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Hello and welcome. I'm Dr George Lundberg, and this is At Large at Medscape.

A few weeks ago, as part of the big (and long) 20th anniversary celebration of Medscape's founding, we published my list of the 15 most important happenings in medicine during those 20 years.

As you may know, editors—not authors—tend to create the titles or headlines of articles. My esteemed Medscape editor called the piece "Achievements (Some Dubious) in Medicine: The Past 20 Years."

The column jerked a lot of people's chains. I invited readers to agree or disagree and to add to the list. More than 90 comments have been posted so far. No one really argued against any of my top 15, and dozens of respondents agreed with the overall list.

Many proposed additions. Here are some of the strongest—some positive achievements and some dubious, or worse. You can decide. Not all are solely events of the past 20 years, but they recently grew to greater prominence.

16. Gender equality in the medical workforce

17. Iatrogenic diseases, including antibiotic resistance and nosocomial infection fatalities

18. Minimally invasive and robotic surgery

19. The death of the physical examination, the patient-physician relationship, and the autopsy

20. The dominance of defensive medicine as a result of our failure to solve the malpractice problem

21. Unregulated nutritional supplements and direct-to-consumer advertising of prescription pharmaceuticals

22. Obamacare, positive and negative

23. Flourishing of psychiatric and addiction medications, including mass distribution of psychotropic drugs to children

24. Enhanced shared decision-making and emergence of the concept of "number needed to treat"

25. That god-awful term "provider"

26. Splendid new treatments such as those for hepatitis C, with horrifying price tags in the United States

27. Finally, some clinical fruits of the Human Genome Project, with pharmacogenomics and precision medicine

28. Beginning recognition of the biologic dominance of the macro– and micro–immune systems and resulting immunotherapies

29. Huge growth of hospitalists

30. Caring replaced by coding

Another strong list, including many positive achievements, but still many problems that cry out to be fixed.

That's my opinion. I'm Dr George Lundberg, at large for Medscape.


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