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medicine,
the science and art of treating and preventing disease.

History of Medicine
Ancient Times
Prehistoric skulls found in Europe and South America indicate that Neolithic man was already able to trep
hine, or removedisks of bone from, the skull successfully, but whether this delicate operation was perform
ed to release evil spirits or as asurgical procedure is not known. Empirical medicine developed in ancient
Egypt, and involved the use of many potent drugsstill in use today, such as castor oil, senna, opium, colc
hicine, and mercury. In spite of their skill in embalming, however, theEgyptians had little knowledge of an
atomy.
In Sumerian medicine the Laws of Hammurabi

established the first known code of medical ethics, and laid down a feeschedule for specific surgical proc
edures. In ancient Babylonia, every man considered himself a physician and, according toHerodotus, gav
e advice freely to the sick man who was willing to exhibit himself to passersby in the public square. TheM
osaic Code of the Hebrews indicated concerns with social hygiene and prevention of disease by dietary r
estrictions andsanitary measures.
Although ancient Chinese medicine was also influenced adversely by the awe felt for the sanctity of the h
uman body, the NeiChing, attributed to the emperor Huang-Ti (2698–
2598 B.C.), contains a reference to a theory of the circulation of the bloodand the vital function of the hear
t that suggests familiarity with anatomy. In addition, accurate location of the proper points forthe traditiona
l Chinese practice of acupuncture

implies some familiarity with the nervous and vascular systems. TheChinese pharmacopoeia was the mo
st extensive of all the older civilizations. The Hindus seem to have been familiar withmany surgical proced
ures, demonstrating skill in such techniques as nose reconstruction (rhinoplasty) and cutting forremoval of
bladder stones.
In Greek medicine the impetus for the rational approach came largely from the speculations of the pre-
Socratic philosophersand such philosopher-
scientists as Pythagoras, Democritus, and Empedocles. Hippocrates

, the father of Western medicine,taught the prevention of disease through a regimen of diet and exercise;
he emphasized careful observation of the patient,the recuperative powers of nature, and a high standard
of ethical conduct, as incorporated in the Hippocratic Oath. By the 4thcent. B.C., Aristotle had already sti
mulated interest in anatomy by his dissections of animals, and work in the 3d cent. B.C.on human anatom
y and physiology was of such high quality that it was not equaled for fifteen hundred years.
The Romans advanced public health and sanitation through the construction of aqueducts, baths, sewers,
and hospitals. Theencyclopedic writings of Galen

constitute a final synthesis of the medicine of the ancient world. Revered by Arabic andWestern physicia
ns alike, his concepts stood virtually unchallenged until the 16th cent. Unfortunately, his prolific researche
son anatomy and physiology were not invariably accurate, and reliance on them impeded subsequent pro
gress in anatomy.
The Middle Ages
With the destruction or neglect of the Roman sanitary facilities, there followed a series of local epidemics t
hat culminatedmany centuries later in the great plague

of the 14th cent. known as the Black Death. During the Middle Ages certainmonastic libraries, notably tho
se at Monte Cassino, Bobbio, and St. Gall, preserved a few ancient medical manuscripts, andArab and Je
wish physicians such as Avicenna

and Maimonides

continued medical investigation.

The first real light on modern medicine in Europe came with the translation of many writings from the Arab
ic at Salerno, Italy,and through a continuing trade and cultural exchange with Byzantium. By the 13th cent
. there were flourishing medicalschools at Montpellier, Paris, Bologna and Padua, the latter being the site
of production of the first accurate books on humananatomy. At Padua, Vesalius

proved that Galen had made anatomical mistakes. Prominent among those who pursued thenew interest
in experimental medicine were Paracelsus

, Ambroise Paré

, and Fabricius

, who discovered the valves of theveins.

The Birth of Modern Medicine
In the 17th cent. William Harvey

, using careful experimental methods, demonstrated the circulation of the blood, a conceptthat met with c
onsiderable early resistance. The introduction of quinine marked a triumph over malaria, one of the oldest
plagues of mankind. The invention of the compound microscope led to the discovery of minute forms of lif
e, and thediscovery of the capillary system of the blood filled the final gap in Harvey's explanation of bloo
d circulation.
In the 18th cent. the heart drug digitalis was introduced, scurvy was controlled, surgery

was transformed into anexperimental science, and reforms were instituted in mental institutions. In additi
on, Edward Jenner

introducedvaccination

to prevent smallpox, laying the groundwork for the science of immunization.

The 19th cent. saw the beginnings of modern medicine when Pasteur

, Koch

, Ehrlich

and Semmelweis

proved therelationships between germs and disease

. Other invaluable developments included the use of disinfection and theconsequent improvement in medi
cal, particularly obstetrical, care; the use of inoculation; the introduction of anesthetics insurgery (see ane
sthesia

); and a revival of better public health

and sanitary measures. A significant decline in maternal andinfant mortality followed.

Modern Medicine
Medicine in the 20th cent. received its impetus from Gerhard Domagk

who discovered the first antibiotic, sulfanilamide, andthe groundbreaking advancements in the use of pe
nicillin

. Further progress has been characterized by the rise ofchemotherapy

, especially the use of new antibiotics

; increased understanding of the mechanisms of the immune system(see immunology

) and the increased prophylactic use of vaccination

; utilization of knowledge of the endocrine system totreat diseases resulting from hormone imbalance, suc
h as the use of insulin to treat diabetes; and increased understandingof nutrition and the role of vitamins

in health.
In Mar., 1953, at the Univ. of Cambridge, England, Francis Crick

, age 35, and James Watson

, age 24, announced "We havediscovered the secret of life." Indeed, they had unraveled the chemical stru
cture of the fundamental molecule of heredity,deoxyribonucleic acid (DNA), giving science and medicine t
he basis for molecular genetics and leading to a continuingrevolution in modern medicine.
Much medical research is now directed toward such problems as cancer

, heart disease, AIDS

, reemerging infectiousdiseases such as tuberculosis

and dengue fever

, and organ transplantation

. Currently, the largest worldwide study is theHuman Genome Project

, which will identify all hereditary traits and body functions controlled by specific areas on thechromosom
es

. Gene therapy

, the replacement of faulty genes, offers possible abatement of hereditary diseases. Genetic engineering

has led to the development of important pharmaceutical products and the use of monoclonal
antibodies
,offering promising new approaches to cancer treatment. The discovery of growth factors has opened up t
he possibility ofgrowth and regeneration of nerve tissues.
With the surge of general and specialized medical knowledge, the educational requirements of the medic
al profession haveincreased. In addition to the four-
year medical course and the general hospital internship required almost everywhere,additional years of st
udy in a specialized field are usually required. Similar progress and increased requirements in educationa
re reflected in ancillary professions such as nursing.

Modern Health Care Management

Modern medicine, characterized by growing specialization and a complex diagnostic and therapeutic tech
nology, facesproblems in the allocation of capital and personnel resources. Some authorities advocate an
increase in the use ofparamedical personnel to supervise the care of individuals with common, chronic, o
r terminal illnesses, leaving the physicianin charge of treating curable disease. Others emphasize the phy
sician's responsibility to help patients and families in theoverall management of their health problems, ma
ny of which are thought to reflect the social ills of living in an urban,industrialized society.
In some countries, such as Great Britain, medical care is under government control and is available virtua
lly without chargeto all. In the United States, medical practice is characterized by a patchwork mixture of g
overnment and private control. TheKefauver-
Harris amendments to the federal Food, Drug, and Cosmetic Act of 1962 empower the Food and DrugAd
ministration to require stricter testing and licensing of new drugs. There have also been federal, state, and
local programsfor mass vaccination and other public health programs. The Medicare

program, enacted in 1965, provides subsidizedhospital and nursing-

home care for persons over 65 and, with the Hill-
Burton Act, provides funds for state aid to the medicallyindigent (Medicaid

).
A wide variety of private medical insurance plans are also available to those who can afford them, and ma
ny employers payall or part of their employees' health insurance premiums. In addition, health
maintenance organizations

(HMOs), or grouppractice plans, are designed to promote disease prevention and reduce medical expen
ditures.

Bibliography
See J. Walton et al., ed., The Oxford Companion to Medicine (2 vol., 1986); historical study by H. E. Siger
ist (2 vol., 1951–
61); studies by R. Hudson (1983), P. Starr (1983), D. Dutton (1988), E. Shorter (1991), and J. Duffin (2d e
d., 2010); M. Bliss,The Making of Modern Medicine (2011).
Current Scenario of HIV/AIDS, Treatment Options, and Major
Challenges with Compliance to Antiretroviral Therapy
Monitoring Editor: Alexander Muacevic and John R Adler
Adnan Bashir Bhatti, 1
Muhammad Usman,2 and Venkataramana Kandi3

Author information ► Article notes ► Copyright and License information ►

This article has been cited by other articles in PMC.

Abstract
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Introduction and background

Acquired immunodeficiency syndrome (AIDS) is a medical condition caused by the human
immunodeficiency virus (HIV). HIV infection is a very current threat and can easily be termed as
a curse upon the human race. The scientific community first noticed and recognized the presence
of AIDS as an actual disease following an increase in the incidence of very rare opportunistic
infections and cancers among otherwise healthy homosexual men [1]. HIV-1 was identified as
the causative organism soon after the first official recognition of HIV patients in the
USA [2]. HIV-2 was reported first in Africa in 1985 and is markedly different from HIV-
1 [3]. It closely resembles a simian virus that infects macaques in captivity. Simian viruses that
naturally infect African primates are suspected to reach humans via multiple cross-species
transmissions resulting in the spread of HIV-1 and HIV-2 [2]. The global prevalence of HIV has
expanded since its discovery and has now spread across the globe despite advances in
antiretroviral treatments (ART). The mortality and morbidity rates related to HIV infections
remain high in developing countries largely due to food insecurity and malnutrition [4]. Long-
term concomitant sexual relationships and high infectivity during the early phase of HIV
infections are other factors behind the extensive spread of HIV in the general population [5].
Figure Figure11 summarizes the number of victims by gender, incidence, and death, as well as
the latest statistical data covering the 2014 AIDS epidemic [6].

Figure 1
Prevalence of HIV/AIDS as of 2014.
Go to:

Review

The infection
The main site of the attack is the immune system, especially the CD4 T-lymphocytes (CD4
cells). Once infected, the virus gradually and silently overpowers the host’s defense mechanisms,
resulting in opportunistic infections and cancers that are otherwise rare. Activated and
differentiated CD4 cells have a pivotal role in the activation of cell-mediated and humoral
immune systems [7]. HIV infection results in the depletion of CD4 cells in the peripheral
blood [8]. Among untreated patients, the depletion continues over a course of several years until
the patient succumbs to AIDS. It is the last stage of the HIV infection, and it presents itself
anywhere between two and 15 years post-infection [9]. The following figure represents the
timeline of HIV infection from the initial infection to the expression of AIDS-defining symptoms
(Figure 2) [10].

Figure 2
HIV time course.

HIV subgroups
HIV -1
HIV-1 is well-known for its extensive genetic diversity. There are four different lineages coming
under HIV-1: M, N, O, and P. The most commonly reported HIV virus across the globe is group
M [2]. Group N less prevalent, reported only from Cameroon [11]. Group O is accountable for
1% of the total HIV-1 cases and is mainly found Cameroon and Gabon [12]. Group P is the
rarest of all and has been identified in Cameroonian pregnant woman in France [13]. It has a
prevalence of 0.06% of total HIV infections [14].
HIV-2
HIV-2 is most commonly reported in West Africa, with Guinea-Bissau and Senegal having the
highest incidence. Eight different types of HIV-2 exist, labeled HIV-A to HIV-H. Group A is
reported throughout the sub-Saharan region [15]. Group B is reported more commonly in the
Ivory Coast [16]. Due to the sporadic nature of the infection and incidence, C to H are
categorized as “dead-end” transmissions that produce no subsequent infections [2].

Current status of HIV infection and mortality rate

Western, Central Europe, and North America
Approximately 2.4 million individuals are HIV-positive in this region. An estimated 85,000 new
HIV infections were reported in 2014, and more than 50% of infections were from the United
States of America. About 26,000 AIDS-related deaths were also reported in the same
period [17].
Asia and Pacific
As of 2014, approximately five million individuals were previously infected in Asia and the
Pacific, with as many as 340,000 new HIV infections arising that year. China, Indonesia, and
India contribute to about 78% of the total new disease burden in Asia and the Pacific with about
240,000 deaths. Patients receiving ART are approximately 36%, with 3.2 million active HIV
patients having no access to ART [17].
Pakistan
In Pakistan, the index case of HIV infections was reported in 1987 [18]. As per the annual report
of Pakistan National AIDS Control Program, the incidence of HIV has been increasing since first
reported. According to UNAIDS, the joint United Nations program on HIV/AIDS, the total
number of individuals with an active HIV infection is approximately 94,000. The prevalence rate
among adults is between < 0.1% and 0.2%. Currently, there are as many as 26,000 women, age
15 and older, and approximately 2,100 children, up to age 14, currently living with HIV. The
total number of AIDS-related deaths in this region was 2,800 in the year 2014 [19].

Treatments options for HIV

HIV infection has a very complex pathogenesis and varies substantially in different patients.
Therefore, it can easily be considered as a very host-specific infection. The specificity of
pathogenesis often complicates treatment options that are currently available for HIV infection
[20]. Effective management of HIV infection is possible using different combinations of
available drugs. This method of treatment is collectively known as antiretroviral therapy (ART).
Standard ART is comprised of a concoction of at least three medicines (termed as “highly active
antiretroviral therapy” or HAART) [21]. Effective ART often helps control the multiplication of
HIV in infected patients and increases the count of CD4 cells, thus, prolonging the asymptomatic
phase of infection, slowing the progression of the disease, and also helps in reducing the risk of
transmission. Figure 3 demonstrates the percentage of HIV patients under ART [22].

Figure 3
Percentage of HIV patients under antiretroviral therapy (WHO 2014).

FDA-approved HIV drug classes

Reverse Transcriptase Inhibitors
Reverse transcriptase inhibitors are a group of drugs, which can bind and inhibit the reverse
transcriptase enzyme to intercept the multiplication of HIV. There are two types of inhibitors:
non-nucleoside reverse transcriptase inhibitors (NNRTIs) [23] and nucleoside reverse
transcriptase inhibitors (NRTI) [24]. Examples of this group of drugs include zidovudine,
didanosine, abacavir, tenofovir, and Combivir.
Protease Inhibitor
Regulation of HIV protease is of high importance for the correct assembly and production of
HIV. Protease inhibitors effectively block the functioning of protease enzymes in acutely and
chronically HIV-infected CD4 cells. Inhibition of HIV protease enzymes results in the liberation
of immature and noninfectious viral particles [25]. Examples of this group of drugs include
lopinavir/ritonavir, indinavir, ritonavir, nelfinavir, and amprenavir.
Fusion Inhibitors
This class of drugs acts by blocking HIV from entering the CD4 cells of infected patients. They
inhibit the fusion of HIV particles with the CD4 cells [26]. Enfuvirtide is an example of a fusion
inhibitor used in HIV treatment.
Chemokine Receptor 5 Antagonist
This group of drugs prevents the infection by blocking the chemokine receptor 5 (CCR5)
antagonist receptor present on CD4 cells. In the absence of vacant CCR5 receptors, HIV fails to
gain entry and infect the cell [27]. Maraviroc is an example of a CCR5 antagonist used in HIV
treatment.
Integrase Strand Transfer Inhibitors
Strand transfer inhibitors prevent the integration of viral DNA into the host genome of CD4 cells
by an integrase enzyme. Blocking integrase prevents HIV from replicating [28]. Raltegravir,
elvitegravir, and dolutegravir are some medications in this category.

Treatment regimen for HIV

Present HIV treatment guidelines recommend ART treatment for all patients, irrespective of the
CD4 cell count, to improve and prolong the progression of disease to AIDS [29]. Adherence to
treatment is of paramount importance in order to achieve the full efficacy of treatment and also
to prevent the incidence of drug resistance [30].

Latest WHO recommendations for ART

A concise form of first, second, and third line treatment options recommended by the World
Health Organization (WHO) is given below [29].
First-line ART
Adults: First-line ART treatment for adults consists of two NRTIs and one NNRTI. Tenofovir
disoproxil fumarate (TDF) + lamivudine (3TC) or emtricitabine (FTC) + efavirenz (EFV) as a
fixed dose is the favored choice for this type of ART. When this drug combination is
contraindicated or is unavailable, 1) zidovudine (AZT) + 3TC + EFV, 2) AZT + 3TC +
nevirapine (NVP), or 3) TDF + 3TC (or FTC) + NVP is used.
Contraindications:
1. Creatinine clearance is less than 50 ml per minute: Tenofovir. 2. Patients on psychoactive drug
treatment: Efavirenz. 3. Patients who are pregnant or who are trying to conceive: Efavirenz. 4.
ALT elevation: Nevirapine.
Pregnant and breastfeeding patients: First-line ART in this subpopulation is comprised of a
single daily dose of TDF + 3TC (or FTC) + NVP. Breastfeeding infants of mothers who are
receiving ART must receive six weeks of infant prophylaxis with a daily dose of NVP. The
preventive medication should commence immediately post-delivery or when HIV exposure is
identified.
Pediatric patients: Patients below three years of age should be given Lopinavir/Ritonavir
(LPV/r)-based treatment, even under NNRTI exposure. When LPV/r is not a viable option, NVP-
based treatment should be used. For infected children who are over age three, EFV is the ideal
NNRTI while NVP has been identified as the second option. For infected children younger than
three years of age, who develop TB while on the Lopinavir/Ritonavir (LPV/r)-based
treatment, the NRTI regimen should be switched to abacavir (ABC) + 3TC or AZT + 3TC until
the TB infection is cleared. NRTI regimens similar to that of adults (TDF + 3TC (or FTC)) or
(AZT + 3TC) or (ABC + 3TC) are preferred for patients between 10 and 19 years of age who
weigh 35 kg or more.
Second-line ART
Adults, including pregnant and breastfeeding patients: When a first-line treatment of ART fails, a
second-line ART should be utilized. The second-line ART is comprised primarily of two
NRTIs and a ritonavir-boosted PI. The recommended option for second-line ART includes AZT
and 3TC as the NRTI. After the failure of AZT or stavudine (d4T) + 3TC-based first-line
regimen, TDF + 3TC (or FTC) as the NRTI should be considered. When first-line NNRTI-based
treatment fails, two NRTIs + a boosted PI are suggested
Pediatric patients: For children below three years of age, first-line ART is continued even when
it fails. No change in treatment is recommended; instead, adequate steps should be taken to
improve adherence to the ART regimen. If first-line ART fails in children ages three and up, a
second-line treatment consisting of one NNRTI and two NRTIs should be given. If ABC or TDF
+ 3TC (or FTC) fails, the recommended option is AZT + 3TC. After a failure of AZT or d4T +
3TC (or FTC) in first-line treatment, the preferred NRTI option is ABC or TDF + 3TC (or FTC).
Third-line ART
If first- and second-line ART fails, the WHO recommends inclusion of new medicines with the
least amount of risk for development of cross-resistance towards previously used drugs (e.g.
integrase inhibitors and second-generation NNRTIs and PIs).

Factors to consider when selecting ART

The major factors that deserve thorough consideration while choosing an ART for a patient
include the viral load and CD4 cell count before the treatment, the result of HIV genotypic drug
resistance test, HLA-B*5701 status, patient preferences, and anticipated adherence. Comorbid
conditions to screen prior to ART include cardiovascular disease, hyperlipidemia, renal disease,
osteoporosis, psychiatric illness, neurologic disease, drug abuse or dependency requiring narcotic
replacement therapy, pregnancy, coinfections with hepatitis C (HCV), hepatitis B (HBV), and
tuberculosis (TB) [31].

CD4 count monitoring for therapeutic response

Monitoring patients’ viral load is critical to identify ART response (WHO 2015). When the viral
load analysis is not practical via polymerase chain reaction (PCR), branched chained DNA
(bDNA), and nucleic acid sequence-based amplification (NASBA), the CD4 count is used as an
indicator of HIV treatment response. During the first year of treatment, increases in CD4 count
from 50 to 150 cells/mm3 with an increased response in the first trimester are considered as a
positive response. CD4 count rises steadily ranging from 50 to 100 cells/mm3 per year until
equilibrium is reached in the subsequent years (normal range: 500 cells/mm3 to 1200
cells/mm3) [32]. Periodic monitoring of CD4 count is required during and even after the patient
achieves normal CD4 count under ART. A number of treatment independent factors like age,
viral load, genetic make-up, lifestyle, quality of health care, etc., negatively influence the CD4
counts and HIV disease progression. Under such circumstances, a change in ART medication
might be required.

Major factors for ART non-adherence

Adverse Effects of ART
One of the major challenges that patients and physicians face with ART is the incidence of
adverse drug reactions (ADR). ADR is defined as “a response to a drug that is noxious and
unintended and occurs at doses normally used in man for the prophylaxis, diagnosis, or therapy
of disease, or for modification of physiological function” [33]. ADR often persuades patients
from continuing treatment, thus resulting in suboptimal efficacy. A serious consequence
of treatment discontinuation is the emergence of drug resistance, making future therapeutic
interventions ineffective [30].
The major adverse effects of ART can be grouped into the following categories:
1. Gastrointestinal: Nausea, diarrhea, vomiting, taste perversion, constipation, dyspepsia,
abdominal pain, hepatotoxicity, and pancreatitis [34-35]. 2. Central nervous system: Headache,
vision problems, dizziness, tinnitus, insomnia, paresthesia, pain/numbness/tingling in
extremities, peripheral neuropathy, somnolence, excessive sleep at night, memory problems, loss
of olfactory function, and hearing impairment [34]. 3. Hematological: Anemia, bilirubinemia,
increased urate, and blood in the urine [35]. 4. Psychological: Anxiety, confusion, depression,
nightmares, elation, and delusions [35]. 5. Metabolic: Abnormal fat distribution (lipodystrophy),
anorexia, dyspnea, fatigue, lethargy, and weight gain [34-35]. 6. Dermatological: Skin rash,
facial discoloration, and pruritus [35]. 7. Musculoskeletal: Body aches and vague chest
pain [34]. 8. Miscellaneous: Hypersensitive reactions, oral ulcerations, fever, and irregular
menstrual cycles [34].
Drug Abuse
Continuous drug abuse is an important risk factor in HIV/AIDS patients’ ART, nonadherence,
and mortality [36]. In a study conducted on HIV-positive drug addicts in Canada, heroin and
cocaine injections were reported to adversely affect adherence to ART [37]. In a separate six-
month long longitudinal study, which examined the effect of drug use and abuse on ART among
150 HIV positive patients, it was discovered that acute effects of intoxication negatively
influence ART adherence. The major mechanisms by which drug abuse results in ART
nonadherence include drug abuse induced neurocognitive/psychosocial impairment and
psychiatric dysfunctions [38].
Mental Disorders
The prevalence of psychiatric disorders is reported to be very high among HIV-infected
individuals [36]. In a longitudinal study investigating the mental health, substance abuse, and
psychosocial predictors among HIV-positive mothers, the presence of psychiatric disorders,
stressful lifestyles, suboptimal living conditions, and parenting stress were associated
significantly with ART nonadherence [39]. Childhood sexual violence-induced anxiety and
depression may also result in ART nonadherence [40]. Hazardous drinking is another significant
precipitator of anxiety and depression among HIV patients that results in ART
nonadherence [41].
Socioeconomic Status
Socioeconomic status is strongly associated with HIV-related mortality in the contemporary
universal healthcare system because opportunities for patients of lower socioeconomic status to
receive ART are meager. In a study conducted among HIV-positive Cambodian women, 80% of
those who discontinued ART were of low socioeconomic status. The estimated risk for low
adherence in this population was reported to be five times higher for women than those in a
medium or high social position [42]. Poverty-induced stress is an important aspect that has to be
addressed in issues regarding ART nonadherence [43]. The quality of housing and access to food
are the two most important factors that prevent the poverty-ridden population from ART
adherence [43].
Poor Literacy
Literacy is another major factor closely associated with ART nonadherence with people of lower
health literacy experiencing higher illness severity than people with better health literacy [44].
Health literacy has been defined by the WHO as “the cognitive and social skills which determine
the motivation and ability of individuals to gain access to, understand, and use information in
ways which promote and maintain good health” [45]. Many reports suggested that the inability to
comprehend medication instructions by illiterate HIV-positive patients is an important factor
resulting in failure to follow accurate daily medication therapy [46].
Social Stigma
The stigma of HIV and AIDS is assumed to have a negative influence on ART
adherence [47]. Stigma can be defined as an “attribute that is deeply discrediting” imposed by
society that reduces someone “from a whole and usual person to a tainted, discounted one” [48].
In a cohort study conducted in five African countries (Lesotho, Malawi, South Africa,
Swaziland, and Tanzania) among 1,457 HIV-positive patients over a period of 12 months,
individuals perceiving a high HIV stigma reported greater nonadherence to ART. Symptom
intensity is also high when compared to those who did not experience such a stigma [49]. One
study conducted in South Africa reported that internalized stigma is responsible for 4.8% of the
variance in cognitive-affective depression leading to ART nonadherence. Furthermore, the
researchers urge the medical community to introduce social reform efforts to reduce stigma and
assist people living with HIV/AIDS in adjusting and adapting [50].
Go to:
Conclusions
Recent advances in HIV treatments have dramatically altered the nature and progression of
HIV/AIDS. It can be safely considered as a “chronic” disease, provided the infected patients
receive proper ART. Unfortunately, current statistics of the worldwide HIV burden tells another
story: one with a steady rate of HIV-related deaths. More people die of complications and the
progression of HIV to AIDS than should be when ART is used properly. The major hurdle a
physician faces with ART is the incidence of adverse side effects of the treatment, which
persuade patients to discontinue the treatment. Poverty, lack of awareness, and the social stigma
associated with the infection complicate an already complicated situation. Appropriate changes
in treatment regimens and medications can help patients overcome such adverse effects and
potential complications inherent to the disease. Additionally, it is highly advisable to provide
patients and their immediate family members with appropriate counseling for treatment
compliance and psychological support.
Go to:

Notes
The content published in Cureus is the result of clinical experience and/or research by
independent individuals or organizations. Cureus is not responsible for the scientific accuracy or
reliability of data or conclusions published herein. All content published within Cureus is
intended only for educational, research and reference purposes. Additionally, articles published
within Cureus should not be deemed a suitable substitute for the advice of a qualified health care
professional. Do not disregard or avoid professional medical advice due to content published
within Cureus.
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Footnotes
The authors have declared that no competing interests exist.

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History of Cancer, Ancient and Modern Treatment Methods
Akulapalli Sudhakar1,2,3

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History of Cancer
Cancer is the second leading cause of death in the world after cardiovascular diseases. Half of
men and one third of women in the United States will develop cancer during their lifetimes.
Today, millions of cancer people extend their life due to early identification and treatment.
Cancer is not a new disease and has afflicted people throughout the world. The word cancer
came from a Greek words karkinos to describe carcinoma tumors by a physician Hippocrates
(460–370 B.C), but he was not the first to discover this disease. Some of the earliest evidence of
human bone cancer was found in mummies in ancient Egypt and in ancient manuscripts dates
about 1600 B.C. The world’s oldest recorded case of breast cancer hails from ancient Egypt in
1500 BC and it was recorded that there was no treatment for the cancer, only palliative treatment.
According to inscriptions, surface tumors were surgically removed in a similar manner as they
are removed today.
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What is Cancer? and Cause of Cancer

Cancer develops when normal cells in a particular part of the body begin to grow out of control.
There are different types of cancers; all types of cancer cells continue to grow, divide and re-
divide instead of dying and form new abnormal cells. Some types of cancer cells often travel to
other parts of the body through blood circulation or lymph vessels (metastasis), where they begin
to grow. For example when a breast cancer cell spread to liver through blood circulation, the
cancer is still called as breast cancer, not a liver cancer. Generally cancer cells develop from
normal cells due to damage of DNA. Most of the time when ever DNA was damaged, the body is
able to repair it, unfortunately in cancer cells, damaged DNA is not repaired. People can also
inherit damaged DNA from parents, which accounts for inherited cancers. Many times though, a
person’s DNA becomes damaged by exposure to something in the environment, like smoking.
Cancer generally forms as a solid tumor. Some cancers like leukemia (blood cancer) do not form
tumors. Instead, leukemia cells involve the blood and blood forming organs and circulate
through other tissues where they grow. Not all tumors are cancerous, some tumors are benign
(non-cancerous). Benign tumors do not grow and are not life threatening. Different types of
cancer cells can behave differently. The risk of developing many types of cancers can be reduced
by changes in lifestyle by quitting smoking and eating low fat diet. If cancer is identified in early
stage it is easy to treat and may have better chances for living many years.

Old Theories about Cancer

Humoral theory
Hippocrates believed that the body contained 4 humors (body fluids), (a) blood, (b) phlegm, (c)
yellow bile and (d) black bile. Any imbalance of these fluids will result in disease and excess of
black bile in a particular organ site was thought to cause cancer. This theory of cancer was
standard through the Middle Ages for over 1300 years. During this period autopsies were
prohibited for religious reasons, thus limiting knowledge about cancer.

Lymph theory
This theory proposed that cancer formation was by fluid called lymph. Life was believed to
consist of continuous movement of the fluids like as blood and lymph in the body. The lymph
theory was supported in 17th century that tumors grow from lymph constantly thrown out by the
blood.

Blastema theory
Muller demonstrated that cancer is made up of cells but not with lymph in 1838. His student,
Virchow (1821–1902) determined that all cells including cancer cells were derived from other
cells.

Chronic irritation theory

Virchow proposed that chronic irritation was the cause of cancer. Later Thiersch was showed
that cancers metastasize through the spread of malignant cells and not through some unidentified
fluid.

Trauma theory
From the late 1800s until the 1920s, cancer was thought to be caused by trauma.

Parasite theory
Till 18th century, scientists believed that cancer was contagious and spreads through parasite.

Discovery of Oncogenes and Tumor Suppressor Genes

By the middle of the 20th century, scientists began solving the complex problems of chemistry
and biology behind cancer. Watson and Crick were received Nobel Prize in 1962 for the
discovery of DNA helical structure. Later scientists learned how genes were worked and how
they could be damaged by mutations. Scientists identified that cancer could be caused by
chemicals (carcinogens), radiation, viruses and also inherited from ancestors. Most carcinogens
were damage the DNA, which led to abnormal growth of cells. Cancer cells with damaged DNA
do not die, where as normal cells with damaged DNA die. During the 1970s, scientists
discovered 2 important families of genes

Oncogenes
These genes that cause normal cells to grow out of control and become cancer cells. They are
formed by the mutations of certain normal genes of the cell called protooncogenes (genes that
normally control how often a cell divides and the degree to which it differentiates).

Tumor suppressor genes

These are normal genes that control cell division, DNA repair and inform cells when to die.
When a tumor suppressor gene doesn’t work properly, cells can grow out of control, which can
lead to cancer. Scientists identified oncogenes and tumor suppressor genes that are damaged by
chemicals or radiation. For example, the discovery of breast cancers genes BRCA1 and BRCA2.
Other genes have been discovered that are associated with cancers that run in families, such as
thyroid, pancreas, rectum, colon, kidney, ovary and skin cancers.
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Modern Carcinogens
In 1911 Peyton Rou was discovered a type of cancer in chickens that was caused by Rous
sarcoma virus. In 1915, cancer was induced for the first time in rabbits by coal tar applied to
skin. 150 years had passed since the most destructive source of chemical carcinogens known to
man, tobacco (nicotin) was rediscovered as a carcinogen. As of today more than 100 carcinogens
(chemical, physical, and biological) were identified. From many of these carcinogens
associations recognized long before, scientists understood the mechanism by which the cancer
was produced. The continuing research is discovering new carcinogens, explaining how they
cause cancer and providing insight into ways to prevent it.

Cancer causing viruses

(1) Hepatitis B or C viruses cause liver cancer. (2) Epstein-Barr viruses cause non-Hodgkin
lymphomas and nasopharyngeal cancer. (3) The human immunodeficiency virus (HIV) is
associated with Kaposi Sarcoma and non-Hodgkin lymphoma. (4) Human papilloma viruses
(HPVs) are associated with cervix, vulva and penis cancers.

Cancer screening and early detection

The first cancer screening test to be widely used was the Pap test. The test was first developed by
George Papanicolaou as a method in understanding the menstrual cycle. He also identified Pap
tests potential for early detection of cervical cancer. In 1960s mammography was developed for
identification of breast cancer. Later early detection of cervix, breast, colon, rectum,
endometrium, prostate, thyroid, oral cavity, skin, lymph nodes, testes, and ovaries cancers were
identified and practiced in the clinic.
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Cancer Treatment Methods

Surgery and use of modern technology

Ancient surgeons knew that cancer would usually come back after it was removed by surgery.
Many people even today consider that many types of cancers are incurable and may delay to
consult a doctor in early stage. After anesthesia was invented in 1846, surgeons Bilroth, Handley
and Halsted led cancer operations by removing entire tumor together with lymph nodes. Later
Paget a surgeon reported that cancer cells were spread from primary tumor to other places
through the blood stream (metastasis). Understanding the mechanism(s) of cancer spreading
became a key element in recognizing the limitations of cancer surgery.
In the beginning of 1970s, progress in ultrasound (sonography), computed tomography (CT
scans), magnetic resonance imaging (MRI scans) and positron emission tomography (PET scans)
have replaced most exploratory operations. Using miniature video cameras and endoscopy,
surgeons can remove colon, esophagus and bladder tumors through tubes. Recently, less invasive
ways of destroying tumors without removing them are being studied including liquid nitrogen
spray to freeze and kill cancer cells (cryosurgery). Lasers also can be used to cut the tumor tissue
of cervix, larynx, liver, rectum, skin and other organs.

Chemotherapy
During the last decades of the 20th century, surgeons developed new methods for cancer
treatment by combining surgery with chemotherapy and/or radiation. Roentgen discovered X-
rays after 50 years of anesthesia was discovered. Later doctors identified that nitrogen mustard
can kill rapidly proliferating lymphoma cancer cells. Over the years, use of many chemotherapy
drugs has resulted in the successful treatment of many types of cancers. Now new approaches are
being studied to reduce the side effects of chemotherapy including use of, (a) new combinations
of drugs, (b) liposomal and monoclonal antibody therapy to target specifically cancer cells, (c)
chemoprotective agents to reduce chemotherapy side effects, (d) hematopoietic stem cell
transplantation and (e) agents that overcome multidrug resistance.

Hormonal therapy
In 1878 Thomas Beatson discovered that the breasts of rabbits stopped producing milk after he
removed ovaries. Later scientists identified that dramatic regression of metastatic prostate cancer
following removal of the testes. Now new classes of drugs (aromatase inhibitors, LHRH analogs)
are being used to treat prostate and breast cancers. How hormones influence growth of cancer
has guided progress in developing as well as reducing the risk of breast and prostate cancers.

Radiation therapy
In 1896 Roentgen discovered “X-ray” and after 3 years later radiation was used for cancer
diagnosis and in treatment. In the early 20th century, researchers discovered that radiation could
cause cancer as well as cure it. Now several radiation therapies are being used, these include: (a)
conformal proton beam therapy(proton beam will be used for killing tumor cells instead of X-
rays); (b) stereotactic surgery and stereotactic therapy (gamma knife can be used to deliver and
treat common brain tumor); (c) intra-operative radiation therapy (cancer has been removed
surgically followed by radiation to the adjacent tissues).

Adjuvant therapy
It is the use of chemotherapy after surgery to destroy the few remaining cancer cells in the body.
Adjuvant therapy was used in colon and testis cancers.

Immunotherapy
Use of biological agents that mimic some of the natural signals that body uses to control tumor
growth is called immunotherapy. These natural biological agents can now be produced in the
laboratory including interferons, interleukins, cytokines, endogenous angioinhibitors and
antigens. In 1990s scientists produced therapeutic monoclonal antibodies rituximab and
trastuzumab that specifically targeted lymphoma and breast cancer cells. At present scientists are
developing vaccines to boost the body’s immune response against cancer cells.
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Targeted Cancer Treatments

Until late 1990’s most of the drugs used in cancer therapy worked by killing cancer cells.
Unfortunately chemotherapy agents used, also killed some normal cells and had a greater effect
on cancer cells.

Growth signal inhibitors

Growth factors will inform cells when to grow and divide. Around 1960s growth factors role in
fetal growth and tissue repair was recognized and later scientists realized that abnormal levels of
growth factors contribute to the growth of cancer cells. During 1980’s scientists recognized that
changes in growth factors signaling leads to abnormal behavior of cancer cells. Present targeted
therapies that block growth factor signals are trastuzumab, gefitinib, imatinib and cetuximab.

Drugs that induce apoptosis

Apoptosis is a natural process through which cellular DNA gets damaged and cells ultimately
will die where as apoptosis induced drugs can force cancer cells to die without DNA repair.

Endogenous angioinhibitors
Angiogenesis is the formation of new blood vessels from existing vessel. Normally angiogenesis
is a healthy process, that help the body to heal wounds and repair damaged body tissues, whereas
in cancerous condition this process supports new blood vessel formation that provide a tumor
with its own blood supply, nutrients and allow it to grow. Angioinhibition is a form of targeted
therapy that uses drugs to stop tumors from making new blood vessels. This concept was first
proposed by Judah Folkman from Harvard Medical School, but it wasn’t until 2004 that the first
angioinhibitor bevicizumab was approved for clinical use. At present there are about 25
endogenous angioinhibitors in clinical trials and many more in preclinical studies for the
treatment of cancer. There are two general categories of angioinhibitors: (i) antibodies or small
molecules that target pro-angiogenic factors of tumor cells such as VEGF, bFGF or PDGF, and
(ii) endogenous angioinhibitors such as thrombopondin-1, angiostatin, interferons, endostatin,
arresten, canstatin and tumstatin that inhibit angiogenesis by targeting vascular endothelial cells.
We have discovered several angioinhibitors signaling mechanisms and their significance for the
treatment of cancer.
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Future Cancer Treatments

The growth in knowledge of cancer biology has led to remarkable progress in cancer early
detection, treatment and prevention in recent years. Cancer research is currently advancing on so
many fronts that are highlighted below.

Antiangiogenic chemotherapy
Recently, in many clinical trails angioinhibitors were also being used in combination with
conventional chemotherapy. Clinical trails generally combine very low-dose of chemotherapy
followed by angioinhibitor therapy. Combination of angioinhibitors will need to be tested
vigorously in the future, as single angioinhibitors are approved for use of cancer. For example, it
is very important to know whether bisphosphonates are synergistic with certain natural
angioinhibitors such as angiostatin, endostatin, thrombospondin, arresten, canstatin tumstatin etc.
Preventive angioinhibitory therapy may also be possible in the future, because angioinhibitory
therapy is generally less toxic and less susceptible to induction of acquired drug resistance.
Recently, some reports suggested that some foods have angioinhibitory substances. It is also
better to test food that has high levels of natural angioinhibitors for prevention of cancer.

More targeted treatments

As more is learned about the molecular biology of cancer cell, researchers developed new classes
of molecules such as antisense oligodeoxynucleotides and small interfering RNA (siRNA) for
the treatment of cancer.

Nanotechnology
It is the use of extremely tiny particles for diagnostic imaging to more accurate location of
tumors for delivering drugs more specifically and effectively into cancer cells.

RNA expression profiling and proteomics

RNA expression profiling permits scientists to determine relative amounts of numerous RNA
molecules at one time. Knowing what proteins or RNA molecules are present in cancer cell can
tell lot about how a cell is behaving and often can help to predict which drugs that particular
tumor cell is likely to respond.
Finally winning the war against human cancer has been the focal point of present medical
research. Single “cure-all” drug for cancer has not yet been developed, even though many new
cancer treatment methods and drug targets have been discovered. More research studies and
different clinical trails are the key to find a cure for cancer. The complexity of cancer disease
requires scientific battle to fight against cancer in all frontiers.
Necessary of many open access cancer journals
Many popular cancer journals require payment for downloading research articles. Open access
journals are freely available without subscription fee via the internet for immediate worldwide
access to the full text of articles serving the best interests of the international research
community without financial, legal, or technical barriers. Journal of Cancer Science & Therapy
(JCST)), is an open-access and peer-reviewed international journal, recently created in response
to the NIH Public Access Policy, in addition JCST using online manuscript submission, review
and tracking systems of Editorial Manager® for quality and quick review processing.
At every stage of cancer research and development, quality of open access literature is integral to
success. JCST is an Open Access journal that provides comprehensive scientific capabilities, and
state-of-the-art technical reports to bring outstanding cancer R&D support.
Advances in global internet communication, and quality research reports under Open Access
publication provide rapid scientific review of reports/research articles to consistently meet the
requirements of human health.
The Main objective of JCST is to translate scientific and behavioral research into relevant cancer
therapeutics development, strategic planning, sharing exchanging best practices under Open
Access platform, and implementing effective cancer therapy requirements.
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Acknowledgments
This work was supported by Flight Attendant Medical Research Institute Young Clinical
Scientist Award Grant (#062558), Dobleman Head and Neck Cancer Institute Grant (#61905)
and #RO1CA143128, startup funds of Cell Signaling and Tumor genesis Laboratory at Boys
Town National Research Hospital to AS.
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Footnotes
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source
are credited.

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 Modern Medicine versus Traditional Medicine

Introduction
The controversy surrounding the issue of traditional medication versus modern education has been going
on for a long time. While there some people who are for traditional medication there are others who are
for modern medication. Traditionally, herbs were used to treat different forms of diseases and ailments in
humans. This kind of medication did not have to go through several testing procedures. The major
reason is because there was no equipment or technology for conducting such testing. With advancement
in technology, modern medicine emerged. Although modern medicine may be drawn from tradition
medicine such as herbs, testing procedures are mandatory. This means that before medicine can be
approved or considered appropriate, it has to go through laboratory trials and pass different testing
stages. Currently, many health professionals prefer the use of modern medicine over tradition medicine.
This essay will give some of the arguments to show that modern medicine has an advantage over
traditional medicine.

Discussion
The supporters of traditional medicine strongly believe that this kind of medicine is preferable over
modern medicine simply because it is derived from natural sources. This means that traditional medicine
has not been interfered by adding chemicals and other elements, which are a characteristic of modern
medicine. The supporters of traditional medicine overlook the essence of testing so as to ascertain the
effectiveness of medicine or a specific therapeutic initiative. Despite the mentioned arguments in support
of traditional medicine, I strongly believe that modern medicine is more advantageous over traditional
medicine. Some of points that can be used to support the argument revolve around technology, specific
tests that modern medications go through as well as governmental regulation (Xie).

Over the past few decades, technology has greatly advanced. The contribution that technology makes in
the medical arena is tremendous. Technology has made it possible for medical practitioners to access the
internet and hence information on a diverse range of medication. The Internet acts as a perfect source of
information on several research studies that have been conducted to investigate the effectives of specific
medical interventions of medications. Nowadays, it is recommendable for any medical intervention given
to a patient to be backed by relevant evidence supporting its effectiveness. This is referred to as
evidence-based practice. The basic meaning of the term is that any health care practice has to be based
on strong evidence. Advancement in technology has made its possible to invent effective machinery and
equipment for diagnostic and treatment processes. Rather than just relying on symptoms presented by
patients, health care professions use modern machinery to diagnose various health conditions and
diseases. For instance, it is possible to examine various diseases causing microorganisms under the
microscope. Generally, patients can get appropriate and effective medical intervention, owed to
technology (Huremovic et al, 158-162).

Technology has greatly improved health outcomes. This is mainly because both the patient and health
care provider can negotiate on the appropriate modern medication to use. Owed to the internet, patients
can gain access to a wide range of information concerning their health condition. The internet provides
evidence on different modern medication but rarely gives adequate information on traditional medicine.
This is an indication that modern medicine is well known in comparison to traditional medicine Knowledge
availability is and advantage that modern medicine has over traditional medicine. Traditionally, if a doctor
or researcher invented or found a cure for a specific illness, it was extremely hard for a person located a
few miles away to get information concerning the cure. Technology has led to improved and effective
communication. Nowadays, one can learn about different diseases and their cures through their
computers. Therefore, the availability of information and knowledge on modern medicine makes it
advantageous over traditional medicine (Huremovic et al, 158-162).
Another major advantage that modern medicine has over traditional medicine is regarding specific
testing. Trails on effectiveness of medical interventions and medicines entail lab testing. Animals such as
rabbits and mice are used by scientists and medical researchers to test the effectiveness of modern
medicine. There are several steps of testing that should be followed. A medical intervention that
successfully passes through all the stages is said to be effective. Despite the fact that it is not possible to
conduct the tests using human subjects due to toxicity issues, the trails that have been done using
animal subjects have always proved to be effective. Testing is a means of making sure that patients will
be given effective medication (Kizilhan, 359-373).

Contrary to modern medicine, the effectiveness of traditional medicine was based on beliefs rather than
testing. People used different traditional herbs based on their cultural or even religious beliefs. There
were neither theories nor assumptions under which traditional medicine was based on. This means that
there was limited evidence concerning the effectiveness of such evidence. Traditional healers
administered different forms of herbs without taking into consideration the possibility of them causing
harm to a patient. This is an indication that with traditional medicine the risk of adverse health conditions
and even death is much higher. Moreover, traditional medicine such as herbs lacked dosage instructions.
This could lead to toxicity due to taking an overdose or ineffectiveness of the medicine due to an under-
dose (Xie).

This risk is lowered in modern medicine, which has to go through different testing stages prior to being
approved or used to treat specific diseases. Testing enables researchers to know the right dosage of
medicine required to treat a specific condition as well as the side effects that can be caused by the
treatment. There were some diseases that were traditionally considered to be deadly since they had no
cure. However, scientific method has made it possible for different tests to be done. Cures for diseases
such as Grave’s disease, which was traditionally considered deadly, have been discovered. Also, sudden
and serious illnesses and accidents can be treated more effectively by modern medicine. Therefore,
because of testing procedures that modern medicine go through, they can be said to be more effective
compared to traditional medicine (Kizilhan, 359-373).

The fact that modern medicine is often under governmental regulation makes it advantageous over
traditional medicine. Herbal products or traditional medicine lack tight governmental regulation. This
means that there is a risk for consumers to buy herbs that are of inferior quality. Different brands,
batches or brands may have different herbal product quality. Therefore, lack of regulation makes the
consumer at a losing end since they can distinguish between the batches or brands with low quality herbs
and those with high-quality herbs. Lack of governmental regulation on herbal products or traditional
medicine further makes it difficult for practitioners to determine the required herb dosage that would
treat a disease without causing numerous adverse effects (Xie).

A few years ago, there were many cases of manufacturers accused on carelessness in testing the
effectiveness of drugs manufactured. For instance, in the year 2001, deaths that were directly caused by
improper testing amounted to 783,936 in the United States. Governmental regulation has solved such
testing issues. Legal measures are now taken against manufactures that carelessly test for drugs without
establishing their exact effectiveness. Governmental regulation in modern medicine has evidently led to
provision of high-quality medicine for consumers. The ultimate effect is that it has led to improved health
outcomes and due to administration of better form of treatment. Therefore, modern medicine is more
preferable compared to traditional medicine, owed to governmental regulation (Huremovic et al, 158-
162).

Conclusion
As discussed above, it is clear that modern medicine has more advantages than traditional medicine.
Advanced technology has made it possible for medical practitioners to use effective diagnostic and
treatment procedures. Communication has also improved and it is now possible to easily gain access to
new medical interventions and drugs discovered. Modern medicine is strongly backed by evidence from
numerous research studies that can be easily access through computers. The fact that modern medicine
has to go through intensive testing before it can be approved and administered to patients means that it
is more effective than traditional medicine. Finally, modern medicine is normally under strict
governmental regulation, which means that consumers can be assured of buying high-quality medicine.

References
Huremovic, Eldin et al. “Modern Information Communication Technologies and
Educational Technologies apply to education of Medicine.” Healthmed 4:1 (2010), 158-162. Academic
Search Complete. Web. 21 April 2012
Kizilhan, Jan Ilhan. “Understanding and Treatment of diffuse aches and pains of patients
from traditional-bound cultures.” Europe’s Journal of Psychology 7:2 (2011), 359-373. Academic Search
Complete. Web. 21 April 2012
Xie, Huisheng. “Chinese Veterinary Herbal Medicine: History, Scientific Validation and
Regulations.” American Journal of Chinese Veterinary Medicine, I Feb 2012. Academic Search
Complete. Web. 21 April 2012
Benefits of Modern Medicine
Benefits of Modern Medicine

Modern medicine is the kind of medicine used by the common doctors and it is also referred to as
Western medicine. This kind of medicine is quite effective and it acts much faster than the
traditional herbal medicine. Besides this, modern medicine has countless other benefits and some
are discussed in the following article.

1. Trauma treatment

Modern medicine practices are best matched for dealing with traumatic conditions. For instance,
severe injuries got from an automobile accident or a heart attack can only be assisted through
intensive and immediate medical attention. In such cases, surgeons and nurses assist each other in
performing lifesaving surgeries that benefit the patients.

2. Eliminates symptoms

A key aim of practicing Western medicine is to completely eliminate the symptoms of whichever
condition. Doctors normally prescribe drugs for reducing a fever, alleviating upset stomach or pain
so as to increase the patient’s comfort level. Through the elimination of uncomfortable symptoms,
patients can resume their normal lives almost immediately after treatment.

3. Advanced medical devices

Modern medicine boasts of highly advanced medical devices that doctors can use to ensure proper
treatment. For instance, by looking at the images got from an X-ray, a doctor is able to locate the
problem and then deal with it accordingly. This is not possible in herbal medicine, which is known
to focus the emotional state of the patient.

4. Flexibility

The other key benefit linked to Western medicine is that it is highly flexible. Patients can
go online and post some of their key symptoms and then get some treatment suggestions based on
what they posted. Similarly, medical aids enable patients to go on recovering at home, lessening
hospital stay.

Consequently, modern medicine has some demerits as well. Its main drawback is that it is generally
very expensive to acquire, particularly to those without health insurance.