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Studying the past helps doctors navigate present, future challenges

Interest in the history of medicine has notched up, and scholars say it’s a must-study for the medical community. A KU Medical Center professor recently published two articles on the subject in The Lancet.

Chris Crenner stands in an office, with a bookcase behind him
Chris Crenner, M.D., Ph.D., chair of the Department of History and Philosophy of Medicine, said studying history shows future doctors how diseases, institutions, practices and even ethics all change over time.

Sometimes, diseases change biologically — like COVID-19 mutating to survive despite humans developing immunity to previous strains of the virus. Other times, a medical condition itself may stay the same while scientific knowledge and societal constructs surrounding it morph to the point it’s nearly unrecognizable.

Rickets once caused widespread bone deformities in city-dwelling children across the globe. Rickets symptoms still look like they did centuries ago, but the discovery that vitamin D can prevent rickets has transformed the disease’s modern persona. Same with peptic ulcers, once a top-20 cause of death blamed on stress. Since the discovery that a bacteria strain causes most peptic ulcers, they’re more easily treatable — and joking about your horrible boss giving you an ulcer is now passe.

Studying the history of medicine, including examples like these, is important for doctors practicing today and in the future, said Chris Crenner, M.D., Ph.D., professor and chair of the Department of History and Philosophy of Medicine at the University of Kansas Medical Center. Crenner penned two articles for The Lancet in 2024, one exploring the history of ulcers, in June, and one featuring the evolution of rickets, in November.

“If you understand how diseases move through history, you understand how your own work will change over your career,” Crenner said. “Because the patterns of disease that you’ll face will change, too.”

Especially since the pandemic, interest in the history of medicine has grown, Crenner and other scholars say. Professors at institutions nationwide, including KU Medical Center, are trying more interactive approaches to teaching the history of medicine.

“It really grabs the students’ attention if they have an artifact or a document to look at,” said Laura Hirshbein, M.D., Ph.D., vice president of the American Association for the History of Medicine and professor at the University of Michigan. “We want our students to engage in discussion… We want them to think, grapple and really wrestle with how medicine has changed.”

Pandemics point to the importance of learning from the past

Waves of interest in history of medicine seem to rise when the medical field is in crisis, Hirshbein said.

“We haven’t had a pandemic like the one we had with COVID since 1918, and the people who knew what that was like were the historians,” Hirshbein said.

Crenner said that while public health officials knew social distancing was a common-sense tactic, they needed evidence that it had worked before. Since the COVID pandemic was unprecedented in this lifetime, they turned to studies published about the 1918 influenza outbreak. Those showed that Philadelphia’s mortality rate rose in the wake of the city’s victory parade, while other cities that canceled parades and employed social distancing had better outcomes.

The medical community also is looking to history to understand factors leading to modern health disparities and distrust of medicine.

An infamous example is the Tuskegee syphilis experiment that began in the 1930s, in which the U.S. Public Health Service enrolled hundreds of mostly poor and illiterate Black men with a promise of free medical care, but without today’s standard of informed consent. After penicillin became an approved treatment, the government, seeking to document the progression of untreated syphilis, withheld the drug even as some men spread the disease to partners, suffered severe health problems or died.

“What historians have been able to do is really raise awareness of bad things that have happened in the past,” Hirshbein said. “The history of what people have experienced in this country is important. We need to know that.”

Change is not always progress

Crenner’s own research has included exploring scientific racism’s influence on medical practice in the early 20th century, when a high point of scientific racism and eugenics in the United States coincided with the development of major institutions that shaped the course of medicine, he said.

Crenner’s current research focus is surgery.

His Lancet article on ulcers was tied to the 40th anniversary of the discovery of the ulcer-causing bacterium Helicobacter pylori, or H pylori. Scientists published their initial findings in the Lancet in 1984 and later won a Nobel Prize.

Crenner also is researching the history of appendectomies, and he presented a paper about it at a conference in Ireland last summer.

Inspiration came from his own family’s history. In the 1940s, Crenner’s father’s brother died as a child because of misdiagnosed appendicitis, he said. The child’s appendix burst after a doctor attributed his pain to an upset stomach instead of performing an appendectomy.

This tragedy had an unusual twist, because at that time about 20% of all appendices doctors removed turned out to be healthy, Crenner said. Without a way to definitively diagnose appendicitis, doctors often took a better-safe-than-sorry approach. Today’s negative appendectomy rate is only about 5%, thanks to readily available ultrasounds and CT scans, Crenner said.

Tracing the history of appendectomies can inform modern debates over surgical judgment, Crenner said.

Currently at KU School of Medicine, courses in the history of medicine are offered as electives. The Department of History and Philosophy of Medicine is developing a certificate of distinction in medical humanities and bioethics, a four-year program of coursework designed by the department.

Crenner is the series editor for Rochester Studies in Medical History with University of Rochester Press. He is past president of the American Association for the History of Medicine and past editor in chief of the Journal of the History of Medicine and Allied Sciences. He said studying history shows future doctors how diseases, institutions, practices and even ethics all change.

Often, we discover we were wrong about what we thought, Crenner said. “What looks like change is not always progress.”

Digital lessons can access the past

At KU Medical Center in November 2024, a group of geriatric medicine fellows and staffers embarked on a newly created digital lesson while moving through the Clendening History of Medicine Library.

This “GeriJourney” was the brainchild of Candice Coffey, M.D., assistant professor of geriatric medicine at KU Medical Center and the fellowship director.

Participants responded to questions asking them to describe, assess and reflect on medical artifacts, Coffey said. They perused everything from old-fashioned wheelchairs to 120-year-old patient charts to antique hearing aids, which, Coffey noted, “were ridiculously expensive back then, too.”

Coffey said she’d always been fascinated by the museum — which boasts “one of the most outstanding collections of books and artifacts relative to the history of medicine that exists in the United States” — and enlisted librarians’ help to create a “tangible” lesson.

A special challenge of geriatrics is that patients’ life experiences often pre-date their doctors. Knowing a patient started driving a tractor at elementary-school age puts into perspective the desire to continue driving at 85, she said. Or knowing that prior to the 1980s, nursing homes lacked today’s levels of oversight to ensure safety — something to consider instead of assuming patients who balk at moving are just “stubborn and old.”

“It’s really important for all of us, but particularly any learner, to understand some history of medicine,” Coffey said. “Because we’re always trying to help understand where our patients are coming from.”

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