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  • Yuzo Endo, M.D., Ph.D.
  • Masahito Hitosugi, M.D., Ph.D.
  • John E. Lewis, Ph.D.

Doctor’s Health Advice

Doctor’s Health Advice

Pathologist’s advice on how to combat cancer

No.2

Contemporary Medicine and Pathology

Contemporary medicine has become an integrated part of our lives

If you catch a cold or get appendicitis, you probably would not think that you would die from it. Indeed, antibiotics or surgery can easily cure these diseases, and nowadays people take this for granted. Similarly, if you become pregnant, you would not think that you would die during childbirth. Instead, you will be filled with joy when your baby is born in perfectly good health, thanks to the help of hospital staff or midwives. Contemporary medicine has really become an integrated part of our lives.

Let us look back on the state of medical care about fifty years ago, for example, around the period after World War II. Antibiotics were not readily available, and technologies for anesthesia, sterilization, and disinfection were still underdeveloped. Back in those times, people were constantly faced with the possibility of death from bacterial infections such as tuberculosis.

This also included deaths from childbirth (due to puerperal fever). Considering these circumstances, the fear of diseases that people had in the past is probably incomparable to the fear people have today. During those times, the average life span of Japanese men and women was around 50 years. Who could have imagined that only five decades later, the average life span would increase to around 80 years?

In the past, before vaccination and antibiotics were discovered, many children passed away before they reached the age of majority (which is 20 years of age in Japan). This is why the coming of age celebration was significant.

The birth of modern medicine in the mid 19th century

Modern medicine was the forefather of contemporary medicine, which is now integrated with our lives. How did modern medicine and modern medical care arise? Modern medicine developed in the mid 19th century in Europe. It was a period when doctors were not as skilled and “magician-like doctors” were providing medical care. This was the time when evidence-based medicine began to emerge in Germany (Berlin) and France (Paris).

By today’s standards, the facilities available to doctors in the 19th century would be considered dangerously unprotected against infection. Those doctors dissected the bodies of patients who had passed away, seeking to understand the origins of diseases and the cause of death of the patients. The doctors in Paris matched the macroscopic observations (observations that were visible to the eye) made for each of the patients at the bedside with those made in the autopsy room, and recorded details of each case.

In Berlin, the light microscope (“microscope”) was adopted as a new tool in pathological autopsy, and doctors sought to understand diseases at the cellular level. The observations using microscopes required another room in addition to the hospital room and autopsy room: the research laboratory. These approaches in Berlin laid the foundations of contemporary medicine (laboratory medicine). In any case, we must not forget to acknowledge the many doctors and researchers who dedicated their lives to academic study.

The tar in tobacco cigarettes causes skin cancer in animal experiments

German medicine during the latter half of the 19th century had an incredible driving force. One of the leaders behind it was Rudolf Ludwig Karl Virchow. Rudolf Virchow scientifically established the concept that “every cell originates from another existing cell like it” (omnis cellula e cellula) and founded the discipline of “cytopathology”. Virchow was a revolutionary figure in both political and academic arenas. It is not an overstatement to say that our present understanding of concepts such as cancer and inflammation was established based on the research achievements of Rudolf Virchow and other German scientists.

Rudolf Virchow sought to understand disease as a body’s response to stimuli. A Japanese scientist by the name of Katsusaburo Yamagiwa followed this approach in his research. Katsusaburo Yamagiwa and his assistant Kouichi Ichikawa continuously stimulated the ears of rabbits with coal tar. After several years, their work bore fruit. They were the first in the world to produce skin cancer under experimental conditions and their work was highly appraised. Coal tar contained not only stimulants, but also countless carcinogenic substances. These substances were the same as those found in tobacco tar, and scientists in the United States later conducted experiments using tobacco tar on rabbits’ ears and similarly produced skin cancer under experimental conditions.

Mastering the use of the microscope leads to the discovery of antibiotics

The work of Heinrich Hermann Robert Koch led to the development of the discipline of bacteriology. This was during a time when diseases were primarily caused by bacteria. For a while, the study of infectious diseases became the central focus among other disciplines in medicine. During that period, intellectuals from around the world gathered in Germany to study medicine. Researchers from the United States were among them. Prominent intellectuals from Japan, including Shibasaburo Kitasato and Kiyoshi Shiga, went to study in Germany and contributed to research in bacteriology.

As mentioned earlier, pathology is characterized by mastering the use of the microscope. The approach of enlarging by a thousand times objects that could not be seen by the naked eye, and examining the forms of diseases and bacteria in this manner, was in fact a revolutionary movement. This was the origin from which bacteriology and almost all other academic disciplines in medicine developed, which later led to contemporary medicine being established as a field of science.

World War I ended in 1918 with German defeat. As a result, the center of medicine started shifting from Germany to the USA, together with a shift in the center of the world economy to the USA and England, a trend that has remained unchanged since then. Such changes led to the discovery of antibiotics, a revolutionary treatment for bacterial infections.

The judgment of the skilled pathologist determines the fate of the patient

If we likened contemporary medicine and medical care to a tree, diseases can be likened to the roots and trunk of the tree. The wealth of information accumulated from microscope studies in the past 150 years is crucial for an accurate diagnosis of diseases. This can then lead to the treatment of diseases, which can be likened to the various branches and leaves of the tree.

For example, the diagnosis of cancer is made by skilled pathologists in university hospitals or municipal hospitals.(*) A doctor specializing in surgery may provide surgical treatment, such as removing stomach cancer or colon cancer tumors. Alternatively, a doctor specializing in internal medicine may use a thin, needle-like device to take a biopsy sample, such a sample from the liver or kidney. The tumor cells and biopsy samples receive treatment that allows them to be examined under a microscope. Here, the judgment of the pathologist determines the fate of the patient.

Some pathology tests are urgent and performed during surgery (intraoperative evaluation). In such cases, the surgeon requests a pathology test on a small sample from the patient’s body during surgery, and the sample is examined under a microscope. Microscopic examinations of these samples may be necessary in order to confirm the extent of the spread of cancer and judge the appropriate surgical resection; for example, in a patient with stomach cancer, surgeons can use microscopic evaluation to determine whether the stomach can be partially retained or whether it should be completely removed.

In such cases, the pathologist acts as the headquarters for planning the surgery. If you have had surgery before, I would like to remind you of the pathology team, who were vigorously working-even more so than the surgeon-while you were sleeping under anesthesia. The pathology team is the “unsung hero” that works behind the scenes; medical care relies upon teamwork.

Reconsidering “magic-like” traditional medicine, which was formerly the target of criticism by proponents of modern medicine

Another important area in pathology is pathological autopsy. The purpose of pathological autopsy is to reveal the cause of death, to identify the state of disease, and to evaluate the effects of treatment, from a perspective that is different to the patient’s doctor in charge, in unfortunate cases where patients pass away in hospital. Pathological autopsy is unprofitable work considering the present state of affairs in medical care. However, I believe that this is the minimum requirement for objectively evaluating modern medicine. Even though pathological autopsy is not profitable, it is done for purposes of inspection and improvement of a hospital’s medical care, as this reflects the hospital’s philosophy and moral standards.

Before I finish this chapter, I would like to mention that certain elements of “magic-like” traditional medicine, which were formerly the target of criticism by proponents of modern medicine, are being reconsidered today. Despite many infectious diseases being conquered using antibiotics, some diseases remain difficult to cure, such as cancer and chronic diseases. These are diseases that cannot be cured suddenly. These are known as lifestyle-related diseases. It is being increasingly acknowledged that changing one’s lifestyle, improving the content of one’s diet, and experiencing the natural power of healing, are also important treatment methods.

There is a need for a system of medicine that integrates contemporary medicine with complementary and alternative medicine, and a need for a patient-focused treatment that is individually customized for each patient. The message I wish to get across to patients is that they should think of themselves as the key players in their treatment.

(*) Contemporary medicine is considered to be based on evidence, and is known as evidence-based medicine. Therefore, both the diagnosis of a patient’s illnesses and the selected treatments should be based on evidence. Patients have the right to receive this evidence, i.e., their medical records, as an official document. The medical service provider has an obligation to disclose information to patients. Pathology test reports are official documents containing personal information of the patient, and they belong to the patient. Therefore, pathology reports are very important documents, not only for applications for cancer insurance, but also for seeking a second opinion.

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Yuzo Endo, M.D., Ph.D.

Yuzo Endo, M.D., Ph.D.
Hamamatsu University School of Medicine

1969.9: Graduated from Medical School, University of Tokyo Consultant pathologist in Hamamatsu University, Medical School, and Fujimoto General Hospital. Medical Consultant in conventional and integrative medicine.

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