Surgery. Early in my career, radical mastectomy was the gold standard for treating breast cancer, and I recall saying that would be my choice if I got this disease. Little by little, through large, costly clinical trials, this body-deforming operation has been almost entirely replaced by early detection and minimal surgery, often followed by radiation and chemotherapy, while survival rates have soared.
Likewise, I’ve witnessed major improvements in surgery to remove cataracts (now an outpatient procedure); replace hips, knees, shoulders, elbows and even finger joints crippled by arthritis; and prevent heart attacks and strokes by bypassing obstructed arteries. Not to mention the ability to transplant organs between genetically different people, or even from animals to humans. Today, most recipients of heart and lung transplants achieve long-term benefits.
Pediatric surgeons now operate to correct or minimize major potentially fatal defects, including spina bifida and obstructed airways, while babies are still in the womb. Intrauterine gene therapy, now being tested in fetal animals, is likely next. And bariatric surgeons can now safely facilitate substantial weight loss in teenagers and adults with health-threatening obesity when dietary changes don’t suffice.
Sexuality and gender. Our understanding of human sexuality has also undergone a cataclysmic shift toward medical and cultural acceptance of lesbian, gay, transgender and queer people. It may shock you to learn that a Page 1 article I wrote in 1971 suggested that psychotherapy could help homosexuals become heterosexual, an idea that I, along with health professionals, now scorn as abusive.
Medicine now recognizes and accepts a wide range of gender and sexual identities. Increasingly, people who identify as transgender, for example, are able to adopt a gender identity or gender expression that differs from what is typically associated with the “male” or “female” sex they were assigned at birth.
Mental health. The closing of most psychiatric hospitals and deinstitutionalization of people with serious emotional disorders during the 1950s and ’60s lit a fire under long-needed efforts to develop better therapies for mental illness. There are now many effective medications and other treatments for common deficit conditions including bipolar disorder, depression, anxiety, attention hyperactivity disorder, post-traumatic stress disorder and psychosis.
The recognition of autism as a spectrum disorder is fostering greater understanding of children and adults with this condition. Leaders in their field, like the animal scientist Temple Grandin and the actor Sir Anthony Hopkins, who have talked openly about being on the spectrum, are helping others find acceptance in society.
More than anything else, what’s kept me writing beyond age 80 is the feedback I’ve received from readers with heartwarming personal accounts of lives transformed through the information and advice my column provided. May my successors glean as much satisfaction as I have from researching and writing about whatever the future holds.