From the Editor: A Land Far Away … Was Challenged By The Same Problems

  In June, I took my teenage son to visit one of my favorite places in the world, Turkey. I worked there in the 1980s and wanted to introduce my son to this fascinating, beautiful, and welcoming country. One of my favorite sites is the ancient city of Pergamum. It was one of the most important cities of the Greek east under Roman rule. The city cascades down a hill from a spectacular acropolis to the plain below. During the first and second centuries, Pergamum was also famous for its extensive hospital and healing sanctuary dedicated to the god Asclepius. The sanctuary covered nearly 154,000 square feet and contained temples, baths, spa, springs, exercise rooms, a famous library, and a small theater. The complex was the ancient version of one of our great modern medical centers and I can imagine what a hub of activity it must have been. I would have felt right at home working there. All of the most ‘modern’ medical treatments of the day were provided.

  A local boy, Galen, was the most outstanding physician of antiquity after Hippocrates. His anatomical studies dominated medical theory and practice for 1400 years. A physician to the Gladiators, Galen knew a lot about wound care and was the first to distinguish between acute and chronic wounds. Galen also showed that arteries carry blood (something else he probably learned from personal, sad observation in caring for Gladiators), disproving the 400-year-old belief that arteries carry air. By Galen's time, there were two major schools of philosophy influencing medicine and science. Empiricists believed that a competent doctor only gained knowledge by experience, not by creating or following medical theories. In other words, the empiricists view was the opposite of ‘evidence based medicine.’ Galen himself was devoted to, ‘the constant endeavor to find out what is true and to discern what is true and false in the claims made by others.’ He believed that both reason and observation helped one arrive at truth.

  So, I was walking around the ruins of Pergamum and thinking about medical treatment, healthcare systems, and the pursuit of truth. At Pergamum physicians used to ‘whisper’ to patients through special vents in the roof of the patient rooms, telling them they were going to get better. It would be nice to think we have more efficacious treatments nowadays, but recently the Obama administration earmarked millions of dollars for studies of ‘comparative effectiveness’ in order to determine which combination of treatments really work best for a given disease. We know practically nothing about comparative effectiveness in wound care. And what is driving this debate nationally is the issue of cost of care.

  It goes without saying that only the rich had access to Pergamum’s marble spas. Two thousand years later we are still wrestling with issues of access to healthcare. We have come a long way in our understanding of the science of medicine. However, we still struggle with what therapies work best in practice, and how to get them to the patients who need them. This issue wrestles with these topics as they relate to wound care. We hope that Today’s Wound Clinic will help you in your constant endeavor to ‘find out what is true and to discern what is true and false in the claims made by others.’

  Caroline E. Fife, MD, FAAFP, CWS, Co-Editor of Today’s Wound Clinic, cfife@intellicure.com.