Some of the ugliest mounds of debris in the junkyard of medicine are filled with discredited medicines and surgical procedures once considered dramatic ”breaththroughs.” Physicians take pride in being a conservative lot, skeptical about embracing new treatments. Indeed, this reluctance to accept innovation sometimes frustrates biomedical researchers who conduct successful clinical trials of new therapies. It may take the medical community years to adopt the results of research, and begin using a new treatment in day-to-day practice.
Government health officials agonize over ways of encouraging more rapid adoption of research results-especially in serious diseases such as AIDS and cancer.
But root around in the junkyard of medicine, and you uncover good reasons for caution.
Treatments for all kinds of diseases, once enthusiastically adopted by physicians, now rot among other rejects, duds and flops of science.
Lying somewhere among the litter is a medical procedure-once widely used but now thoroughly discredited-termed psychosurgery.
Better known as the lobotomy, psychosurgery was a shockingly crude brain operation performed on tens of thousands of mentally ill people during the 1940s and 1950s. It was based on the notion that mental illness results from abnormal ideas etched in nerve tissue in the frontal lobes of the brain. Destroying this brain tissue was supposed to destroy the ideas and cure patients.
One of the most popular surgical procedures was the transorbital lobotomy, which was known-indelicately but with some accuracy-as the ”ice pick operation.”
Patients were given electroshock treatments, which made them unconscious and eliminated the need for anesthesia. The doctor took a sharp instrument, resembling an ice pick, and quickly drove it through the thin bone near the eye socket.
Swishing the instrument up and down, side-to-side, he destroyed brain tissue in the patient`s frontal lobes. The procedure took about five minutes. Patients woke up and could walk back to their wards, usually requiring minimal post-operative care.
Many patients did improve. Violent patients and those suffering from extreme anxiety and agitation were calmer and no longer had to be kept under restraint. Some were well enough to return home and to work.
But others became impulsive and childlike. Some slid into a condition popularly associated with lobotomy: They were ”vegetables,” emotionally numb and unable to respond to the world.
At first lobotomy was used only as a last resort, on hopeless, incurable patients who could not be helped in any other way. But use expanded to others, including retarded adults and children, alcoholics, sex offenders and people convicted of violent crimes.
Sometimes improvement was only temporary and patients underwent a second- and even a third-treatment.
Dr. Elliot Valenstein, author of a history of lobotomy, pointed out that lobotomy was very much a part of mainstream medicine.
Its developer, Dr. Egas Moniz, was awarded the Nobel Prize. The New England Journal of Medicine hailed lobotomy as ”sound.” The president of the American Psychiatric Association was an enthusiast. Political figures praised it for reducing the amount of tax money spent to care for the mentally ill. The popular press hailed it as a ”medical breakthrough” as a cure of hopelessly ill people.
The sad history of the lobotomy, like other stories from medicine`s waste dump, carries an important lesson of caution for us today:
When it comes to your health, develop a healthy amount of skepticism about revolutionary new treatments-even those backed by the medical establishment.
