Ed Norton, Man of the Century

As the youngsters among you may not know, Ed (Played by Art Carney) was Ralph Kramden's (Jackie Gleason) sidekick on the TV Sitcom The Honeymooners. He was a New York City sewer worker. Actually, he's the Man of the Century and a half. Readers of the British Medical Journal voted for the most important medical advance since 1840, and sanitation -- yup, sewers -- is # 1. Most BMJ readers are MDs, so I congratulate them -- or at least 15.8% of them -- for recognizing that medical intervention is not, after all, the most important determinant of our health.

It's also not surprising that the medical interventions that did score high are now pretty long in the tooth. Antibiotics -- which date back to World War II -- came in at #2, followed by anaesthesia (19th Century), and vaccines, which technically shouldn't even be eligible since the smallpox vaccine dates to before 1840. However, it wasn't until the 1950s that scientists began to understand how to create new ones from deactivated viruses, so I guess we'll allow it. Some of the other entries aren't interventions or public health measures at all, but basic scientific discoveries (DNA, germ theory, immunology) and techniques (tissue culture, X-rays).

The major lesson to be drawn from all this is that the huge breakthroughs are in the past. The huge investment we've been making biomedical research and development since the 1950s has produced much more incremental progress. The main reason, I would say, is that the conquest of infectious disease (not a complete victory, but a major route) eliminated much of the disease that used to cut people down before they ran into the diseases of aging. Those are not only harder to fight, but we get less benefit from the measures that do ameliorate them because, sad to say, even if we survive our first heart attack, or cancer, we're still getting older.

The only breakthrough that could ever rival sanitation, antibiotics and vaccines would be the conquest of aging. That is nowhere in sight.