Heroic medicine

Heroic medicine has several meanings, depending on the era of discussion. In the pre-scientific period, it referred to such things as belief all disease was believed to be due to overstimulation, or to an imbalance humors, which needed to be balanced or released by bloodlettin or other means. Later, it referred to using extremely toxic treatments, without strong justification, for ill-defined illnesses.

Today, it can refer to two quite dissimilar things. One is treatment that really needs to be recognized as futile care with no hope of improving quality of life. The other is exceptionally high-risk treatment where risk is proportional to benefit.

Early usage

Benjamin Rush, in The Enlightenment, pushed bloodletting, strong and toxic laxatives such as calomel and other harsh methods to reduce overstimulation.

Homeopathy, introduced by Samuel Hahnemann as an alternative to 19th century heroic medicine. Homeopathic practitioners often obtained better survival rates than their heroic counterparts, but, from the contemporary medical perspective, this was due to the homeopaths' not administering actively dangerous treatments.

Modern period

Futility

See also: Futile care

One special new challenge is determining death.

High-risk

Open-heart surgery, in which the heart is stopped and bypassed so surgeons can work on a nonmoving organ, is an excellent example of modern heroic medicine that is not futile.

In the past, rabies was invariably lethal, and only comfort care was tried. The new Milwaukee protocol is an attempt to save the life and rebuild neurological function of a person with rabies. It requires extremely intense critical care and a deep understanding of pathological mechanisms and drug interactions.

A number of cancer therapies use extremely toxic drugs, with side effects managed in the hope of a net benefit. Some protocols, such as leucovorin rescue, administer a known lethal dose, with an antidote administered at a precisely delayed time afterwards.

Pelvic exenteration is a radical surgical procedure, but aimed at curing disease rather than palliating it. The extensive surgery essentially removes all organs in the pelvis of a woman or man. It is used for cases of locally aggressive cancers: rectal in both sexes, prostate in men, or of the reproductive organs in women. "Pelvic exenteration continues to be the only curative option in certain patients with centrally recurrent cervical, vaginal, or vulvar cancers...Currently, operative mortality rates are 3-5%, the major perioperative complication rate is 30-44%, and the overall 5-year survival rate in patients who successfully undergo the procedure is 20-50%." In contrast, the 1- and 5-year survival rates for chemotherapy alone are 15% and less than 5 years. Selecting patients for the procedure includes a psychosocial evaluation for their tolerance for what many consider mutilating surgery.