MOUNT HOPE:

LIFE AND DEATH AT THE HOSPITAL

Faces of Mount Sinai

Diagnostic Tests and Procedures

A Mini-History of Hospitals

Money and Medication

FACES OF MOUNT SINAI
	Donald Low: Chief of microbiology, medical director of the Ontario government’s publichealth labs and University of Toronto professor with 24 other current appointments. His CV is 132 pages long.
	Alison McGeer: An infectious-disease expert who became famous when she contracted SARS herself during that health crisis.
	Leslie Vincent: Senior vice-president of nursing, who manages 1,200 employees and a budget of $115-million, but still brings her own lunch to work.
	Jay Wunder: Surgeon, researcher and teacher, and a specialist in osteosarcomas — a form of musculoskeletal cancer that Dr. Wunder sums up simply by saying, ‘Terry Fox.’

A Mini-History of Hospitals

• Egyptian temples were the earliest known institutions to offer cures. In Greece, temples dedicated to the healer-god Asclepius admitted the sick, who would wait for guidance from the god in a dream.
• The first institutions created specifically to care for the ill appeared in India. The Persian Empire saw the world’s first teaching hospital, the Academy of Gundishapur.
• The oldest known lab test, circa 400 BC, involved pouring urine on the ground. If this attracted insects, the diagnosis was boils.
• In medieval Europe, hospitals were religious institutions, caring for lepers, the poor or pilgrims. Some of them didn’t care for the sick. Early Christians believed that disease was either a punishment for sin or the result of witchcraft or possession. Diagnosis was superfluous.
• The Hotel-Dieu in Paris, founded in 660 AD, is the oldest hospital still in use. In medieval times, when European understanding of contagion was sketchy, this hospital housed up to six patients in the same bed, with no attempt made to isolate the infectious ones.
• Hospitals evolved from charities and almshouses. Not until the 19th century did hospitals serving all classes emerge.
• Canada’s first general hospitals were charitable institutions, relying on donations from individuals and benevolent organizations. In 1867, Toronto General Hospital was forced to close for a year, because of lack of funds.
• In the 18th century, the state of hospitals in the Western world was alarming by modern standards. Recovery from surgery was rare, because of blood poisoning. Hospitals remained notorious for filth and disease well into the 19th century.
• The demonstration of anesthesia in 1846 allowed hospitals eventually to perform slower, more careful operations. Before that, surgeries required brute force and speed, because it was important to get in to and out of the body as quickly as possible.
• Around 1880, antiseptic techniques became general practice. Before this, mortality rates were grim for surgeries — the rate for amputations was about 40 per cent — and surgeons penetrated the major body cavities only as a last resort.
• Before 1900, the hospital offered no special advantages over the “kitchen surgery” at home. Periodic outbreaks of disease made physicians reluctant to send patients to the hospital, where dirty and overcrowded conditions often became traps for infection. The most prosperous citizens were treated at home.
• In the 1900s, tuberculosis hospitals were established to sequester the “incurables” from the general public. The development of antibiotics, with the appearance of penicillin circa 1941, revolutionized hospitals’ management of diseases.

Money and Medication

• One of the most expensive drugs on the market is Xigris, a version of human Activated Protein C, which helps sepsis patients by preventing blood clotting, controlling inflammation and regulating blood flow to the organs. It costs an average of $10,720 for a one-time, 96-hour course of therapy, or $2,680 a day, depending on the patient’s weight.
• Human growth hormone is another high-rolling pharmaceutical. When short children in an Eli Lilly study received HGH over several years, the height gain over what was predicted to occur naturally was only 3.7 cm, The New York Times reports. At a cost for the medication of roughly $20,000 (U.S.) a year over four to five years, these were, in the words of Canadian pediatric endocrinologist Harvey Guyda, “very expensive centimetres.”
• One of the cheapest is lithium, which in 1949 became the first drug ever approved for treatment of severe mental illness. Its effect in reducing suicidal behaviour in people with bipolar disorder “puts it right up there with the century’s other miracle drugs,” Vincent Gallicchio of the University of Kentucky said in 1999. However, he added that despite indications that lithium salts can also boost the immune system and help to fight AIDS and cancer, the chemicals are so inexpensive there’s no incentive for drug companies to finance the research.
• In 2004, the most-prescribed drugs by Canadian family physicians, general practitioners and internists were: Lipitor, Altace (for high blood pressure) and Synthroid (for thyroid deficiency).
• In 2004, about 80 prescription drugs had worldwide sales of more than $1-billion (U.S.), mainly from the U.S. market. For instance, Lipitor, the world’s bestselling drug, reached sales of $10-billion but 75 per cent of that came from the United States. Lipitor, Pfizer’s lipid-lowering medication, is expected to bring in $12-billion this year, generating more revenue than the entire U.S. vaccine market.
• In 2003, Americans received 3.4 billion prescriptions, an average of about 12 each — that was a record high and nearly double the amount of just a decade ago. By comparison, in 2004 Canadians bought 382 million prescriptions from retail pharmacies.
• The pharmaceutical industry began in 1899, when Bayer of Germany launched sales of acetylsalicylic acid, the world’s first synthetic drug. Its developer, 29-year-old Felix Hoffman, was convinced his creation would revolutionize medicine. In the 1918 flu pandemic, ASA became the must-have drug. Today, ASA is taken an estimated 58 billion times per year worldwide, for everything from headaches to prevention of cardiovascular disease.
• At the time ASA was introduced, however, Bayer’s boss was more excited about another of its formulas, aimed at treating coughs and colds, especially in babies. The company named this drug “heroin,” because it made users feel heroic.
• The most expensive pill, pharmaceutical executives say, costs less than the cheapest hospital stay.