What's the Greatest Medical Advance?

In the world of medicine, "breakthrough" is not a word taken lightly. But the prestigious British medical journal BMJ soon plans to name what it considers the greatest medical breakthrough since 1840 -- the year the journal was launched.

Last year, BMJ invited readers to submit nominations for the honor. Now in contention are 15 medical advances, ranging from anesthesia to vaccines, that over the decades have saved millions of lives and immeasurable human suffering.

These breakthroughs were culled from more than 100 nominations from BMJ readers -- mostly physicians and scientists -- based on the ability of each medical development to transform lives around the world.

Among the suggested breakthroughs that didn't make the cut? Condoms, Viagra, soap, exercise, and the mobile phone.

For the 15 advances that made the short list, BMJ has chosen 15 leading doctors and scientists to champion each milestone in contention for top honor. These are respected medical experts, including the creator of the modern birth controlbirth control pill, a descendent of the scientist who helped developed anesthesia, and the author of a book on the history of penicillin.

Beginning Friday, Jan. 5, subscribers and the general public can log onto the web site, read arguments for all 15 advances, and vote for their personal favorite. The deadline for voting is Sunday, Jan. 14, and the winning breakthrough will be announced Jan. 18 on the site.

The Nominations, Please

Here is a sneak peek and description of the 15 advances that made the shortlist, to give you a running start:

• Anesthesia: In 1846, a Boston dentist used ether during surgery, putting an end to much of the pain of undergoing surgery. Since then, general anesthesia has become a mainstay in operations.
• Antibiotics: Alexander Fleming, a British bacteriologist, discovered penicillin in 1928 by accident when he sloppily left a Petri dish of bacteria uncleaned in his lab. He found a substance (later named penicillin) growing on it that killed the bugs, and thus was the beginning of modern-day antibiotics. Fleming shared the Nobel Prize in 1945 for the discovery.
• Chlorpromazine: Discovered in 1952, chlorpromazine (Thorazine) was the first antipsychotic medication. It was used to treat psychotic disorders and their symptoms, such as hallucinations, hostility, and delusions. Its development brought new understanding of the biological basis for mental illness, and some say it provided more humane management.
• Computers. From medical records to insurance, to making sure your new medication isn't going to clash with an existing one, computers are now viewed by some doctors as being as important as their stethoscopes. They've been in use in medicine since the early 1960s. Doctors can access information on new drugs and interactions, new medical studies, clinical trials, or keep patient records stored at their fingertips -- so they'll know in an instant if you really have kept the weight off.
• DNA structure. Scientists James Watson and Francis Crick presented the structure of the DNA helix, the molecule responsible for carrying genetic information from one generation to the next, in 1953. It earned them the Nobel Prize in 1962.
• Evidence-based medicine. As the name suggests, evidence-based medicine involves making use of the current best evidence (such as research), a patient's values, and a doctor's clinical experience to make decisions about patient care. The term was coined in the early '90s and the concept has been evolving ever since.

More Nominations

• Germ theory. In the late 1800s, Louis Pasteur was the first to suggest the theory that disease is caused by exposure to microorganisms. Others furthered the theory, showing that specific diseases are caused by specific "bugs."
• Imaging. The X-ray was accidentally discovered in 1895. Since then, the field has expanded, giving us computed tomography (CT scans), positron emission (PET scans), magnetic resonance imaging (MRIs), and ultrasound.
• Immunology. The history of immunology is traced to 1798, when Edward Jenner found that people could be immunized against the disease smallpox. Numerous other immunology discoveries followed, leading to a greater understanding of such things as allergiesallergies and antibodies.
• Oral rehydration therapy. As the name suggests, ORT involves giving fluids by mouth to replace losses of body water. It was first reported in 1964; now it's a mainstay of treatment in patients with cholera, acute diarrheadiarrhea, and other conditions.
• The pill. Since the pill arrived on the U.S. market in 1960, it's been hailed as one of the seven wonders of the world. For women who use it correctly, oral contraceptioncontraception can be up to 99% effective.
• Risks of smoking. The first report of the connection between smoking and lung cancerlung cancer was published in BMJ in 1950. Even so, tobacco use still kills an estimated 440,000 Americans each year.
• Sanitation. The importance of clean drinking water and waste disposal emerged in the late 1800s, as diseases began to be linked to impure water. But the World Health Organization says there is a long way to go. More than 1.1 billion people still lack access to drinking water from an improved source; 2.6 billion do not have basic sanitation.
• Tissue culture. Tissue culture (keeping tissue alive and growing it in a culture medium for research or other purposes) was "discovered" in 1907, but it took until the 1950s for it to become an important tool for clinical investigation.
• Vaccines. Vaccines have helped prevent a variety of diseases -- including polio, whopping cough, and measlesmeasles. The first was Edward Jenner's smallpox vaccine, in 1796.

The Envelope, Please
To vote, visit www.bmj.com.