-based medicine. In fact, the term was coined by Dr Gordon Guyatt, a McMaster University professor of medicine and clinical epidemiology and biostatistics, in 1991. "Evidence-based medicine is one of our most important medical milestones because, without it, the other 14 of the BMJ's milestones would not have been implemented," read the entry's supporting essay.

COMPUTERS
Computers have done much more than expand our ability to waste time creatively. They have also enabled the creation of a global network of researchers and an ever-growing knowledge base for the general public. Two Ontario epidemiologists — Drs Alejandro Jadad and Murray Enkin — threw their votes to this unprecedented technological achievement. Computers have allowed humans to "[transcend] physical, geographical and cultural barriers," they wrote.

THE PILL
The simple fact that when someone says, "the Pill," we know exactly what they're referring to should instantly qualify the birth control pill as one of our most important medical advances.