Kolata Gina Bari - The New York Times book of medicine: more than 150 years of reporting on the evolution of medicine

I like to remind my interns that what we seem most sure of today, the evidence-based medicine we espouse (which by implication suggests that everything before was witchcraft) will in fifty years be viewed as primitive and absurd. An attitude of humility is therefore prudent. But perhaps one has to be humbled first to arrive at this stance.

When I was an intern in America in 1980, there was a palpable sense that medicine had pretty much sorted out all the major puzzles. Many cancers were treatable and even curable, a dizzying array of new antibiotics was coming out, surgeons were doing heroic things through tiny incisions, and transplantation of organs was an industry. The word to describe our attitude in those days was conceit. It was the conceit of cure: the sense that there was nothing we couldnt fix. And if we couldnt, it was only because the patient had come too late or the protoplasm was too weak.

Of course that was before AIDS.

I recall The New York Times article by Lawrence Altman in July of 1981: Rare Cancer Seen in 41 Homosexuals. It paralleled reports in the medical journals; these were all harbingers of the epidemic. By that time Id already decided to pursue a fellowship in infectious diseases in Boston. I had no notion that this one diseaseas yet unnamedwould encompass most of what I would do as an infectious disease specialist. I imagined it would be something like Legionnaires disease or Lyme: a mysterious syndrome at first, but one whose cause would soon be discovered. Then treatment would emerge, and voilait would be a nuisance at best. We could not have imagined AIDS, its magnitude, its scope, and the way it had arrived seemingly from nowhere.

Traveling with the virus was the metaphor it carried, a metaphor of shame and secrecy that was almost as devastating as the disease itself. The metaphor was rooted in those first patients being gay men and intravenous drug users.

The AIDS epidemic changed my career and my life. Among the many things I learned was that when one could not cure, one could heal. By that I mean that even in this fatal illness, one could help the patient and the family come to terms with the disease, one could relieve pain and suffering; I learned that healing occurred by ones presence, by caring, by being there for the patient through thick and thin. It was something the horse-and-buggy doctor of a century before understood; even in those pre-antibiotic and pre-vaccine days when scarlet fever and typhoid and tuberculosis were untreatable scourges, the doctor still had much to offer.

It is fitting that this collection of medical reporting and essays from The New York Times should begin with AIDS. One sees here the very first report, the first blip of the epidemics arrival. The reports that follow are the milestones (each unforgettableI can remember the season and what songs were hot on that new channel, MTV): the finding of the causative virus; the first (much heralded and ultimately disappointing) drug, AZT The last chapter in the AIDS saga is unwritten: a vaccine that prevents the infection, or a treatment that eradicates the virus rather than just keeping it in check. (And lest we think this idea is far-fetched, we have just arrived at that moment with hepatitis C, a terrible scourge for which new drugs offer a complete eradication after a finite course of treatment.)

The art of chronicling the march of medical history, discovery, and the changing landscape of illness is a genre in itself, one that has been a regular feature of The New York Times from its inception. Arguably The Times defined the genre. Weve come to rely on familiar names such as Altman, Kolata, Grady, and others to tell us the story. Their voices, their writing form the fabric of our personal memories of each era. And as this genre of writing has evolved, so has a healthy skepticism, a rigor that makes it unlikely that headlines the equivalent of these two from 1913 could appear: Cause of Cancer Found at Last by Boston Scientist or Diabetes Cure Confirmed by Treatment of 176 Cases. But perhaps we are being unfair to that era; with the extant knowledge and the peer-review process of 1913, those claims might have seemed plausible.

We are now entering the personalized omics era where as routinely as we measure our cholesterol, we will soon be mapping out our genome, the proteome, the transcriptome, the metabolome, the phenome, and much moreall this during one office visit. The magnitude of electronic data that we will need to store on any one patient will eclipse what is presently in the entire Library of Congress. But what will this mean for public policy, for the individual? And as we harness the power of shared databases, who will own our individual data and what are the implications for privacy? Clearly, the progress of science and the shifting landscape of disease (such as the arrival of Ebola on U.S. shores as I write) will require the best of medical reporting. The responsibility of the Fourth Estate to lay out for public debate not just the facts but the ethical and social issues will be huge. Its an important responsibility, one that requires objectivity, skill, research, immersion, and an appreciation of history.

In Camuss The Plague, Raymond Rambert, a journalist from Paris, finds himself inadvertently stuck in Oran when the town is quarantined because of the outbreak. When the moment finally comes after many days when he can in fact leave, Rambert decides to stay. He says, Until now I always felt a stranger in this town But now that Ive seen what I have seen, I know that I belong here whether I want it or not. This business is everybodys business.

The business of medicine is truly everybodys business. It is writing of the sort that is in these pages that makes it so.

Abraham Verghese
Vice Chair of the Department of Medicine at Stanford University
and author of Cutting for Stone