By Chet Yarbrough
Extreme Medicine: How Exploration Transformed Medicine in the Twentieth Century
By: Kevin Fong
Narrated by Jonathan Cowley
KEVIN FONG (MD, SPECIALIZES IN SPACE MEDICINE IN THE UK)
Though not precisely on point, Doctor Kevin Fong addresses the principle of “right to try” drugs for treatment of terminal patients. In 2018 the House of Representatives of the United States voted a majority for “right to try”. The Senate rejected it.
Fong, a physician, believes exploration and extreme medicine are linked. He believes human survival depends on that linkage. Fong’s book, Extreme Medicine, links exploration and medical advance with real-life stories of adventure, discovery; failure and success. He argues that exploration of the unknown transforms medicine.
Jean Hilliard (Frozen for six hours in January 2018–heart stopped and was clinically dead but recovered with no brain damage.)
Fong begins with a story of frostbite in the early 20th century. The two edges of subzero weather are revealed; one edge destroys while the other preserves life
Fong recounts the life of a mariner that dies from frostbite. Frostbite slowly saps life from his limbs, his brain, and finally his heart. Then Fong tells of a skier’s accident in freezing weather that leaves her clinically dead for three hours. The skier lives; even though more than 20 minutes passed without an operating autonomic system.
It took the ski patrol 20 minutes more to dig Kristin out as she was buried head first in the snow.
“She was completely unconscious,” McAllister said. “She was completely cyanotic, which means she was blue all over. When I got down there I just opened her airway and started to clear her chest of snow. Doing so she spontaneously started breathing on her own.
The mariner slowly succumbs to extreme cold and dies. The skier rapidly succumbs to extreme cold and lives. To Fong, this is a trans-formative discovery in medicine. The skier’s recovery demonstrated the value of rapidly reducing one’s body temperature to arrest deterioration from physical trauma. Doctors who treated the skier were using extreme medicine to preserve life when history suggests she would never recover. That extreme medicine became standard operating procedure for certain kinds of traumatic injury.
Fong offers several more stories of extreme medical practice. Extreme medicine may initially kill patients but become life lines to future patients once extreme practices prove successful. Big examples are heart surgery and organ transplants. In the beginning, physicians abhorred the idea of cracking a living person’s chest to operate on a human heart. Fong correlates humankind’s instinct for exploration with doctor’s exploration of medicine.
There seems some truth in that suggestion but there is an ethical difference. Doctors are taking someone else’s life in their hands. An explorer of the North or South Pole is choosing to risk his own life in exploration. As a patient, fear of death is a constant motivation. As an explorer, fear of death is situational rather than ever-present.
Ethics come into issue in the doctor’s sale of extreme medicine. Life is always, to quote a book and movie title, a matter of “me before you”. Doctors are human. Money, power, and prestige affect their decisions just as they affect all human decisions. The difference is that the patient has more to lose than the doctor.
A logical extension of “Extreme Medicine” is the Chinese scientist, He Jiankui, who chooses to be the first to edit the genome of a baby — allegedly to protect the baby from contracting AIDS.
Dr. He is criticized as irresponsible for using a gene-editing technology called CRISPR that is presently being tested around the world. The ramification of Dr. He’s genomic editing gives rise to concern over experiments like those conducted by the fictional scientist, Dr. Moreau.
The ethics issue is exemplified by Congress’s rejection of “right to try” legislation. A patient’s right to choose is a form of extreme medicine with ethical and, many would say, moral significance.
Living life is by nature an exploration. Human beings that choose to explore advance knowledge. Knowledge drawn from exploration does transform medicine. Knowledge transforms everything in life. Life on earth is finite; with exploration, life is potentially infinite. However, it is self-deluding to forget the moral and ethical questions raised by “Extreme Medicine”.