Medicine: Difference between revisions

[[File:The Doctor Luke Fildes crop.jpg|thumb|upright=1.1|alt=Oil painting of medicine in the age of colonialism|''The Doctor'' by [[Wikipedia:Sir Luke Fildes|Sir Luke Fildes]] (1891)]]

[[File:Elizabeth Blackwell.jpg|thumb|[[Elizabeth Blackwell]], the first female physician in the United States graduated from [[:en:State University of New York Upstate Medical University|SUNY Upstate]] (1847)]]

Medical availability and clinical practice varies across the world due to regional differences in culture and technology. Modern scientific medicine is highly developed in the [[Wikipedia:Western world|Western world]], while in [[:en:developing country|developing countries]] such as parts of Africa or Asia, the population may rely more heavily on [[traditional medicine]] with limited evidence and efficacy and no required formal training for practitioners.

In the [[:en:developed country|developed world]], [[evidence-based medicine]] is not universally used in clinical practice; for example, a 2007 survey of literature reviews found that about 49% of the interventions lacked sufficient evidence to support either benefit or harm.

In modern clinical practice, [[physicians]] and [[physician assistants]] personally assess patients in order to [[medical diagnosis|diagnose]], [[prognosis|prognose]], treat, and prevent disease using clinical judgment. The [[doctor-patient relationship]] typically begins an interaction with an examination of the patient's [[medical history]] and [[medical record]], followed by a medical interview and a [[physical examination]]. Basic diagnostic [[medical device]]s (e.g. [[stethoscope]], [[tongue depressor]]) are typically used. After examination for [[Medical sign|signs]] and interviewing for [[symptoms]], the doctor may order [[medical test]]s (e.g. [[blood test]]s), take a [[biopsy]], or prescribe [[pharmaceutical drug]]s or other therapies. [[Differential diagnosis]] methods help to rule out conditions based on the information provided. During the encounter, properly informing the patient of all relevant facts is an important part of the relationship and the development of trust. The medical encounter is then documented in the medical record, which is a legal document in many jurisdictions. Follow-ups may be shorter but follow the same general procedure, and specialists follow a similar process. The diagnosis and treatment may take only a few minutes or a few weeks depending upon the complexity of the issue.

The components of the medical interview and encounter are:

* Social history (SH): birthplace, residences, marital history, social and economic status, habits (including [[diet (nutrition)|diet]], medications, [[:en:tobacco smoking|tobacco]], alcohol).

* [[Family history (medicine)|Family history]] (FH): listing of diseases in the family that may impact the patient. A [[Wikipedia:family tree|family tree]] is sometimes used.

* Review of systems (ROS) or ''systems inquiry'': a set of additional questions to ask, which may be missed on HPI: a general enquiry (have you noticed any [[Wikipedia:weight loss|weight loss]], change in sleep quality, fevers, lumps and bumps? etc.), followed by questions on the body's main organ systems ([[human heart|heart]], [[human lung|lungs]], [[digestive tract]], [[Urinary system|urinary tract]], etc.).

The [[physical examination]] is the examination of the patient for [[medical sign]]s of disease, which are objective and observable, in contrast to symptoms that are volunteered by the patient and not necessarily objectively observable. The healthcare provider uses sight, hearing, touch, and sometimes smell (e.g., in infection, [[uremia]], [[diabetic ketoacidosis]]). Four actions are the basis of physical examination: [[inspection (medicine)|inspection]], [[palpation]] (feel), [[percussion (medicine)|percussion]] (tap to determine resonance characteristics), and [[auscultation]] (listen), generally in that order although auscultation occurs prior to percussion and palpation for abdominal assessments.

The clinical examination involves the study of:

* Vital signs including height, weight, body temperature, [[blood pressure]], [[pulse]], respiration rate, and hemoglobin [[oxygen saturation]]

* Head, [[eye]], [[ear]], nose, and throat ([[HEENT examination|HEENT]])

* [[Respiratory]] (large airways and [[Human lung|lungs]])

The treatment plan may include ordering additional [[medical laboratory]] tests and [[medical imaging]] studies, starting therapy, referral to a specialist, or watchful observation. Follow-up may be advised. Depending upon the [[health insurance]] plan and the [[managed care]] system, various forms of "[[utilization review]]", such as prior authorization of tests, may place barriers on accessing expensive services.

[[File:Pellegrinaio Santa Maria della Scala n5.jpg|thumb|alt=Color fresco of an ancient hospital setting|The Hospital of [[:en:Santa Maria della Scala (Siena)|Santa Maria della Scala]], fresco by [[Wikipedia:Domenico di Bartolo|Domenico di Bartolo]], 1441–1442]]

Contemporary medicine is in general conducted within [[health care system]]s. Legal, [[Wikipedia:credential|credential]]ing and financing frameworks are established by individual governments, augmented on occasion by international organizations, such as churches. The characteristics of any given health care system have significant impact on the way medical care is provided.

From ancient times, Christian emphasis on practical charity gave rise to the development of systematic nursing and hospitals and the [[Wikipedia:Catholic Church|Catholic Church]] today remains the largest non-government provider of medical services in the world. Advanced industrial countries (with the exception of the [[Wikipedia:United States|United States]]) and many [[:en:Developing country|developing countries]] provide medical services through a system of [[universal health care]] that aims to guarantee care for all through a [[single-payer health care]] system, or compulsory private or co-operative [[health insurance]]. This is intended to ensure that the entire population has access to medical care on the basis of need rather than ability to pay. Delivery may be via private medical practices or by state-owned hospitals and clinics, or by charities, most commonly by a combination of all three.

Most [[:en:tribe|tribal]] societies provide no guarantee of healthcare for the population as a whole. In such societies, healthcare is available to those that can afford to pay for it or have self-insured it (either directly or as part of an employment contract) or who may be covered by care financed by the government or tribe directly.

Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality, and pricing greatly affects the choice by patients/consumers and, therefore, the incentives of medical professionals. While the US healthcare system has come under fire for lack of openness, new legislation may encourage greater openness. There is a perceived tension between the need for transparency on the one hand and such issues as patient confidentiality and the possible exploitation of information for commercial gain on the other.

The [[health professional]]s who provide care in medicine comprise multiple [[Wikipedia:profession|profession]]s such as [[Doctor of Medicine|medics]], [[Nursing|nurses]], [[Physical therapy|physio therapists]], and [[psychologist]]s. These professions will have their own [[:en:Professional ethics|ethical standards]], professional education, and bodies. The medical profession have been conceptualized from a [[Medical sociology#The Medical Profession|sociological perspective]].

Provision of medical care is classified into primary, secondary, and tertiary care categories.

[[File:Nurses at Butawin Urban Clinic, PNG (10711159465).jpg|thumb|alt=photograph of three nurses|Nurses in [[Wikipedia:Kokopo|Kokopo]], [[Wikipedia:East New Britain|East New Britain]], [[Wikipedia:Papua New Guinea|Papua New Guinea]]|upright]]

[[Primary care]] medical services are provided by [[physician]]s, [[physician assistant]]s, [[nurse practitioner]]s, or other health professionals who have first contact with a patient seeking medical treatment or care. These occur in physician offices, [[clinic]]s, [[nursing home]]s, schools, home visits, and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses, [[preventive care]] and [[health education]] for all ages and both sexes.

[[Secondary care]] medical services are provided by [[medical specialist]]s in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both [[ambulatory care]] and [[inpatient]] services, [[Emergency department]]s, [[intensive care medicine]], surgery services, [[physical therapy]], [[childbirth|labor and delivery]], [[endoscopy]] units, diagnostic [[Medical laboratory|laboratory]] and [[medical imaging]] services, [[Hospice care|hospice]] centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting.

[[Tertiary care]] medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include [[Wikipedia:trauma center|trauma center]]s, [[burn (injury)|burn]] treatment centers, advanced [[neonatology]] unit services, [[organ transplant]]s, high-risk pregnancy, [[radiation therapy|radiation]] [[oncology]], etc.

In low-income countries, modern healthcare is often too expensive for the average person. International healthcare policy researchers have advocated that "user fees" be removed in these areas to ensure access, although even after removal, significant costs and barriers remain.

[[Wikipedia:Separation of prescribing and dispensing|Separation of prescribing and dispensing]] is a practice in medicine and pharmacy in which the [[physician]] who provides a [[medical prescription]] is independent from the  [[pharmacist]] who provides the [[prescription drug]]. In the [[Wikipedia:Western world|Western world]] there are centuries of tradition for separating pharmacists from physicians. In Asian countries, it is traditional for physicians to also provide drugs.

[[File:Drawing by Marguerite Martyn of a visiting nurse with medicine and four babies, 1918.jpg|thumb|left|Drawing by [[Wikipedia:Marguerite Martyn|Marguerite Martyn]] (1918) of a visiting nurse in St. Louis, Missouri, with medicine and babies]]

Working together as an [[Wikipedia:interdisciplinary team|interdisciplinary team]], many highly trained [[health profession]]als besides medical practitioners are involved in the delivery of modern health care. Examples include: [[nurse]]s, [[emergency medical technician]]s and paramedics, laboratory scientists, [[pharmacists]], [[podiatry|podiatrists]], [[physiotherapists]], [[respiratory therapists]], [[speech therapy|speech therapists]], [[occupational therapy|occupational therapists]], radiographers, [[dietitian]]s, and [[bioengineering|bioengineers]], [[medical physics|medical physicists]], [[surgeons]], [[surgeon's assistant]], [[surgical technologist]].

Within medical circles, specialities usually fit into one of two broad categories: "Medicine" and "Surgery". "Medicine" refers to the practice of non-operative medicine, and most of its subspecialties require preliminary training in Internal Medicine. In the UK, this was traditionally evidenced by passing the examination for the Membership of the [[Royal College of Physicians]] (MRCP) or the equivalent college in Scotland or Ireland. "Surgery" refers to the practice of operative medicine, and most subspecialties in this area require preliminary training in General Surgery, which in the UK leads to membership of the [[Wikipedia:Royal College of Surgeons of England|Royal College of Surgeons of England]] (MRCS). At present, some specialties of medicine do not fit easily into either of these categories, such as radiology, pathology, or anesthesia. Most of these have branched from one or other of the two camps above; for example anaesthesia developed first as a [[Faculty (teaching staff)|faculty]] of the Royal College of Surgeons (for which MRCS/FRCS would have been required) before becoming the [[Wikipedia:Royal College of Anaesthetists|Royal College of Anaesthetists]] and membership of the college is attained by sitting for the examination of the Fellowship of the Royal College of Anesthetists (FRCA).

Surgical subspecialties include those a physician may specialize in after undergoing general surgery residency training as well as several surgical fields with separate residency training. Surgical subspecialties that one may pursue following general surgery residency training:  

'''Internal medicine''' is the [[medical specialty]] dealing with the prevention, diagnosis, and treatment of adult diseases. According to some sources, an emphasis on internal structures is implied. In North America, specialists in internal medicine are commonly called "internists". Elsewhere, especially in [[Commonwealth of Nations|Commonwealth]] nations, such specialists are often called [[physician]]s. These terms, ''internist'' or ''physician'' (in the narrow sense, common outside North America), generally exclude practitioners of gynecology and obstetrics, pathology, psychiatry, and especially surgery and its subspecialities.

Because their patients are often seriously ill or require complex investigations, internists do much of their work in hospitals. Formerly, many internists were not subspecialized; such ''general physicians'' would see any complex nonsurgical problem; this style of practice has become much less common. In modern urban practice, most internists are subspecialists: that is, they generally limit their medical practice to problems of one organ system or to one particular area of medical knowledge. For example, [[gastroenterology|gastroenterologists]] and [[nephrology|nephrologists]] specialize respectively in diseases of the gut and the kidneys.

In the [[Wikipedia:Commonwealth of Nations|Commonwealth of Nations]] and some other countries, specialist [[Pediatrics|pediatricians]] and [[Geriatrics|geriatricians]] are also described as ''specialist physicians'' (or internists) who have subspecialized by age of patient rather than by organ system. Elsewhere, especially in North America, general pediatrics is often a form of [[primary care physician|primary care]].

* ''[[Therapeutics]]'' is the field, more commonly referenced in earlier periods of history, of the various remedies that can be used to treat disease and promote health.

Since knowledge, techniques, and medical technology continue to evolve at a rapid rate, many regulatory authorities require [[continuing medical education]]. Medical practitioners upgrade their knowledge in various ways, including [[medical journal]]s, seminars, conferences, and online programs.  A database of objectives covering medical knowledge, as suggested by national societies across the United States, can be searched at http://data.medobjectives.marian.edu/.

[[File:Madrid (RPS 13-07-2010) Organización Médica Colegial de España, fachada.jpg|thumb|left|upright=0.8|Headquarters of the [[Wikipedia:Organización Médica Colegial de España|Organización Médica Colegial de España]], which regulates the medical profession in Spain]]

In Egypt, [[Imhotep]] (3rd millennium BCE) is the first physician in history known by name. The oldest [[Egyptian medical papyri|Egyptian medical text]] is the ''[[Kahun Gynaecological Papyrus]]'' from around 2000 BCE, which describes gynaecological diseases. The ''[[Edwin Smith Papyrus]]'' dating back to 1600 BCE is an early work on surgery, while the ''[[Ebers Papyrus]]'' dating back to 1500 BCE is akin to a textbook on medicine.

In China, archaeological evidence of medicine in Chinese dates back to the [[Bronze Age]] [[Shang Dynasty]], based on seeds for herbalism and tools presumed to have been used for surgery. The ''[[Huangdi Neijing]]'', the progenitor of Chinese medicine, is a medical text written beginning in the 2nd century BCE and compiled in the 3rd century.

In India, the surgeon [[Sushruta]] described numerous surgical operations, including the earliest forms of [[plastic surgery]]. Earliest records of dedicated hospitals come from Mihintale in [[Sri Lanka]] where evidence of dedicated medicinal treatment facilities for patients are found.

[[File:HSAsclepiusKos retouched.jpg|thumb|upright=1.1|Mosaic on the floor of the [[Asclepieion]] of Kos, depicting [[Hippocrates]], with [[Wikipedia:Asklepius|Asklepius]] in the middle (2nd–3rd century)]]

In Greece, the [[Ancient Greek medicine|Greek physician]] [[Hippocrates]], the "father of modern medicine", laid the foundation for a rational approach to medicine. Hippocrates introduced the [[Hippocratic Oath]] for physicians, which is still relevant and in use today, and was the first to categorize illnesses as [[Acute (medical)|acute]], [[Chronic (medicine)|chronic]], [[Endemic (epidemiology)|endemic]] and epidemic, and use terms such as, "exacerbation, [[relapse]], resolution, crisis, [[paroxysm]], peak, and [[convalescence]]". The Greek physician [[Galen]] was also one of the greatest surgeons of the ancient world and performed many audacious operations, including brain and eye surgeries. After the fall of the [[Western Roman Empire]] and the onset of the [[Wikipedia:Early Middle Ages|Early Middle Ages]], the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in the [[:en:Eastern Roman Empire|Eastern Roman (Byzantine) Empire]].

Most of our knowledge of ancient [[Hebrew medicine]] during the [[:en:1st millennium BC|1st millennium BC]] comes from the [[Wikipedia:Torah|Torah]], i.e. the Five Books of [[Moses]], which contain various health related laws and rituals. The Hebrew contribution to the development of modern medicine started in the [[Wikipedia:Byzantine Era|Byzantine Era]], with the physician [[Wikipedia:Asaph the Jew|Asaph the Jew]].

[[File:Al-Risalah al-Dhahabiah.JPG|thumb|left|A manuscript of ''[[Wikipedia:Al-Risalah al-Dhahabiah|Al-Risalah al-Dhahabiah]]'' by [[Wikipedia:Ali al-Ridha|Ali al-Ridha]], the eighth Imam of [[Twelver|Shia Muslims]]. The text says: "Golden dissertation in medicine which is sent by Imam Ali ibn Musa al-Ridha, peace be upon him, to [[Wikipedia:al-Ma'mun|al-Ma'mun]]."]]

The concept of hospital as institution to offer medical care and possibility of a cure for the patients due to the ideals of Christian charity, rather than just merely a place to die, appeared in the [[Wikipedia:Byzantine Empire|Byzantine Empire]].

Although the concept of [[uroscopy]] was known to Galen, he did not see the importance of using it to localize the disease. It was under the Byzantines with physicians such of [[Theophilus Protospatharius]] that they realized the potential in uroscopy to determine disease in a time when no microscope or stethoscope existed. That practice eventually spread to the rest of Europe.

After 750 CE, the Muslim world had the works of Hippocrates, Galen and Sushruta translated into [[Wikipedia:Arabic|Arabic]], and [[Islamic medicine|Islamic physicians]] engaged in some significant medical research. Notable Islamic medical pioneers include the [[:en:Persians|Persian]] [[Wikipedia:polymath|polymath]], [[Wikipedia:Avicenna|Avicenna]], who, along with Imhotep and Hippocrates, has also been called the "father of medicine". He wrote ''[[Wikipedia:The Canon of Medicine|The Canon of Medicine]]'' which became a standard medical text at many medieval European [[:en:University|universities]], considered one of the most famous books in the history of medicine. Others include [[:en:Abu al-Qasim al-Zahrawi|Abulcasis]], [[Wikipedia:Ibn Zuhr|Avenzoar|Ibn Zuhr|Avenzoar]], [[Wikipedia:Ibn al-Nafis|Ibn al-Nafis]], and [[Wikipedia:Averroes|Averroes]]. Persian  physician [[:en:Muhammad ibn Zakarīya Rāzi|Rhazes]] was one of the first to question the Greek theory of [[Wikipedia:humorism|humorism]], which nevertheless remained influential in both medieval Western and medieval [[Islamic medicine]]. Some volumes of [[:en:Muhammad ibn Zakarīya Rāzi|Rhazes]]'s work ''Al-Mansuri'', namely "On Surgery" and "A General Book on Therapy", became part of the medical curriculum in European universities. Additionally, he has been described as a doctor's doctor, the father of [[pediatrics]], and a pioneer of [[ophthalmology]]. For example, he was the first to recognize the reaction of the eye's pupil to light. The Persian [[Wikipedia:Bimaristan|Bimaristan]] hospitals were an early example of [[Wikipedia:public hospital|public hospital]]s.

In Europe, [[Wikipedia:Charlemagne|Charlemagne]] decreed that a hospital should be attached to each cathedral and monastery and the historian [[Wikipedia:Geoffrey Blainey|Geoffrey Blainey]] likened the [[:en:Catholic Church and health care|activities of the Catholic Church in health care]] during the Middle Ages to an early version of a welfare state: "It conducted hospitals for the old and orphanages for the young; hospices for the sick of all ages; places for the lepers; and hostels or inns where pilgrims could buy a cheap bed and meal". It supplied food to the population during famine and distributed food to the poor. This welfare system the church funded through collecting taxes on a large scale and possessing large farmlands and estates. The [[Wikipedia:Benedictine|Benedictine]] order was noted for setting up hospitals and infirmaries in their monasteries, growing medical herbs and becoming the chief medical care givers of their districts, as at the great [[Wikipedia:Abbey of Cluny|Abbey of Cluny]]. The Church also established a network of [[Wikipedia:cathedral schools|cathedral schools]] and universities where medicine was studied. The [[Wikipedia:Schola Medica Salernitana|Schola Medica Salernitana]] in Salerno, looking to the learning of [[:en:Greeks|Greek]] and [[Wikipedia:Arab|Arab]] physicians, grew to be the finest medical school in Medieval Europe.

[[File:SantaMariaDellaScalaSienaBack.JPG|thumb|upright=1.2|Siena's [[:en:Santa Maria della Scala (Siena)|Santa Maria della Scala Hospital]], one of Europe's oldest hospitals. During the Middle Ages, the Catholic Church established universities to revive the study of sciences, drawing on the learning of Greek and Arab physicians in the study of medicine.]]

However, the fourteenth and fifteenth century [[Wikipedia:Black Death|Black Death]] devastated both the Middle East and Europe, and it has even been argued that Western Europe was generally more effective in recovering from the pandemic than the Middle East. In the early modern period, important early figures in medicine and anatomy emerged in Europe, including [[Wikipedia:Gabriele Falloppio|Gabriele Falloppio]] and [[Wikipedia:William Harvey|William Harvey]].

The major shift in medical thinking was the gradual rejection, especially during the [[Wikipedia:Black Death|Black Death]] in the 14th and 15th centuries, of what may be called the "traditional authority" approach to science and medicine. This was the notion that because some prominent person in the past said something must be so, then that was the way it was, and anything one observed to the contrary was an anomaly (which was paralleled by a similar shift in European society in general – see [[:en:Nicolaus Copernicus|Copernicus]]'s rejection of [[Wikipedia:Ptolemy|Ptolemy]]'s theories on astronomy). Physicians like [[Vesalius]] improved upon or disproved some of the theories from the past. The main tomes used both by medicine students and expert physicians were [[Wikipedia:Materia Medica|Materia Medica]] and [[Wikipedia:Pharmacopoeia|Pharmacopoeia]].

[[Wikipedia:Andreas Vesalius|Andreas Vesalius]] was the author of ''[[Wikipedia:De humani corporis fabrica|De humani corporis fabrica]]'', an important book on [[human anatomy]]. Bacteria and microorganisms were first observed with a microscope by [[Wikipedia:Antonie van Leeuwenhoek|Antonie van Leeuwenhoek]] in 1676, initiating the scientific field [[microbiology]]. Independently from [[Wikipedia:Ibn al-Nafis|Ibn al-Nafis]], [[Wikipedia:Michael Servetus|Michael Servetus]] rediscovered the [[pulmonary circulation]], but this discovery did not reach the public because it was written down for the first time in the "Manuscript of Paris" in 1546, and later published in the theological work for which he paid with his life in 1553. Later this was described by [[Wikipedia:Renaldus Columbus|Renaldus Columbus]] and [[Wikipedia:Andrea Cesalpino|Andrea Cesalpino]]. [[Wikipedia:Herman Boerhaave|Herman Boerhaave]] is sometimes referred to as a "father of physiology" due to his exemplary teaching in Leiden and textbook 'Institutiones medicae' (1708). [[Wikipedia:Pierre Fauchard|Pierre Fauchard]] has been called "the father of modern dentistry".

[[File:Paul-Louis Simond injecting plague vaccine June 4th 1898 Karachi.jpg|thumb|left|[[Wikipedia:Paul-Louis Simond|Paul-Louis Simond]] injecting a plague vaccine in [[Wikipedia:Karachi|Karachi]], 1898]]

Veterinary medicine was, for the first time, truly separated from human medicine in 1761, when the French veterinarian [[Wikipedia:Claude Bourgelat|Claude Bourgelat]] founded the world's first veterinary school in Lyon, France. Before this, medical doctors treated both humans and other animals.

Modern scientific [[biomedical research]] (where results are testable and [[reproducible]]) began to replace early Western traditions based on herbalism, the Greek "[[Wikipedia:humorism|four humours|humorism|four humours]]" and other such pre-modern notions. The modern era really began with [[Wikipedia:Edward Jenner|Edward Jenner]]'s discovery of the [[smallpox vaccine]] at the end of the 18th century (inspired by the method of [[inoculation]] earlier practiced in Asia), [[Wikipedia:Robert Koch|Robert Koch]]'s discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of [[antibiotic]]s around 1900.

The post-18th century [[modernity]] period brought more groundbreaking researchers from Europe. From [[Wikipedia:Germany|Germany]] and Austria, doctors [[Wikipedia:Rudolf Virchow|Rudolf Virchow]], [[Wikipedia:Wilhelm Conrad Röntgen|Wilhelm Conrad Röntgen]], [[Wikipedia:Karl Landsteiner|Karl Landsteiner]] and [[Wikipedia:Otto Loewi|Otto Loewi]] made notable contributions. In the [[Wikipedia:United Kingdom|United Kingdom]], [[Wikipedia:Alexander Fleming|Alexander Fleming]], [[:en:Joseph Lister, 1st Baron Lister|Joseph Lister]], [[Wikipedia:Francis Crick|Francis Crick]] and [[Wikipedia:Florence Nightingale|Florence Nightingale]] are considered important. [[:en:Spain|Spanish]] doctor [[Wikipedia:Santiago Ramón y Cajal|Santiago Ramón y Cajal]] is considered the father of modern [[neuroscience]].

From New Zealand and Australia came [[Wikipedia:Maurice Wilkins|Maurice Wilkins]], [[Wikipedia:Howard Florey|Howard Florey]], and [[Wikipedia:Frank Macfarlane Burnet|Frank Macfarlane Burnet]].

Others that did significant work include [[Wikipedia:William Williams Keen|William Williams Keen]], [[Wikipedia:William Coley|William Coley]], [[Wikipedia:James D. Watson|James D. Watson]] (United States); [[Wikipedia:Salvador Luria|Salvador Luria]] (Italy); [[Wikipedia:Alexandre Yersin|Alexandre Yersin]] (Switzerland); [[Wikipedia:Kitasato Shibasaburō|Kitasato Shibasaburō]] (Japan); [[Wikipedia:Jean-Martin Charcot|Jean-Martin Charcot]], [[Wikipedia:Claude Bernard|Claude Bernard]], [[Wikipedia:Paul Broca|Paul Broca]] (France); [[Adolfo Lutz]] (Brazil); [[Wikipedia:Nikolai Korotkov|Nikolai Korotkov]] (Russia); [[:en:William Osler|Sir William Osler]] (Canada); and [[Wikipedia:Harvey Cushing|Harvey Cushing]] (United States).

As science and technology developed, medicine became more reliant upon [[medication]]s. Throughout history and in Europe right until the late 18th century, not only animal and plant products were used as medicine, but also human body parts and fluids. [[Pharmacology]] developed in part from [[herbalism]] and some drugs are still derived from plants ([[atropine]], [[ephedrine]], [[warfarin]], [[aspirin]], [[digoxin]], [[vinca alkaloid|''vinca'' alkaloids]], [[taxo]]l, [[hyoscine hydrobromide|hyoscine]], etc.). [[Vaccine]]s were discovered by [[Wikipedia:Edward Jenner|Edward Jenner]] and [[Wikipedia:Louis Pasteur|Louis Pasteur]].

The first antibiotic was [[arsphenamine]] (Salvarsan) discovered by [[Wikipedia:Paul Ehrlich|Paul Ehrlich]] in 1908 after he observed that bacteria took up toxic dyes that human cells did not. The first major class of [[antibiotic]]s was the [[Sulfonamide (medicine)|sulfa drugs]], derived by German chemists originally from [[azo dye]]s.

[[File:Sydänlääkkeen pakkausta lääketehdas Starilla vuonna 1953. Kuva Vapriikin kuva-arkisto. (16248845637).jpg|thumb|Packaging of [[Cardiology|cardiac medicine]] at the Star pharmaceutical factory in [[Wikipedia:Tampere|Tampere]], [[Wikipedia:Finland|Finland]] in 1953.]]

Evidence-based medicine is a contemporary movement to establish the most effective [[algorithms]] of practice (ways of doing things) through the use of [[systematic review]]s and [[meta-analysis]]. The movement is facilitated by modern global [[information science]], which allows as much of the available evidence as possible to be collected and analyzed according to standard protocols that are then disseminated to healthcare providers. The [[Wikipedia:Cochrane Collaboration|Cochrane Collaboration]] leads this movement. A 2001 review of 160 Cochrane systematic reviews revealed that, according to two readers, 21.3% of the reviews concluded insufficient evidence, 20% concluded evidence of no effect, and 22.5% concluded positive effect.

[[Evidence-based medicine]], prevention of [[medical error]] (and other "[[iatrogenesis]]"), and avoidance of [[unnecessary health care]] are a priority in modern medical systems. These topics generate significant political and public policy attention, particularly in the United States where healthcare is regarded as excessively costly but [[population health]] metrics lag similar nations.

Globally, many [[:en:Developing country|developing countries]] lack access to care and [[access to medicines]]. As of 2015, most wealthy developed countries provide [[Universal health care|health care to all citizens]], with a few exceptions such as the United States where lack of [[health insurance]] coverage may limit access.