1207??? Century of Trust

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What is the most widely read book on medicine?

• It is Merck Manual !

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Western vs. Eastern
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Western vs. Eastern

• In Medicine, which world advances faster and is
  more successful?
• Eastern or Western?

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Amazon.com
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This is serious stuff. The most widely used
medical text in the world. Ref. Amazon. com
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• more than 10 million copies
• sold in 18 languages
• since it was first published
• in 1899

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• the oldest continuously
• Published general medical text
• in the English language.

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• The year 1999 marks a milestone in medical
  publishing
• the 100th anniversary of
• The Merck Manual

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The Merck ManualA Century of Medical Publishing
and Practice
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A Century of Trust

• The Merck Manual
• Centennial Edition

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• What a century
• for advances
• in medicine!

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Keryn AG Lane Executive Editor Merck Manuals
Robert Berkow Editor-in-Chief Merck Manuals
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• The history of the Manual provides a wonderful
  overview of how medical practice has changed.

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The first edition reveals a remarkable reliance
on poisons, such as strychnine and arsenic.
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• Arsenic was listed as a medication for
• more than 100 diseases, including jaundice,
  hydrophobia, elephantiasis, and impotence.

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Tobacco was recommended to treat asthma
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The first edition was an instant success!
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A book reviewer in the Chicago Medical Recorder
commented

• Although this little book is gotten out
• by a manufacturing firm----,
• it nonetheless is of such merit -----.

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Dr M R Dinkelspiel, the 7th edition (1940)
editor noted that therapy was approached not as
a science, but as an art.
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The ninth edition (1956) reflected the
growinglist of corticosteroids for pain.
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• The 12th edition (1972) contained many new
  chapters, for example, on coronary
• care units, cardiovascular and malignant
  diseases, immunology and genetics, and the
• chemotherapy of psychiatric disorders.

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• As an interesting endnote, all people who
  purchase the 17th edition of The Merck Manual
  during its centennial year will receive a
  facsimile copy of the first edition.

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• Readers can then see for themselves how much
  medicine has changed during this century.

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What about oriental medicine?

• How much has been advanced in
• herbal medicine in the past 100 years?

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In the USA, herbal medicine pills are noted
frequently to containwestern medications suchas
steroid (cortical), chemotherapeutic agents
(method rebate), anticonvulsants (Dilating) and
others.
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• Based on the 100 years of experience
• with Merck Manual,
• could we, the doctors, be looked back stupid in
  year 2099?

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In the 18th Century

• Doctors are killing patients with arsenic,
  strychnine and other poisons

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100 years from now how the contemporary doctors
then would see their counterparts 100 years
earlier?
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Traffic death in the US

• 50,000 a year

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Death caused byhealthcare professionalsin the
US

• 100,000 a year!

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Death caused by medications prescribed by doctors
in the US

• 200,000 a year!

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Health care professionals and the medications
they prescribed kill 6 times more people than
traffic accident in the US
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Are you convinced that doctors kill patients?
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In Israel

• A nation-wide physician strike
• in 1972
• lowered the mortality in the nation
• by more than 50

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In Los Angeles, California

• A partial physician strike
• lowered the mortality in the city
• by 18

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In Bogota, Columbia

• A partial physician strike
• lowered the mortality in the city
• by 36

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In Singapore, Hong Kong and Taiwan

• SARS mortalities were
• more than 10

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In Vietnam

• SARS mortality was
• 5

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In Vietnam

• There were no modern meds
• such as antiviral agents or steroids
• to treated patients

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In Vietnam

• There were no advanced facilities such as
  negative pressure wards or respirators to support
  incubated patients

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In medical practice

• Doing nothing could be better than meds or
  interventions such as surgeries

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In medical practice

• The first thing every doctor
• should know is
• Do no harm

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How do we know the meds we give to patients are
helpful to patients?
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How do we prove the meds we prescribe to patients
are helpful scientifically?
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It takes rigorously designed clinical trials to
confirm the efficacy of a drug.
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The gold standards for the criteria to establish
drug efficacy was established byFood and Drug
Administration (FDA)in the US
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FDA established its reputation in a well known
act to prohibits the use of thalidomide in the US
when it was widely used in the Europe for a
number of diseases in the 50s.
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FDA, with its authoritative measures, sets very
high standards to approve drugs that are to be
approved for prescriptions by doctors in the US.
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The rest of the world has since adapted FDA
protocols in approving prescription medications.
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FDA specifically asks if a new drug is
safemakes patient betterkeeps patient live
longer
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A new drug to be approved by FDA entails
extensive preclinical and clinical tests to
fulfill the 3 major criteria on safety, quality
of life and longevity.
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A new drug may take 7-10 years to go from the lab
bench to bedside and costs hundreds of millions
in US dollars to get FDA approval.
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Drug Development and Approval
Process