The year is 1854. Cholera is killing thousands in London. John Snow traces an outbreak to a contaminated water pump. Everyone blames bad air. Eventually cities separate sewage from drinking water. Clean water and sanitation will save more lives than almost anything medicine invents. The year is 1867. Surgery is often more dangerous than the disease it treats. Joseph Lister starts cleaning instruments and wounds with antiseptic. Other surgeons ridicule him. Infections plummet. The year is 1890. Your daughter has diphtheria. A thick membrane is forming in her throat, slowly suffocating her. The doctor injects a new antitoxin. She survives. A disease that killed tens of thousands of children will become almost unheard of in America. The year is 1922. Your 14-year-old son has diabetes. He is starving to death no matter how much he eats. The only treatment is a starvation diet. The doctor injects insulin. His blood sugar falls. Children who would have died within months will grow up and have children. The year is 1943. Your daughter has pneumonia. Before antibiotics, doctors could do little but hope. Now they give her penicillin. The fever breaks. Infections that routinely killed healthy adults become treatable. The year is 1955. Parents are terrified of polio. Swimming pools close. Children become paralyzed. Some spend their lives in iron lungs. Jonas Salk develops a vaccine, tested in more than a million children. Within decades, polio disappears from America. The year is 1960. Your wife is giving birth, and something goes wrong. A century earlier, she might have died. Now there are blood transfusions, antibiotics, safer cesarean sections, and anesthesia. Maternal mortality has fallen dramatically. Millions of women survive childbirth who otherwise wouldn’t have. The year is 1978. Your blood pressure is 180 over 110. You feel fine. The doctor prescribes a pill. Clinical trials show that treating hypertension prevents strokes, heart failure, and death. You take it every morning. Nothing happens. That’s the point. The year is 1980. The WHO declares smallpox eradicated. A disease that killed hundreds of millions in the twentieth century has disappeared from nature. Not treated. Not managed. Eliminated. The year is 1996. Your brother has HIV. A decade earlier, the diagnosis was effectively a death sentence. Now doctors combine antiretroviral drugs. People who had months to live begin living for decades. Many will have near-normal life expectancies. The year is 2014. Your father has hepatitis C. For decades, the infection has meant liver failure and cancer. Now he takes pills for twelve weeks. The virus disappears. A lifelong infection becomes curable in more than 95% of patients. The year is 2019. Your daughter has cystic fibrosis. Her lungs are slowly failing. For decades, treatment meant managing infections and delaying the inevitable. Now doctors have a drug that corrects the underlying protein defect. Her breathing improves. Hospitalizations plummet. Predicted median survival rises from roughly 40 to more than 60 years. The year is 2026. Your doctor has ten minutes and a screen. Your blood pressure is high, so the tablet is for life. Your cholesterol is high, so another tablet is for life. Your weight is high, so she offers an injection. The drugs have side effects. Not everyone needs them. But clinical trials show that appropriate treatment prevents heart attacks, strokes, kidney disease, and death. None of these treatments is perfect. None needs to be. For most of human history, parents buried their children, infections killed healthy adults, and childbirth killed young women. Today, global life expectancy has more than doubled since 1900. Child mortality has collapsed. Medicine has made terrible mistakes. We should remember them. We should also remember the hundreds of millions of people alive because somebody got it right.

Sama Hoole

@SamaHooleOct 29

The year is 1873. Your wife tires easily and reads too much. The doctor prescribes the rest cure: six weeks flat in bed, no books, no visitors, fed on milk, forbidden to sit up without his permission. The man who devised it is the most famous nerve specialist in America, and the women come out of it quieter, which is taken as the cure. The year is 1915. The hospital has a new way of delivering your child. Morphine, then scopolamine, and the mother wakes two days later with a baby she cannot remember having. They call it twilight sleep. The women are strapped into padded cots so they do not hurt themselves while they scream, and the straps are the modern part. The babies arrive blue and slow to breathe. The year is 1945. The truck comes down your street fogging DDT, and the children run behind it in the white cloud because the man on the back says it is harmless. At the beach it is sprayed over the bathers on their towels. It goes on the cattle, over the barn, and across the kitchen table. The year is 1948. Your son has trouble with his ears. The doctor slides a rod tipped with radium up each nostril and holds it there for the best part of ten minutes, and you bring him back three more times. Hundreds of thousands of American children get the same treatment. The cancers arrive in their fifties. The year is 1962. The health visitor tells you breastfeeding is old-fashioned and the formula is scientific. By 1972 fewer than one American baby in four is breastfed at all. The formula is skimmed milk and sugar, with the milk fat taken out and vegetable oil put in. The year is 1971. The family planning clinic fits a small plastic crab called the Dalkon Shield. Its tail is a bundle of fibres that wicks bacteria up into the womb. 2.8 million are fitted in America before it is withdrawn, and the company goes bankrupt under the claims. It had been sold as safe and superior. The year is 1983. The doctor says your arteries are the butter's fault. The dripping tin goes in the bin, the yolks go to the dog, the margarine goes in the fridge, and you have the heart attack anyway, on skimmed milk, having done everything right. The year is 2001. Your 15-year-old is low, and the doctor prescribes Paxil, because the trial in the journal says it is effective and well tolerated in adolescents. The raw data, reanalysed 14 years later, shows more suicidal thinking on the drug than on the sugar pill. The company pays $3 billion to settle. Nobody rings the house. The year is 2009. The government has spent around £500 million stockpiling Tamiflu for the pandemic, on the strength of the manufacturer's trials. When the trials are finally prised loose five years later, the drug shortens flu by about half a day and nothing shows it keeps anyone out of hospital. The stockpile goes out of date in a warehouse. The year is 2026. The doctor has ten minutes and a screen. The number is high, so the tablet is for life. The weight is high, so the injection is for life. The meat is bad for the planet and the oil is good for the heart, and the person in the chair is as certain as everyone who ever sat in it. Every one of those was settled, by a committee, in a journal, with a doubter somewhere being laughed at. The rest cure, the straps, the fog, the rod, the formula, the crab, the margarine, the trial, the stockpile. All of it certain, all of it printed, all of it done to somebody who had asked for help. You were never the one who was wrong. You were the one it was done to, and the only person in the story who did as they were told every single time. The apology comes a generation late, in a footnote, addressed to nobody. The next one is being drafted now.