Surgery. Early in my career, radical mastectomy was the gold standard for treating breast cancer and I remember saying that would be my choice if I had this disease. Gradually, through large and expensive clinical trials, this body-deforming operation has been almost completely replaced by early detection and minimal surgery, often followed by radiation and chemotherapy, while survival rates have fired.
I have also seen significant improvements in cataract removal surgery (now an outpatient procedure); replace hips, knees, shoulders, elbows, and even finger joints paralyzed by arthritis; and prevent heart attacks and strokes by bypassing clogged arteries. Not to mention the ability to transplant organs between genetically different people, or even from animals to humans. Today, most heart-lung transplant recipients achieve long-term benefits.
Pediatric surgeons now operate to correct or minimize major life-threatening defects, including spina bifida and obstructed airways, while the babies are still in the womb. Intrauterine gene therapy, now being tested in animal fetuses, is probably next. And bariatric surgeons can now safely facilitate substantial weight loss in adolescents and adults with health-threatening obesity when dietary changes are not enough.
Sexuality and gender. Our understanding of human sexuality has also undergone a major shift toward medical and cultural acceptance of lesbian, gay, transgender, and queer people. It may surprise you to learn that a Page 1 article I wrote in 1971 he suggested that psychotherapy could help homosexuals become heterosexual, an idea that I, along with health professionals, now dismiss as abusive.
Medicine now recognizes and accepts a wide range of sexual and gender identities. Increasingly, people who identify as transgender, for example, may adopt a gender identity or gender expression that differs from what is normally associated with the “male” or “female” sex they were assigned at birth .
Mental health. The closure of most psychiatric hospitals and the deinstitutionalization of people with serious emotional disturbances during the 1950s and 1960s lit a fire in long-needed efforts to develop better therapies for mental illness. There are now many effective medications and other treatments for common conditions such as bipolar disorder, depression, anxiety, attention deficit hyperactivity disorder, post-traumatic stress disorder, and psychosis.
The recognition of autism as a spectrum disorder is fostering a greater understanding of children and adults with this condition. Leaders in their field, such as animal scientist Temple Grandin and actor Sir Anthony Hopkins, who have been outspoken about being on the spectrum, are helping others find acceptance in society.
More than anything else, what has kept me writing well into my 80s is the feedback I’ve received from readers with moving personal accounts of lives transformed through the information and advice my column provided. May my successors derive as much satisfaction as I do from researching and writing about what the future holds.
