Imaging trails pain and germ fighters in medical achievements poll

In an open online poll conducted by the British Medical Journal, medical imaging was voted as the ninth greatest medical milestone since 1840. Sanitation, antibiotics, and anesthesia topped the list.

Each of the top three winners had strong support, with sanitation garnering 16% of the votes, antibiotics 14.5%, and anesthesia 14%. Vaccines (12%) and the discovery of the DNA structure (9%) rounded out the top five.

The oral contraceptive pill, germ theory, and evidence-based medicine made the list before medical imaging attracted 4% of the votes. Computers fell into the number 10 spot. The last five advances on the list of 15 were oral rehydration therapy, immunology, risks of smoking, chlorpromazine, and tissue culture.

For the most part, specialists tended to vote for their own. Anesthesiologists chose anesthesia, radiologists chose imaging, and general practitioners chose germ theory and sanitation.

Quotes from voters followed this pattern:

• A professor of anesthesia in the U.K.: "Anyone who does not think that anesthesia is the greatest medical discovery since 1840 should go and look at the painting (c1780) of amputation without anesthesia in the Royal College of Surgeons in London."

• A Colombian radiologist: "It is difficult to imagine any medical specialty in which diagnostic images are not useful or indispensable."

• A general practitioner in the U.K.: "The single greatest breakthrough since 1840 that has saved the most lives is germ theory leading to antisepsis."

With a wink and a nod, a botanist in the U.K voted for oral contraception, saying it has a "unique medical result in that the benefits are enjoyed by people other than direct users . . . at least a 200% effectiveness."

More than 11,000 votes were cast during the 10-day polling, mostly from doctors (29%), members of the public (22%), students (14%), and academic researchers (10%).

Most votes came from the U.K. (38%) and the U.S. (20%), followed by Canada, Bulgaria, and Germany, each with about 5%.

Not coincidentally, the year 1840 is when the BMJ debuted, and this project marks a complete redesign of the journal and its Web site.

Medical imaging fared much better in a 2001 survey of 225 internists asked to select the five to seven innovations from a list of 30 whose loss would probably have the most adverse effects on patients and the five to seven whose loss would have the least adverse effects. MRI and CT shared the number one slot on the most adverse list. Mammography came in fifth, while ultrasonography and echocardiography were 11th (Health Affairs 2001;20[5]:30-42).

In contrast to the pill's high placement (6) in the BMJ poll, Viagra limped into 28th place among internists in 2001.