THE 1960s: MEDICINE AND HEALTH: OVERVIEW

Changes in the Medical Profession

The medical profession transformed itself after World War IL New methods of diagnosis and treatment expanded the physician's healing powers enormously, and unprecedented social pressure was applied to assure that those new powers were exercised responsibly. Medicare and Medicaid programs initiated during the administration of President Lyndon B. Johnson routinely extended good medical care to the poor and the elderly for the first time in history, and it cost more than even the most conservative planners imagined. Between 1950 and 1970 the medical workforce tripled to 3.9 million people, and national health-care expenditures increased sixfold to $71.6 billion per year.

Evolving Practices

Innovations in obstetrics, vascular surgery, neurosurgery, transplant surgery, and other medical fields made headlines, but the ability of physicians to perform new procedures did not mean they were available, because physicans' time was limited, and complicated medical procedures took time and money. New techniques, drugs, and instruments required that physicians modify their practices. House calls, common in the years before World War II, became rare as routine diagnoses required medical tools that were not portable, and the doctor's office—or the hospital—became the place to treat illness. The influx of patients to hospitals increased the demand for interns, low-cost medical apprentices; twice as many were needed as graduated from medical schools each year, so the difference was supplied by foreign doctors wishing to gain a license to practice in the United States. Higher medical costs prompted studies into the quality of care, and some health-care consumers began to question the safety of new drugs and procedures. The government responded by instituting a federal bureaucracy to administer health programs and assure the safety of new drugs and new medical procedures.

New Methods of Treatment

Medical scientists introduced equipment during the 1960s that greatly enhanced the effectiveness and efficiency of medical care. Cryosurgical probes, used to remove or deaden diseased tissue by freezing, allowed for attractive alternatives to standard surgery, especially in removal of cancerous tumors. The home-dialysis machine, used to treat patients with kidney failure, allowed patients to undergo the lengthy and awk-ward process of dialysis without disrupting their lives with frequent hospitalizations. The portable electrocardiograph (EKG), which monitors electrical impulses in the heart, allowed doctors to perform a fundamental diagnostic test in their offices instead of in hospitals.

Implantation Surgery Revolutionized

The field of implant surgery was vastly expanded during the decade. Before the 1960s the only successful transplants of organs were of kidneys between identical twins. New drugs that suppressed the immune system to keep it from rejecting foreign cells and the development of a tissue-typing system that decoded genetic messages allowed physicians to begin thinking of body parts as modules that could be removed and reattached or transplanted from body to body. In 1963 the first human-liver transplant occurred when a man with liver cancer was given the healthy organ of a patient who had just died. A lung transplant was also performed that year, and the first heart transplant was performed in 1964 using a chimpanzee heart to replace a human one temporarily while a more suitable donor was located. Recipients of these early transplants did not fare well, but surgeons demonstrated the potential viability of their procedures.

Vascular Surgery

Medical researchers developed mechanical body parts for use when real donor organs were not available. Throughout the decade cardiovascular surgeons worked to design an artificial heart. The first successful models were simple pumps that supplemented the natural pumping action of the heart. The first complete artificial heart was installed in 1969 and served to keep the patient alive for several days until a donor was found. Many other advances were made in areas of cardiovascular surgery, including the coronary-artery bypass, which involves redirecting blood flow to the surface of the heart and bypassing diseased arteries. The first techniques allowed only one artery to be bypassed, but further research into grafting, or transplanting, made multiple bypasses feasible. The surgical procedure of cleaning out fat-clogged arteries was also developed and improved, and a safe and effective method for cardiac resuscitation was developed.

Vaccines

The spread of several devastating and fatal diseases triggered research and development of preventive vaccines. As researchers performed more experiments with live viruses, safety versus effectiveness became a main topic of debate. Live-virus vaccines, which involved injection of the active viral agent, were often more effective than killed-virus vaccines, but they were considered more dangerous. The oral live-virus polio vaccine developed in 1955 was extensively tested throughout the world before it was approved in 1961 for general use in the United States. Both live-virus and killed-virus vaccines were developed to combat measles; although the live-virus vaccine was more effective, it could not be administered to certain patients, and thus the killed-virus was necessary. The development of a live-virus rubella vaccine followed soon after the measles vaccines.

Cancer Research

The success of medical scientists in understanding and combating viruses stimulated research into cancer causes and armed physicians with a better understanding of cancerous diseases. Physicians and the general public became more concerned with discovering and attempting to prevent the causes of cancer. In 1964 the surgeon general warned the public of the dangers of smoking, linking it with deadly illnesses such as lung cancer, heart disease, and emphysema.

Reproduction and Sex

Numerous advances were made in the fields of gynecology and obstetrics during the 1960s. Following approval of a highly effective birth-control pill and other contraceptives, such as the intrauterine device (IUD), women were afforded a measure of sexual freedom not previously available to them. The implications were unsettling to many people and led to a rethinking of matters related to sexuality, involving not only medical but also moral and religious philosophies. The issue of choice became a topic not only for the sexual act but also for the possible consequence involved: pregnancy. The demand for legalization of abortion and safer procedures caused heated debate. Fertility drugs offered the opportunity for pregnancy to previously infertile women, and artificial insemination offered infertile men the possibility of fatherhood. The process of giving birth was facilitated by the use of anesthesia in the delivery room, but natural-childbirth techniques were developed and became popular after the public came to fear the use of drugs during pregnancy.

The Bad with the Good: Drugs Cause Side Effects

Although many advances were made in treating illnesses with newly developed drugs, extensive testing by the Food and Drug Administration (FDA) proved that some of the new drugs were unsafe. The most notorious episode in the 1960s involved thalidomide, a drug prescribed to treat morning sickness (nausea) in pregnant women that caused devastating birth defects in millions of cases worldwide. Because it did not pass the strict safety tests of the FDA, the drug was prohibited in the Unites States. Similarly, cyclamates (sugar substitutes) were distributed, found to have health risks, and then banned because they did not meet FDA standards.

Boom Times

Health care was the fastest-growing industry in the United States during the 1960s, and health-care professionals became more businesslike as the field grew. Helping people regain and maintain their health was still the primary motivation of medical practitioners, but they went about their jobs fully aware of market potential and profits. By 1969 the average net profit for a medical practitioner was $32,000, about four times the net income of the average worker. Some sixty-eight million Americans were covered by Blue Cross health insurance alone. It was a boom time in the field of health care, and the benefits grew proportionately with the costs.