Clinical medicine has seen many paradigm shifts since 1945, with some fields, treatments, and theories being abandoned due to new evidence. Here are some notable examples:
1. Frontal Lobotomy – Abandoned in the 1950s–60s
- What it was: A surgical procedure that severed connections in the prefrontal cortex to treat mental illness, especially schizophrenia and severe depression.
- Why it collapsed: The development of antipsychotic medications (like chlorpromazine in the 1950s) provided a safer and more effective treatment. Lobotomies caused severe cognitive and personality changes, leading to their near-total abandonment.
2. Radical Mastectomy – Replaced by Less Invasive Breast Cancer Surgery
- What it was: A highly invasive procedure removing the breast, chest muscles, and lymph nodes to treat breast cancer.
- Why it collapsed: Studies (notably by Bernard Fisher in the 1970s) showed that less aggressive surgeries (like lumpectomy with radiation) were just as effective but had fewer complications. Radical mastectomy is now rarely performed.
3. Routine Tonsillectomy – Dramatic Decline Since the 1970s
- What it was: The removal of tonsils was once a routine childhood procedure, often done for minor throat infections.
- Why it collapsed: Research showed that most tonsil infections resolve naturally and that tonsillectomy should be reserved for recurrent, severe cases. The procedure is now performed much less frequently.
4. Twilight Sleep for Childbirth – Abandoned by the 1970s
- What it was: A combination of morphine and scopolamine used in the early-to-mid 20th century to induce “painless” childbirth, but it left women semi-conscious and amnesic.
- Why it collapsed: It was found to be dangerous for both mothers and babies, leading to complications like respiratory depression in newborns. It was replaced by epidurals and modern pain management techniques.
5. X-Ray for Pregnancy Monitoring – Stopped in the 1950s–60s
- What it was: X-rays were routinely used to assess fetal position and size during pregnancy.
- Why it collapsed: Research in the 1950s (notably by Alice Stewart) linked prenatal X-ray exposure to childhood cancer (leukemia). Ultrasound, which is much safer, replaced it.
6. Bloodletting for Common Illnesses – Finally Died Out in the Mid-20th Century
- What it was: The ancient practice of removing blood to “balance humors” was still used for conditions like hypertension and pneumonia well into the 20th century.
- Why it collapsed: Scientific studies showed that it was ineffective and often harmful. It was replaced by evidence-based treatments like antibiotics and antihypertensive drugs. (Bloodletting is still used in rare conditions like hemochromatosis but under strict medical guidelines.)
7. Hormone Replacement Therapy (HRT) for All Postmenopausal Women – Drastically Reduced After 2002
- What it was: HRT (estrogen + progestin) was widely prescribed to postmenopausal women to prevent osteoporosis, heart disease, and general aging effects.
- Why it collapsed: The Women’s Health Initiative (WHI) study in 2002 found that HRT increased the risk of breast cancer, heart disease, and stroke. Prescriptions dropped dramatically, and HRT is now used only for specific cases with careful risk assessment.
8. Chelation Therapy for Heart Disease – Debunked in the Late 20th Century
- What it was: Originally developed for heavy metal poisoning, chelation therapy (using EDTA) was promoted as a treatment for coronary artery disease.
- Why it collapsed: Large clinical trials found no clear benefit, and the American Heart Association does not recommend it for cardiovascular disease. However, some alternative medicine practitioners still promote it.
9. Fetal Surgery for Non-Life-Threatening Conditions – Reduced Since the 1990s
- What it was: Experimental in utero surgeries for conditions like spina bifida and congenital diaphragmatic hernia were attempted in the 1980s and 1990s.
- Why it collapsed: Many procedures carried high risks with unclear benefits. Today, fetal surgery is only done for select cases where survival is at stake, and the risks are justified.
10. Therapeutic Use of Leeches and Maggots – Mostly Declined (but Still Used in Niche Cases)
- What it was: Leeches were once widely used for bloodletting, and maggots for wound healing.
- Why it collapsed: Antibiotics and advanced wound care made these treatments obsolete for most conditions. However, maggot therapy is still occasionally used for debridement of chronic wounds, and leeches are used in reconstructive surgery for venous congestion.
11. Laetrile (Vitamin B17) as a Cancer Treatment – Discredited by the 1980s
- What it was: A supposed “natural” cancer cure derived from apricot seeds, heavily promoted in the 1970s.
- Why it collapsed: Clinical trials showed no effectiveness, and it was banned by the FDA due to toxicity (it releases cyanide in the body).
12. Psychosurgery Beyond Lobotomy – Largely Disappeared by the 1980s
- What it was: Other brain surgeries for psychiatric disorders, like cingulotomy and amygdalotomy, were performed after lobotomies fell out of favor.
- Why it collapsed: Advances in psychopharmacology (antidepressants, antipsychotics) and ethical concerns made these procedures rare. Today, deep brain stimulation (DBS) is used in extreme cases, but it’s a much more refined approach.
13. Routine Use of Antibiotics for Viral Infections – Discouraged Since the 1990s
- What it was: For decades, antibiotics were prescribed for colds, flu, and other viral infections due to overconfidence in their benefits.
- Why it collapsed: The rise of antibiotic resistance made this practice dangerous. Guidelines now emphasize antibiotic stewardship, and most doctors avoid prescribing antibiotics for viral illnesses.
These are just some examples of medical practices that were once widely accepted but were later abandoned due to better scientific understanding. Clinical medicine continues to evolve as new evidence emerges.